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Background Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. Objective This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. Methods We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research—including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Results Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. Conclusions The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-040183

Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.

Background Cardiovascular diseases (CVDs) cause most deaths globally and can reduce quality of life (QoL) of rehabilitees with cardiac disease. The risk factors of CVDs are physical inactivity and increased BMI. With physical activity, it is possible to prevent CVDs, improve QoL, and help maintain a healthy body mass. Current literature shows the possibilities of digitalization and advanced technology in supporting independent self-rehabilitation. However, the interpretation of the results is complicated owing to the studies’ high heterogeneity. In addition, the added value of this technology has not been studied well, especially in cardiac rehabilitation. Objective We aimed to examine the effectiveness of added remote technology in cardiac rehabilitation on physical function, anthropometrics, and QoL in rehabilitees with CVD compared with conventional rehabilitation. Methods Rehabilitees were cluster randomized into 3 remote technology intervention groups (n=29) and 3 reference groups (n=30). The reference group received conventional cardiac rehabilitation, and the remote technology intervention group received conventional cardiac rehabilitation with added remote technology, namely, the Movendos mCoach app and Fitbit charge accelerometer. The 12 months of rehabilitation consisted of three 5-day in-rehabilitation periods in the rehabilitation center. Between these periods were two 6-month self-rehabilitation periods. Outcome measurements included the 6-minute walk test, body mass, BMI, waist circumference, and World Health Organization QoL-BREF questionnaire at baseline and at 6 and 12 months. Between-group differences were assessed using 2-tailed t tests and Mann-Whitney U test. Within-group differences were analyzed using a paired samples t test or Wilcoxon signed-rank test. Results Overall, 59 rehabilitees aged 41 to 66 years (mean age 60, SD 6 years; n=48, 81% men) were included in the study. Decrement in waist circumference (6 months: 1.6 cm; P=.04; 12 months: 3 cm; P Conclusions Remote cardiac rehabilitation added value to conventional cardiac rehabilitation in terms of waist circumference and QoL. The results were clinically small, but the findings suggest that adding remote technology to cardiac rehabilitation may increase beneficial health outcomes. There was some level of systematic error during rehabilitation intervention, and the sample size was relatively small. Therefore, care must be taken when generalizing the study results beyond the target population. To confirm assumptions of the added value of remote technology in rehabilitation interventions, more studies involving different rehabilitees with cardiac disease are required. Trial Registration ISRCTN Registry ISRCTN61225589; https://www.isrctn.com/ISRCTN61225589

Background The ongoing COVID-19 pandemic has required social, health, and rehabilitation organizations to implement remote physiotherapy (RP) as a part of physiotherapists’ daily practice. RP may improve access to physiotherapy as it delivers physiotherapy services to rehabilitees through information and communications technology. Even if RP has already been introduced in this century, physiotherapists’ opinion, amount of use, and form in daily practice have not been studied extensively. Objective This study aims to investigate physiotherapists’ opinions of the current state of RP in Finland. Methods A quantitative, cross-sectional, web-based questionnaire was sent to working-aged members of the Finnish Association of Physiotherapists (n=5905) in March 2021 and to physiotherapists in a private physiotherapy organization (n=620) in May 2021. The questionnaire included questions on the suitability of RP in different diseases and the current state and implementation of RP in work among physiotherapists. Results Of the 6525 physiotherapists, a total of 9.9% (n=662; n=504, 76.1% female; mean age 46.1, SD 12 years) answered the questionnaire. The mean suitability “score” (0=not suitable at all to 10=fully suitable) of RP in different disease groups varied from 3.3 (neurological diseases) to 6.1 (lung diseases). Between early 2020 (ie, just before the COVID-19 pandemic) and spring 2021, the proportion of physiotherapists who used RP increased from 33.8% (21/62) to 75.4% (46/61; P20% of their practice time for RP in 2021. The real-time method was the most common RP method in both groups (public sector 46/66, 69.7% vs private sector 157/219, 71.7%; P=.47). The three most commonly used technical equipments were computers/tablets (229/290, 79%), smartphones (149/290, 51.4%), and phones (voice call 51/290, 17.6%). The proportion of physiotherapists who used computers/tablets in RP was higher in the private sector than in the public sector (183/221, 82.8% vs 46/68, 67.6%; P=.01). In contrast, a higher proportion of physiotherapists in the public sector than in the private sector used phones (18/68, 26.5% vs 33/221, 14.9%; P=.04). Conclusions During the COVID-19 pandemic, physiotherapists increased their use of RP in their everyday practice, although practice time in RP was still low. When planning RP for rehabilitees, it should be considered that the suitability of RP in different diseases seems to vary in the opinion of physiotherapists. Furthermore, our results brought up important new information for developing social, health, and rehabilitation education for information and communications technologies.

Introduction: This study aimed to estimate the criterion validity of functional movement and posture measurement using remote technology systems in people with and without Axial spondylarthritis (axSpA). Methods: Validity and agreement of the remote-technology measurement of functional movement and posture were tested cross-sectionally and compared to a standard clinical measurement by a physiotherapist. The feasibility of remote implementation was tested in a home environment. There were two cohorts of participants: people with axSpA and people without longstanding back pain. In addition, a cost-consequence analysis was performed. Results: Sixty-two participants (31 with axSPA, 53% female, age = 45(SD14), BMI = 26.6(SD4.6) completed the study. In the axSpA group, cervical rotation, lumbar flexion, lumbar side flexion, shoulder flexion, hip abduction, tragus-to-wall and thoracic kyphosis showed a significant moderate to strong correlation; in the non-back pain group, the same measures showed significant correlation ranging from weak to strong. Conclusions: Although not valid for clinical use in its current form, the remote technologies demonstrated moderate to strong correlation and agreement in most functional and postural tests measured in people with AxSA. Testing the CV-aided system in a home environment suggests it is a safe and feasible method. Yet, validity testing in this environment still needs to be performed. peerReviewed

COVID-19 was declared a global pandemic on March 11, 2020. Since then, it has had an undeniable impact on many aspects of society, with far-reaching effects. The COVID-19 pandemic has likely affected music therapists in various ways, as they typically work in-person with their clients, often in healthcare related settings. This study aims to investigate the COVID-19 pandemic’s impact on the professional practice of music therapists. A questionnaire was shared online to certified music therapists around the world during the early stages of the COVID-19 pandemic. There were three broad areas of inquiry that the questionnaire covered, including the situational changes and/or practical adaptations that music therapists have seen in their clinical practice, music therapists’ utilisation of technology in their practice in the transition to virtual therapeutic settings, and music therapists’ current self-perception of their professional identity. Results show that music therapists have adapted their professional practices in various ways, resulting in a diverse range of clinical settings. In some circumstances, music therapy has been deemed as an essential service, and music therapists have continued their practices in health care facilities. In others, music therapists have had to shift their practice to a telehealth model of care in order to resume seeing their clients in a virtual therapy setting. The divide between essential and non-essential music therapists is evident from the range of clinical settings reported, and stems further into music therapists’ perceptions of their professional identity. Music therapists who have transitioned to a virtual practice reported some positive business-related outcomes, but also reported limitations to their approaches and use of specific interventions. Results also indicate that there is some hesitancy or uncertainty in regard to relevant data protection laws and their applications within a virtual music therapy practice. peerReviewed

BackgroundPhysical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. ObjectiveThe aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology–based treatment in 12 months of cardiac rehabilitation. MethodsThe cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. ResultsDuring the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95% CI –90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95% CI –585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD –87.9 minutes per week, 95% CI –379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95% CI –75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95% CI –2099.6 to 3833.9; P=.55). ConclusionsThe use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods. Trial RegistrationISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589

The development of digital solutions is becoming increasingly important in facing global challenges. Therefore, research on this topic is important in taking into account cardiac patients’ experiences of the rehabilitation process for the design of digital counseling solutions. The aim of the present qualitative study was to explore the different meanings that patients give to the rehabilitation process using a Glaserian grounded theory (GT) approach. Qualitative interviews were conducted with 30 participants from a rehabilitation center in Finland. The findings indicated a “complex trust-building process” core category comprising five categories of trust-building in rehabilitation: feeling that one has hit rock bottom, facing and coping in a crosscurrent, understanding together as a peer group, moving toward a healthier lifestyle with technology, and finding self-awareness. The complex process of trust-building involved interactions among emotion, cognition, and acceptance and support processes. Therefore, digital rehabilitation should be incorporated into counseling based on patients’ psychosocial, physical and emotional needs to help patients become aware of their own feelings and thoughts during the rehabilitation process. peerReviewed

Background: Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using. Objective: This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation. Methods: Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests—Mann–Whitney and Kruskal–Wallis tests—to compare the 4 e-usage groups—feeling outsider, being uninterested, reflecting benefit, and enthusiastic using—in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory. Results: The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; P=.03) and lower for physical fitness (MD −0.72; 95% CI −1.4 to −0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD −55.8; 95% CI −110.7 to −0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD −7.3; 95% CI −13.5 to −1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence. Conclusions: The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles. peerReviewed

IntroductionDigital behavioural weight loss interventions have the potential to improve public health; however, these interventions are often not adequately tailored to the needs of the participants. This is the protocol for a trial that aims to determine the effectiveness and cost-effectiveness of the Choosing Health programme as a means to promote weight loss and weight loss maintenance among overweight/obese adults.Methods and analysisThe proposed study is a two-group randomised controlled trial with a nested interrupted time series (ITS) within-person design. Participants (n=285) will be randomly assigned to either the Choosing Health digital intervention or a control group. For intervention participants, ecological momentary assessment will be used to identify behavioural determinants for each individual in order to tailor evidence-based behaviour change techniques and intervention content.Control group participants will receive non-tailored weight loss advice via e-book and generic emails. The primary outcome is the mean difference in weight loss between groups at 6 months controlled for baseline. Secondary outcomes include blood pressure and percentage of body fat; self-reported measures of physical activity, sitting time, quality of life, cost and theory-derived correlates of weight loss. Secondary outcomes will be measured at baseline, 3, 6 and 12 months. The primary outcome for ITS will be daily weight loss plan adherence. Data will be analysed using regression and time series analyses.Ethics and disseminationEthics approval was granted by Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland, approval number 03/P/12/2019. The project results will be disseminated through structured strategy implemented in collaboration with the Ministry of Health.Trial registration detailsThis trial was registered with www.clinicaltrials.gov; registration number NCT04291482.

The SHAPES project is an ambitious endeavour that gathers stakeholders from across Europe to create, deploy and pilot at large-scale a EU-standardised open platform incorporating and integrating a broad range of solutions, including technological, organisational, clinical, educational and societal, to enable the ageing population of Europe to remain healthy, active and productive, as well as to maintain a high quality of life and sense of wellbeing for the longest time possible. Not only each digital solution will be ethical, legal and appropriate for users, but also the results will align with the full and ethically responsible end-to-end exploitation of the new functionalities empowered by the secure cloud platform. Relevant EU and national legal or regulatory frames, ethical principles and fundamental rights will be considered, not only to guarantee due alignment with the development and use of the secure cloud platform but also to determine how to contribute to the reinforcement of the legal and policy frames to strengthen the deployment of large-scale cyber-secure digital solutions and the sustainability of the digital transformation of health and care delivery in Europe. This work in progress paper presents the project’s findings so far with regard to privacy and cybersecurity issues of the SHAPES secure cloud platform. peerReviewed

This paper explores the physicians’ perspective regarding the potential of computerised Cognitive Behavioural Therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator. peerReviewed

Background The rapid increase in the number of elderly family caregivers underlines the need for new support systems. Internet-delivered psychological interventions are a potential approach, as they are easy to access for family caregivers who are often homebound with their care recipient. This study examines the relative effectiveness of an internet-based acceptance and commitment therapy (ACT) intervention or a standardized institutional rehabilitation program, first, in reducing depressive symptoms, and second, in improving the well-being and quality of life of elderly family caregivers compared to a control group receiving support from voluntary family caregiver associations. Methods 156 family caregivers aged 60 or more are studied in a quasi-experimental study design that compares three groups of family caregivers (Group 1; n = 65: a guided 12-week web-based intervention; Group 2, n = 52: a standardized institutional rehabilitation program in a rehabilitation center; Group 3, n = 39: support provided by voluntary caregiver associations). Data collection is performed at three time-points: pre-measurement and at 4 months and 10 months thereafter. Caregivers’ depressive symptoms as a primary outcome, and perceived burden, anxiety, quality of life, sense of coherence, psychological flexibility, thought suppression, and personality as secondary outcomes are measured using validated self-report questionnaires. Physical performance and user experiences are also investigated. Between-group differences in the effects of the interventions are examined using multiple-group modeling techniques, and effect-size calculations. Discussion The study will compare the effectiveness of a novel web-based program in reducing depressive symptoms and improving the psychological well-being of elderly family caregivers, or a standardized institutional rehabilitation program representing usual care and a control group receiving support offered by voluntary caregiver associations. The results will expand the knowledge base of clinicians and provide evidence on effective strategies to improve the mental health and overall quality of life of elderly family caregivers. Trial registration The study was retrospectively registered in www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT03391596 on January 4, 2018.

BACKGROUND: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. OBJECTIVE: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. METHODS: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. RESULTS: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. CONCLUSIONS: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13011.

Tutkimuksen tavoitteena oli tutkia ja kehittää etäteknologian käyttöä Kelan laitoskuntoutuksessa ja työhyvinvointipalveluna toteutetussa etäkuntoutuksessa. Kuntoutusryhminä olivat sydänkuntoutukseen osallistuneet, tuki- ja liikuntaelinsairauksia sairastavat ja ammatillisen työkyvyn tuen tarpeessa olevat asiakkaat. Ensimmäisenä tavoitteena oli arvioida eri kuntoutusmallien vaikuttavuutta asiakkaiden fyysiseen toimintakykyyn ja koettuun elämänlaatuun sekä etäteknologiaa hyödyntävän kuntoutuksen osallistumiseen. Toisena tavoitteen oli kartoittaa asiakkaiden ja henkilökunnan kokemuksia etäteknologiasta osana tavanomaista kuntoutusta ja etäkuntoutusta. Lisäksi tässä artikkelissa tarkastellaan tuloksia suhteessa aikaisempaan tutkimus- ja kehitystoimintaan ja arvioidaan tulevaisuuden kehittämistarpeita. Tutkimukseen osallistui 79 asiakasta ja yhdeksän kuntoutustyöntekijää. Asiakkaiden keski-ikä oli 50,6 vuotta (60 % miehiä). Ryhmähaastatteluihin osallistui 39 asiakasta (49 % miehiä). Määrällisissä arviointimenetelmissä keskityttiin kuntoutusmallien ja -ryhmien sisäisiin ja/tai niiden välisiin eroihin muuttujien keskiarvoja vertailemalla. Laadullinen tutkimuksen haastatteluaineisto analysoitiin induktiivisella sisällönanalyysilla. Kuntouksen alussa asiakkailla oli selkeitä toimintakykyyn liittyviä riskitekijöitä ja hyvinvoinnin vajetta. He olivat ylipainoisia ja liikkuivat vähän ja heidän hengitys- ja verenkiertoelimistönsä kunto oli heikko. Lisäksi heidän oma arvionsa fyysisestä ja sosiaalisesta elämänlaadustaan oli alle väestön keskiarvon. Kuuden kuukauden kuntouksen aikana asiakkaiden fyysisessä aktiivisuudessa ja vyötärön ympärysmitassa tapahtui tilastollisesti ja kliinisesti merkitsevää parannusta. Fyysiseen aktiivisuuteen liittyvä myönteinen kehitys tapahtui tavanomaisessa kuntouksessa ja painonhallintaan liittyvä myönteinen kehitys yhdistelmäkuntouksessa, jossa hyödynnettiin tavanomaisen kuntoutuksen lisäksi etäteknologiaa. Kuntoutus ei kuitenkaan edistänyt hengitys- ja verenkiertoelimistön kuntoa tai koettua elämänlaatua. Haastattelun perusteella tuli esille, että asiakkaille on mahdollistettava oma ohjauksellinen polku huomioiden heidän tekninen osaamisensa ja motivaationsa sekä halukkuutensa teknologian käyttöön. Asiakkaat toivoivat, että monia ohjelmia olisi helppo käyttää samanaikaisesti ja eri ohjelmia helppo synkronoida. Lisäksi havaittiin, että teknologian käyttö kuntouksessa voisi aiheuttaa liian suuren stressitekijän niille asiakkaille, joilla ei ole riittävästi teknistä osaamista ja kiinnostusta sen omaksumiseen tai joilla sairauden tai muiden henkilökohtaisten syiden vuoksi ei ole riittävästi kykyä tai motivaatiota. Henkilökunnan haastatteluissa pidettiin tärkeänä sitä, että osaamisen varmistamiseksi järjestetään täydennyskoulutusta teknologiaan ja verkkotyöskentelyyn liittyvien ohjaus- ja valmennusmenetelmien hallintaan sekä työn uudelleen organisointiin. Tulevaisuudessa tulee kiinnittää enemmän huomiota teknologian helppokäyttöisyyteen sekä yksilölliseen teknologian käytön hyödyn arviointiin, jossa huomioidaan tekninen osaamisen taso ja teknologian nonPeerReviewed

IntroductionDrowning due to driving into floodwater accounts for a significant proportion of all deaths by drowning. Despite awareness campaigns such as 'If it's flooded, forget it', people continue to drive into floodwater. This causes loss of life, risk to rescuers and damage to vehicles. The aim of this study was to develop and evaluate an online e-health intervention to promote safe driving behaviour during flood events.Methods and analysisThe study will use a 2×3 randomised controlled trial in which participants are randomised into one of two conditions: (1) education about the risks of driving into floodwater or (2) education about the risks of driving into floodwater plus a theory-based behaviour change intervention using planning and imagery exercises. The effect of the intervention on the primary outcome, intention to drive through floodwater and the secondary outcomes will be assessed using a series of mixed-model analysis of covariances.Ethics and disseminationThe study has been approved by the Griffith University Human Research Ethics Committee. Participants will review a study information sheet and provide informed consent prior to commencing participation. Results will be disseminated through peer-reviewed publications, industry reports, media releases and at academic conferences. Deidentified data will be made publicly available following publication of the results.Trial registration numberACTRN12618001212246.

Hankkeen tavoitteena oli tutkia verkkopohjaisen, hyväksymis- ja omistautumisterapiamenetelmiin perustuvan etäkuntoutusohjelman vaikutuksia yli 60-vuotiaiden omaishoitajien psyykkiseen hyvinvointiin. Hanke toteutettiin näennäiskokeellisessa asetelmassa vertaamalla keskenään ryhmiä, joista yksi osallistui 12 viikon etäkuntoutusohjelmaan (n = 60), yksi omaishoitajien laitoskuntoutukseen (n = 52) ja yksi omaishoitoyhdistysten tarjoamiin toimintoihin (n = 39). Omaishoitajien psyykkistä hyvinvointia arvioitiin tutkimuksen alussa, etäkuntoutusohjelman jälkeen 4 kuukauden välimittauksissa sekä 10 kuukauden kuluttua tutkimuksen alusta. Tässä artikkelissa raportoidaan tuloksia ja kokemuksia hankkeen alku- ja välimittauksista. Hankkeen tulokset osoittivat, että neljän kuukauden kohdalla etäkuntoutus vähensi masennusoireita, paransi elämänlaatua ja lisäsi psykologista joustavuutta eli omaishoitajien kykyä käsitellä omia vaikeita ajatuksiaan ja tunteitaan enemmän kuin laitoskuntoutus ja omaishoitoyhdistysten toiminta. Omaishoitajat myös kokivat verkko-ohjelman suurelta osin helppokäyttöiseksi ja sitoutuivat verkko-ohjelmaan hyvin. nonPeerReviewed

As we live in the digital world, people can be provided with more effective treatment methods that allow them to live longer in their home and to live there better. People can be provided with better home care and preventive health care. People can easily carry portable sensors and intelligent devices in their bodies and wrists that relay their vital information to hospital systems in real time, from which healthcare staff can track human vitality even in real time. Although the digital world offers good opportunities to improve healthcare systems and make disease analyses more effective, we must look deeper about that issue. Devices and systems may not work well together. Almost every manufacturer has their own technical solutions and they only work in certain environments. There is a great need for unified concepts and for IT platform solutions in healthcare systems. The technology currently in use is very varied. Standards are developing now days, but they are not yet ready. In addition, the lack of technical and functional requirements for telemedical communications systems and equipment, as well as the requirements for providing secure data transmission in remote medical care. In the news we can see and hear often that there are a lot of medical devices that have damaged the patient's health around the world. And then there are a lot of vulnerabilities and that means security risks, cyber risks and the risks of reliability of data. These risks are associated with IoT devices and sensors, and in the field of data transfer. This document describes telemedicine solutions for the future of society. Includes a brief introduction of hospital equipment in a hospital environment and a patient's home. The main overall is the communication arrangements, consisting of the bio-signal formation of the patient's sensor and the flow of bio-signals to the hospital information systems for analysis and monitoring. This study examines cyber threats and attacks against e-health systems and what that means for patients` health. This study also examines the authenticity, traceability, authentication and protection of privacy. peerReviewed

Background: The emerging research on nurturing the growth of online communities posits that it is in part attributed to network effects, wherein every increase in the volume of user-generated content increases the value of the community in the eyes of its potential new members. The recently introduced metric engagement capacity offers a means of quantitatively assessing the ability of online platform users to engage each other into generating content; meanwhile, the quantity engagement value is useful for quantifying communication-based platform use. If the claim that higher engagement leads to accelerated growth holds true for online health forums (OHFs), then engagement tracking should become an important tool in the arsenal of OHF managers. Indeed, it might allow for quantifying the ability of an OHF to exploit network effects, thus predicting the OHF’s future success. Objective: This study aimed to empirically analyze the relationship between internal OHF use (quantified using engagement measurement), and external growth. Methods: We collected data from 7 OHFs posted between the years 1999 and 2016. Longitudinal analyses were conducted by evaluating engagement in the OHFs over time. We analyzed 2-way causality effects between the engagement value and metrics evaluating OHF growth using Granger causality tests. User activity metrics per week were correlated with engagement metrics, followed by linear regression analyses. Results: Observational data showed a 1-way causal relationship between the OHF engagement value and reach (P=.02). We detected a 2-way causal relationship between the engagement value and delurking, with further analysis indicating that the engagement value was more likely to cause delurking (P

Digital technologies have significantly changed the role of healthcare clients in seeking and receiving medical help, as well as brought up more cooperative policy issues in healthcare cross-border services. Citizens continue to take a more co-creative role in decisions about their own healthcare, and new technologies can enable and facilitate this emergent trend. In this study, healthcare services have been intended as a critical societal sector and therefore healthcare systems are focused on as critical infrastructures that ought to be protected from all types of fears, including cyber security threats and attacks. Despite continual progress in the systemic risk management of cyber domain, it is clear that anticipation and prevention of all possible types of attack and malfunction are not achievable for current or future cyber infrastructures. This study focuses on the investigation of a cyber security paradigm, adaptive systems and sense of resilience in a healthcare critical information infrastructure. peerReviewed

TIIVISTELMÄ Kirsi Ahde (2015). Mobiilisovelluksen käytettävyys kotiharjoittelun ohjauksessa lievää polven nivelrikkoa sairastavilla postmenopausaalisilla naisilla. Terveystieteiden laitos. Jyväskylän yliopisto, (fysioterapia) pro gradu tutkielma, 59 s., 7 liitettä. Tämän satunnaistetun ja kontrolloidun intervention tarkoituksena oli tutkia mobiilisovelluksen käytettävyyttä lievää polven nivelrikkoa sairastavien naisten kotiharjoittelun ohjauksessa. Lisäksi tutkittiin intervention aikaista dynaamisen tasapainon sekä alaraajojen maksimaalisen voimantuottotehon muutosta. Tutkimus oli osa Jyväskylän yliopiston Arjen mobiilisovellusten hanketta. Tutkimukseen osallistui 23 vapaaehtoista 54-66-vuotiasta lievää polven nivelrikkoa sairastavaa naista, jotka jaettiin satunnaisesti. kahteen ryhmään. Koeryhmäläisille harjoitusohjelma annettiin matkapuhelinsovelluksena ja kontrolliryhmälle paperiversiona. Mobiilisovelluksen käytettävyyttä mitattiin intervention toteutumisena ja käyttäjäkokemuksilla. Intervention toteutumista arvioitiin harjoituspäiväkirjoista. Käyttäjäkokemusta arvioitiin System Usability Scale (SUS) käytettävyyskyselyn, sekä käyttökokemuskyselyiden avulla. Dynaamista tasapainoa mitattiin 8-juoksulla sekä maksimaalista alaraajan voimantuottotehoa Nottingham PowerRig laitteella. Tutkimus toteutettiin kahtena interventiona, syksyllä 2010 ja keväällä 2011. Interventio oli kahdeksan viikkoa kestävä voimaharjoittelu. Molemmissa ryhmissä harjoittelun toteutuminen oli korkea. Mobiiliohjeryhmässä harjoittelu toteutui keskimäärin 91 % (sd 16) ja paperiohjeryhmässä (98% (sd 5) ja Ryhmien välinen ero ei ollut tilastollisesti merkitsevä (p=0,18). SUS kyselyn tulos, 87,3 (sd 7,9) pistettä, kuvaa sovelluksen hyvää käytettävyyttä. Dynaamisessa tasapainossa ja alaraajojen voimantuottotehossa ei havaittu tilastollisesti merkitsevää muutosta kummallakaan ryhmällä. Mobiilisovelluksella annettu ohjaus soveltuu kotiharjoitteluun yhtä hyvin kuin paperiohje. Mobiilisovelluksella tai paperiohjella ohjattu kahdeksan viikon kotiharjoittelu ei paranna dynaamista tasapainoa mitattuna 8-juoksulla eikä alaraajojen maksimaalista voimantuottotehoa. Avainsanat: etäkuntoutus, mobiilisovellus, käytettävyys, kotiharjoittelu, polven nivelrikko ABSTRACT Kirsi Ahde (2015), Feasibility of mobile health solution for home rehabilitation of women with knee osteoarthritis. Department of Health Sciences, University of Jyväskylä, Masters thesis, 59 pp, 7 appendices. Mobile technology is a fast growing topic worldwide in the health promotion. The aim of the study was to examine the feasibility of a user-centered mobile application in the rehabilitation of mild knee osteoarthritis (OA). In addition dynamic balance and leg extenson power were also examined to describe changes in physical performance. Voluntary 23 women (mean age: 60 SD 5) with mild knee OA participated in a eight weeks home strength training intervention. The participants were randomly assigned into 1) a mobile device group (n=13) or 2) a control group instructed by paper (n=10). Adherence to intervention was examined. The feasibility of the mobile application was examined by a 5 graded Likert-scale questionnaire and System Usability Scale (SUS). Also qualitative data were collected. In addition, leg extensor power was measured by Nottingham Powerrig and dynamic balance by figure-8-running test. In the intervention group, the adherence was 91% (SD 16) in the mobile group and 98 % (SD 5) in the control group. There was no significant difference between groups (p=0.18). Usability of the mobile application was ranked 87 (SD 8) out of 100 SUS points. Based on content analysis, functionality, usability and innovativeness were the main categories describing the application. There was no significant difference between the groups in leg extensor power or dynamic balance. In summary, the mobile application turned out to be feasible in the home based rehabilitation in mild knee OA. Eight weeks homebased exercise intervention had no effects for dynamic balance or leg extensor power. There was no differences between groups. Key words: mHealth, mobile solution, feasibility, home exercise, osteoarthritis

Hankkeen tavoitteena oli tutkia verkkopohjaisen, hyväksymis- ja omistautumisterapiamenetelmiin perustuvan yhdistelmämallin eli verkko-ohjelmasta ja kolmesta ryhmämuotoisesta kuntoutusjaksosta koostuvan kuntoutuksen vaikuttavuutta asiakkaiden mielenterveysoireiluun verrattuna Kelan Silmu-mielenterveyskuntoutukseen. Asiakkaat rekrytoitiin lehti-ilmoituksilla kesällä 2017. Tutkimus toteutettiin vuosien 2017–2019 aikana satunnaistetussa kontrolloidussa asetelmassa vertaamalla yhdistelmäkuntoutusryhmää (n = 32) ja perinteistä Silmu-kuntoutusryhmää (n = 27). Yhdistelmäkuntoutusryhmä sai 12 kuukauden kuntoutuksen, johon sisältyi 3 x 2 päivän lähijaksot Peurunka oy:n kuntoutuspalveluissa sekä verkko-ohjelman ensimmäisen lähijakson päätteeksi. Silmu-kuntoutujat saivat 12 kuukauden kuluessa Silmu-kuntoutuksen mukaiset 3 x 5 päivän lähijaksot Peurunka oy:n kuntoutuspalveluissa. Asiakkaiden psyykkistä hyvinvointia arvioitiin itsearviointimittareilla lähijaksoilla tutkimuksen alussa, 6 kuukauden välimittauksissa sekä 12 kuukauden kuluttua tutkimuksen alusta. Ryhmien muutoksessa ei havaittu tilastollisesti merkitseviä eroja kuntoutusmallien välillä. Tulokset osoittivat, että yhdistelmäkuntoutus ja Silmukuntoutus vähensivät psyykkisiä ja fyysisiä sekä masennus- ja ahdistusoireita ja työuupumusta, paransivat elämänlaatua ja hyvinvointia sekä lisäsivät psykologista joustavuutta. Yhdistelmäkuntoutusmalliin kuuluvat asiakkaat sitoutuivat etäkuntoutukseen erittäin hyvin ja raportoivat hyötyneensä kuntoutuksesta. Yhdistelmäkuntoutusta voidaan suositella vaihtoehtona perinteiselle Silmu-kuntoutukselle. nonPeerReviewed