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Introduction: Co-creation is becoming increasingly popular to develop interventions that can achieve results beyond scientific findings. Workshops are one of the main ways to collect data and generate ideas in co-creation, which traditionally have been conducted at a fixed, physical location. However, organising face-to-face workshops is considered challenging, due to the transportation time, low flexibility and high costs. This study aims to investigate the online format of co-creation workshops and to discuss methodological considerations. Methods: Co-creation workshops were organised with 78 medical students, general practitioner (GP) trainees and specialist trainees from five Belgian universities. The study included four different cohorts, namely first-year bachelors (n = 12), first-year masters (n = 13), first-year GP trainees (n = 14) and first-year specialist trainees (n = 39). Three consequential online workshops were organised for each cohort, resulting in 12 workshops in total. The collected data included qualitative data (video-and audio recordings, notes from interdisciplinary team discussions, Miro boards) and quantitative data (registrations and actual attendance rates). All workshops were transcribed verbatim and thematically analysed using NVivo. Results: The participants reported increased flexibility and reduced costs as main benefits of the online format. In addition, the online platforms Miro and Microsoft Teams were considered dynamic and inspiring, facilitating high levels of engagement and interactivity. However, the online format also showed some challenges, such as the need for a digitally educated population and a stable internet connection. Conclusion: This study has shown that online workshops, also in the highly interactive method of co-creation, provide a viable alternative to collect data and generate ideas. This is particularly the case, when the target population is geographically dispersed, has a high workload and is digitally educated. Online workshops, however, also face limitations and challenges that need to be considered when choosing this format. First, we would like to thank the other WeMeds consortium members, who were not involved as co-authors but who contributed significantly to the overall project, namely Prof. Dr. Dirk Devroey, Prof. Dr. Peter Pype, Prof. Dr. Roy Remmen, Prof. Dr. Wim Pinxten and Dr. Sofie vandenbroeck. In addition, we would like to express our gratitude to the students that contributed to the organisation and qualitative analyses of the workshops: Annabel Bijnens, Sofie Boghe, Sofie Van den Acker and Charlotte Vanneck. Third, we would like to thank Elke Smeers, who provided support with the logistical organisation of the online workshops. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is part of the WeMeds study, which received internal funds from KU Leuven (Category 3) under C3/20/040.

In recent years, patient care has partially shifted from the hospital to the patients' homes. 1 This evolution is also seen in cardiac rehabilitation, in which a growing number of patients is participating in cardiac telereh-abilitation programmes. At present, a limiting factor in offering fully remote care is the need for assessing and reassessing the patient's physical fitness at predefined intervals in order to adjust the training programme. Currently, assessing physical fitness is done by either performing a cardiopulmonary exercise test (CPET), which assesses maximal exercise capacity, or a 6-min walking test (6 MWT), which assesses submaximal exercise capacity. 2 This study aimed to investigate a new tool that allows patients to self-test their submaximal exercise capacity in a flexible way by a smartphone-based random walk 6 MWT. This study is a subanalysis of a study that was previously published by our group. 3 In this paper, multiple algorithms were used for performing the 6 MWT, and the best algorithm was determined. This best algorithm is the algorithm that is used for this sub-analysis. The study demonstrated that an algorithm based on the Google Fit step count with the smartphone worn in a strap around the patient's arm performed the best when considering both accuracy and reliability. 3 Seventy-six patients were recruited after performing a standard CPET in the setting of a cardiac rehabilitation programme. All patients then performed two additional tests. In the first test patients performed a 6 MWT outdoors in a park along a flat, straight and fixed 30-meter path. The distance walked was measured by the researcher (as in a standardized 6 MWT). At the same time, the patient wore a smartphone recording the 6 MWT. In the second test, the free walk in the park 6 MWT (FWP-6 MWT), the same setup was applied, but patients were now instructed to walk freely in the park for 6 min. The primary outcome for this study was the correlation between the FWP-6 MWT and the peak oxygen consumption (VO 2); secondary outcomes included the correlation between the FWP-6 MWT and other CPET variables. The mean age was 65.7 ± 10.4 years; most participants were male (75%). Additional baseline characteristics can be found in Appendix. In our previous study it was already demonstrated that FWP-6 MWT is significantly correlated with standard 6 MWT distance (r = 0.929, P < 0.001). This subanalysis revealed a moderate correlation of FWP-6 MWT distance with peak VO 2 (r = 0.558, P < 0.001), VO 2 at ventilatory threshold 2 (r = 0.550, P < 0.001), and with peak power (r = 0.596, P < 0.001). There was no significant difference in the correlation between patients with low 6 MWT distance and higher 6 MWT distance. Multiple linear regression analysis showed that 58.1% of the variance in VO 2 max could be explained by using the free walk smartphone-registered 6 MWT distance, gender, presence of diabetes mellitus and the HDL level. Additional results are depicted in Table 1. In our previous study it was demonstrated that there is a high correlation between the 6 MWT distance measured by a standard 6 MWT and a smartphone-based 6 MWT while performing a free walk in the park. 3 While different aspects of physical fitness are measured by CPET and 6 MWT (maximal exercise capacity and submaximal exercise capacity respectively), a moderate correlation between measures of both tests has also been demonstrated in previous studies. 4,5 However, a study has demonstrated that in certain population such as severe heart failure a 6 MWT could be near to maximal effort. 6 The only moderate correlation could also be explained by the fact that the CPET was performed on a bicycle ergometer. Studies have already demonstrated differences in cardiopulmonary measures be

Supplemental material, sj-docx-1-jtt-10.1177_1357633X221150943 for Smartphone-based gamification intervention to increase physical activity participation among patients with coronary heart disease: A randomized controlled trial by Linqi Xu, Qian Tong, Xin Zhang, Tianzhuo Yu, Xiaoqian Lian,Tianyue Yu, Maarten Falter, Martijn Scherrenberg, Toshiki Kaihara, Sevda Ece Kizilkilic, Hanne Kindermans, Paul Dendale, and Feng Li in Journal of Telemedicine and Telecare

After a cardiac event, secondary prevention is recommended to foster recovery and reduce the risk of recurrent events. European guidelines and EAPC position statements on prevention of cardiovascular diseases recommend a holistic approach that actively engages patients by using shared decision making (SDM). It has been demonstrated that telerehabilitation can be a feasible and effective add-on or alternative compared to conventional in-hospital secondary prevention. However, till date, there is no eHealth solution that offers a holistic approach for secondary prevention that includes SDM. In this paper, we present the CoroPrevention-SDM approach, a technology-supported shared decision making approach for a comprehensive secondary prevention program for cardiac patients. The CoroPrevention Tool Suite consists of three applications that support patients and caregivers in following this approach: 1) a caregiver dashboard that includes decision support systems and supports SDM, 2) a patient mobile application that supports patients in making behaviour changes in their daily life, and 3) an extended ePRO application that collects patient reported outcomes and patient preferences. In a formative usability study, we assessed patients’ and caregivers’ opinion about our approach. The study indicated that both are willing to use our proposed approach to collaboratively set behavioural goals during SDM encounters. publishedVersion

Background While questionnaires for assessing digital literacy exist, there is still a need for an easy-to-use and implementable questionnaire for assessing digital readiness in a broader sense. Additionally, learnability should be assessed to identify those patients who need additional training to use digital tools in a health care setting. Objective The aim of the development of the Digital Health Readiness Questionnaire (DHRQ) was to create a short, usable, and freely accessible questionnaire that was designed from a clinical practice perspective. Methods It was a prospective single-center survey study conducted in Jessa Hospital Hasselt in Belgium. The questionnaire was developed with a panel of field experts with questions in following 5 categories: digital usage, digital skills, digital literacy, digital health literacy, and digital learnability. All participants who were visiting the cardiology department as patients between February 1, 2022, and June 1, 2022, were eligible for participation. Cronbach α and confirmatory factor analysis were performed. Results A total number of 315 participants were included in this survey study, of which 118 (37.5%) were female. The mean age of the participants was 62.6 (SD 15.1) years. Cronbach α analysis yielded a score of >.7 in all domains of the DHRQ, which indicates acceptable internal consistency. The fit indices of the confirmatory factor analysis showed a reasonably good fit: standardized root-mean-square residual=0.065, root-mean-square error of approximation=0.098 (95% CI 0.09-0.106), Tucker-Lewis fit index=0.895, and comparative fit index=0.912. Conclusions The DHRQ was developed as an easy-to-use, short questionnaire to assess the digital readiness of patients in a routine clinical setting. Initial validation demonstrates good internal consistency, and future research will be needed to externally validate the questionnaire. The DHRQ has the potential to be implemented as a useful tool to gain insight into the patients who are treated in a care pathway, tailor digital care pathways to different patient populations, and offer those with low digital readiness but high learnability appropriate education programs in order to let them take part in the digital pathways.

BACKGROUND AND AIMS: Insights into the nature of cognitive bias, including attentional bias to threat signals, are considered pivotal to understanding (chronic) pain and related distress. It has been put forward that attention to pain-related threat is normally dynamic and relates to the motivational state of the individual. In this experiment we aimed (i) to replicate the finding that attentional bias for pain signals in healthy participants can be reduced when a non-pain goal is pursued, and (ii) to extend this finding by taking into account the outcome focus of the non-pain goal. We hypothesised that the reduction in attentional bias for pain signals by concurrent non-pain goal pursuit would be stronger with non-pain prevention goals than with promotion goals. METHODS: Healthy university students performed an attentional bias task (i.e. spatial cueing task) containing visual cues that signalled the possible occurrence of a painful stimulus (electrocutaneous stimulus at tolerance level) or its absence, in combination with a non-pain goal task (i.e. digit naming task). The non-pain goal was either related to acquiring a positive outcome (gaining money depending on digit-naming performance; promotion goal group, n=31) or related to avoiding a negative outcome (losing money; prevention goal group, n=31). A standard attentional bias task served as the control condition (control group, n=31). RESULTS: Spatial cueing effects were larger for pain cues than for no-pain cues, indicating attentional bias for pain signals. The pattern of results suggests that this effect was indeed reduced in the goal groups as compared to the control group, but there was no significant group difference. CONCLUSIONS: We found no statistically-significant evidence for the impact of non-pain goal pursuit or outcome focus on pain-related attentional bias. At best, there were indications of a reduced attentional bias for pain signals with non-pain goal pursuit that was either promotion- or prevention focused. IMPLICATIONS: These data add to the small but growing body of literature on the assumed relevance of motivational context in explaining variations in attentional bias. The results trigger new questions on the nature and assessment of pain-related attentional bias, and more specifically attentional bias for fear-conditioned pain signals (versus safety signals), from a motivational perspective.

Aims Cardiac rehabilitation (CR) is indicated in patients with cardiovascular disease but participation rates remain low. Telerehabilitation (TR) is often proposed as a solution. While many trials have investigated TR, few have studied participation rates in conventional CR non-participants. The aim of this study was to identify the percentage of patients that would be willing to participate in a TR programme to identify the main perceived barriers and facilitators for participating in TR. Methods and results Two groups of patients were recruited: CR non-participants and CR participants. Semi-structured interviews were conducted. Thirty non-participants and 30 participants were interviewed. Of CR non-participants, 33% would participate in TR and 10% would participate in a blended CR programme (combination of centre-based CR and TR). Of CR participants, 60% would participate in TR and 70% would be interested in a blended CR programme. Of those that would participate in TR, 44% would prefer centre-based CR, 33% would prefer a blended CR programme, and 11% would prefer a full TR programme. In both groups, the main facilitating aspect about TR was not needing transport and the main barrier was digital literacy. Conclusion For CR non-participants, TR will only partly solve the problem of low participation rates and blended programmes might not offer a solution. Cardiac rehabilitation participants are more prepared to participate in TR and blended CR. Digital literacy was in both groups mentioned as an important barrier, emphasizing the challenges for healthcare and local governments to keep educating all types of patients in digital literacy.