Lisa Sheehy

Background: Commercial markerless motion capture (MMC) systems show promise for use in rehabilitation and have been validated for the assessment of various parameters. However, no prior studies have evaluated MMC systems to detect stance asymmetry. Objective: The objective of this study was to assess the accuracy and variability of the Jintronix Weight Shift Tool MMC system to estimate the percentage of weight borne on each foot. Methods: Twelve healthy younger adults, 12 healthy older adults, and 12 people living with stroke were recruited for this cross-sectional study. The percentage of weight borne on each foot was simultaneously recorded by the Weight Shift Tool and a validated pressure mat during 2 series (raising the arm to capture the recording and without arm raise) with left lean, right lean, and equal stance. Agreement between the Weight Shift Tool and the pressure mat was assessed using Bland-Altman analyses. Results: Bias was greatest for older adults for all stances except for right lean without arm raise. Variability was greatest for people living with stroke for all stances except for left lean with arm raise. On average, the limits of agreement were narrower during equal stance. Although bias between the Weight Shift Tool and the pressure mat was small to moderate (0.0%-11.7%), the limits of agreement were wide (12.8%-33.6% above and below the bias). Conclusions: The Weight Shift Tool is not clinically acceptable for the estimation of the percentage of weight on each foot due to high variability. Investigation of other MMC systems is required to confirm the validity of MMC for clinical assessment.

Purpose: Despite the health benefits for people with mobility limitations of participating in community-based exercise programmes (CBEPs), accessing and implementing in-person CBEPs can be challenging. We describe a theory-based approach to adapting a group task-oriented, in-person CBEP targeting balance and mobility to a virtual format. Method: We used the Knowledge-to-Action and Medical Research Council frameworks to guide adaptation of an established CBEP for virtual delivery. We undertook consultations with knowledge users (i.e., CBEP providers, health care professionals, managers, policy-makers) and researchers on adapting programme components to optimize the feasibility of virtual delivery and retain benefits of the in-person CBEP. Concurrently, we conducted three feasibility studies involving post-programme participant surveys to evaluate and refine programme components. Results: Programme components, including a pre-programme safety video and use of trained facilitators to stream exercise videos via videoconferencing and facilitate social times, met safety, feasibility, and acceptability benchmarks. In studies 1, 2, and 3, the majority of participants described benefit to physical function (59%, 64%, and 79%, respectively) and emotional well-being (64%, 62%, and 75%, respectively). Conclusions: Theoretical frameworks were useful to guide adaptation of an established in-person CBEP to a virtual format. This theoretical approach may inform virtual programme development for other populations and targeted outcomes.

Radical Connections' program "Unmasked Connections" provides virtual personalized and interactive arts performances to residents living in long-term care (LTC). This project assessed its impact on the quality of life (QoL) of residents, artists and staff. Residents were paired with artists based on shared artistic interests for 40-minute virtual one-on-one sessions. Semi-structured interviews on QoL with 14 participants were transcribed, coded and analyzed using the Framework Method of analysis. Five artists, six residents, a recreation technician and two summer students participated in the interviews. The themes developed included 1) Happiness, Health and Gratitude; 2) Deep and Meaningful Connections; 3) Reminiscence and Nostalgia; and 4) Features of Delivery are Important. Artists expressed compassion and gratitude for the program and staff highlighted residents' excitement. Most participants recommended to others or wished to continue with "Unmasked Connections". "Unmasked Connections" fostered meaningful interactions, improved emotional health and highlighted the important role of arts in healthcare.

To evaluate the feasibility, safety, and potential benefit of a virtual, community-based, task-oriented exercise program (TIME^TM at Home) among people with balance and mobility limitations, and explore program experiences of participants, caregivers, and program providers. In a pre-post study with a qualitative component, community-dwelling adults with balance and mobility limitations completed a virtual 8-week video-based exercise program (2 classes/week, 10 people/class) with 2 live facilitators, a post-class social time, and 3 healthcare partner visits. We administered physical and mental health measures pre- and post-program, and an online questionnaire regarding program acceptability mid- and post-program, and interviewed 10 participants, 7 caregivers, and 6 program providers post-program. A priori benchmarks were achieved for feasibility (e.g., 80% of classes attended) and safety (no serious adverse events). In 17 participants with pre and post data (median age 73 years, 53% post-stroke), significant improvement on measures of leg strength, balance self-efficacy, mood, mobility, everyday functioning, and health status (but not caregiver mood), was observed. Qualitative analysis identified two themes: the program is safe, beneficial, and enjoyable; and implementation considerations. TIME^TM at Home appears feasible, safe, and beneficial to physical and mental health in adults with balance and mobility limitations. www.clinicaltrials.gov, NCT05369741. Registered May 11, 2022 - retrospectively registered.

Introduction While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations. Methods and analysis A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results. Ethics and dissemination TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles. Trial registration number NCT06245135.

Introduction: The rapid adoption of telerehabilitation in physiotherapy and occupational therapy has transformed healthcare delivery, offering new opportunities for patient-centered care. However, its implementation raises critical ethical and equity-related questions that require proactive strategies to ensure fair and responsible practices. This review examines how ethical disparities and equity-related challenges are reflected in the existing literature on telerehabilitation. Objective: To investigate the presence of ethical-disparity and equity-related aspects in the provision of telerehabilitation in physiotherapy and occupational therapy as reflected in the literature. Data Sources: A rapid review methodology was employed to explore ethical and equity-related challenges in telerehabilitation. The search included articles published in English and French between 2010 and 2023 from the Medline and Embase databases. Study Selection: Articles were selected based on their relevance to ethical and equity considerations in telerehabilitation. A total of 1750 sources were initially identified, with 67 articles meeting the eligibility criteria for inclusion in this review. Data Extraction: Data were extracted based on variables such as age, gender, ethnicity, morbidity, cost, privacy, confidentiality, and autonomy. The data extraction and analysis were guided by the Progress Plus and Metaverse Equitable Rehabilitation Therapy frameworks. Data Synthesis: The findings were analyzed and discussed using a narrative synthesis approach. The results highlighted key ethical considerations, including adverse events, patient autonomy, and privacy issues. Equity-related aspects were examined, access to rehabilitation services and gender considerations. Disparities in technology access, socioeconomic status, and ethnicity were also identified. Conclusions: This rapid review highlights the growing relevance of ethical and equity considerations in the design and delivery of telerehabilitation within physiotherapy and occupational therapy. The findings show inconsistent reporting and limited depth in addressing key domains such as patient autonomy, privacy, and adverse events, alongside disparities related to age, gender, socioeconomic status, and geographic access. Although telerehabilitation holds promise for expanding access, particularly in underserved areas, this potential remains unevenly realized. The review underscores the critical need for structured, equity-driven, and ethically grounded frameworks such as the Metaverse Equitable Rehabilitation THerapy (MERTH) framework to guide future implementation, research, and policy.

Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9

BACKGROUND Commercial markerless motion capture (MMC) systems show promise for use in rehabilitation and have been validated for the assessment of various parameters. However, no prior studies have evaluated MMC systems to detect stance asymmetry. OBJECTIVE The objective of this study was to assess the accuracy and variability of the Jintronix Weight Shift Tool MMC system to estimate the percentage of weight borne on each foot. METHODS Twelve healthy younger adults, 12 healthy older adults, and 12 people living with stroke were recruited for this cross-sectional study. The percentage of weight borne on each foot was simultaneously recorded by the Weight Shift Tool and a validated pressure mat during 2 series (raising the arm to capture the recording and without arm raise) with left lean, right lean, and equal stance. Agreement between the Weight Shift Tool and the pressure mat was assessed using Bland-Altman analyses. RESULTS Bias was greatest for older adults for all stances except for right lean without arm raise. Variability was greatest for people living with stroke for all stances except for left lean with arm raise. On average, the limits of agreement were narrower during equal stance. Although bias between the Weight Shift Tool and the pressure mat was small to moderate (0.0%-11.7%), the limits of agreement were wide (12.8%-33.6% above and below the bias). CONCLUSIONS The Weight Shift Tool is not clinically acceptable for the estimation of the percentage of weight on each foot due to high variability. Investigation of other MMC systems is required to confirm the validity of MMC for clinical assessment.