“Introducing personalized healthcare in daily clinical practice” Miriam Vollenbroek-Hutten
Introduction • Chronic diseases are the leading cause of mortality and morbidity in Europe • Traditionally chronic diseases concern, cardiovascular disease, diabetes and asthma or chronic obstructive pulmonary disease (COPD) chronic pain. • As survival rates and durations have improved, nowadays chronic diseases also concern many varieties of cancer, HIV/AIDS, mental disorders and disabilities such as sight impairment and arthroses 2 Roessingh Research and Development, Enschede, the Netherlands
Introduction Commonalities of chronic diseases • they need a long-term and complex response, coordinated by di ff erent health professionals • They need access to the necessary drugs and equipment, treatments like physiotherapy, cognitive behavioral treatment and extending into social care. • Improving vitality and functional status is key 3 Roessingh Research and Development, Enschede, the Netherlands
Introduction However Most health care today, however, is still structured around acute episodes Main Challenges • Prevention and early detection • Coordinating care for individual chronic diseases: DMPs • Managing care across chronic Chronic Care Model, diseases: integrated care Wagner 2001 models 4 Roessingh Research and Development, Enschede, the Netherlands
Current status Marco Rogante 1 , Mauro Grigioni 1 , Daniele Cordella 2 , Claudia Giacomozzi 1 Rogante, M., et al., Ten years of telerehabilitation: A literature overview of technologies and clinical applications. 1 Technologies and Health Department, Italian National Institute of Health, Rome, Italy NeuroRehabilitation, 2010. 27 (4): p. 287-304. 2 SIDBAE Informatic Sector, Italian National Institute of Health, Rome, Italy This paper aims at delivering a structured overview of telerehabilitation literature by analysing the entire set Category 1 – synchronous communication technologies of articles under the search terms "telerehabilitation" or "tele-rehabilitation" to portray "state of the art" ten years after the publication of the first scientific article on the topic. A structured study has been conducted Category 2 – asynchronous communication technologies by considering all those articles containing the word "telerehabilitation" or "tele-rehabilitation". Medline, Embase, Cochrane, UK Centre for Reviews and Dissemination, Canadian Agency for Drugs and Category 3 – sensor-based technologies Technologies in Health databases have been interrogated for articles between 1998 and 2008. 146 Category 4 – exercise-applications scientific articles were found. 56 articles focus on patient treatment, 23 are reviews, 3 are to be considered as both patient treatment papers and reviews, 53 are either technical reports, system descriptions or Category 5 - virtual reality and gaming analyses of new approaches; 8 are general discussion on telerehabilitation. The present paper draw the scenario of the first ten years of telerehabilitation, focussing on clinical applications and technologies. Basically, it confirms the lack of comprehensive studies providing evidence for supporting decision and policy-makers in adopting telerehabilitation technologies in the clinical practice. An overall lack of standardisation in the used terminology also results from the analysis of keywords, which is typical of quite recent fields of application. 5 Roessingh Research and Development, Enschede, the Netherlands
Current status Currently finding it way in clinical practice are Category 1 and Category 2 - Video consultation between professionals Professional-professional - Videoconsultation between patients and professionals - E-mail consultation Patient-professional 6 Roessingh Research and Development, Enschede, the Netherlands
Why telemedicine does not find its way towards sustainable implementation? Stephanie Jansen- Kosterink*, Rianne Huis in ’t Veld*,Karlijn Cranen* ,Hermie Hermens*# ,Miriam Vollenbroek-Hutten*# Category Number of Technology Clinical purposes paper Synchronous 24 papers Videoconferencing To enable contact communication 1 paper Telephone between patient and 1 paper Telephone +webcam professionals A-synchronous 4 papers E-mail To enable contact communication 2 papers Asychronous messaging between patient and technology technology professionals Sensor based 26 papers 8 papers ECG, O2 Secure exercising technology 7 papers HR, BP To monitor progression 9 papers motion detection Quality/Quantity motion 3 papers EMG Treatment/Coaching Exercise 18 papers 10 papers web application Providing treatment applications 6 papers PC workstation plans 3 papers phone application Virtual 4 papers 7 community/games Roessingh Research and Development, Enschede, the Netherlands
Category 3: Sensor based technology Example: Activity Coaching Towards a balanced and active life 1600 1600 1600 1600 Gemiddelde activiteit 1400 1400 1400 1400 1200 1200 1200 1200 Controls 1000 1000 1000 1000 Controles Controles CLBP 800 800 800 800 CLBP Controles CLBP COPD COPD 600 600 600 600 CVS 400 400 400 400 200 200 200 200 0 0 0 0 8 8 8 9 10 11 12 13 14 15 16 17 18 19 9 10 11 12 13 14 15 16 17 18 19 9 10 11 12 13 14 15 16 17 18 19 9 10 11 12 13 14 15 16 17 18 19 8 Sensor for Smartphone wireless measuring daily connected with Uur van de dag sensor and coaching activities engine to provide tips M. Van Weering , M. Tabak , R. Evering 8 Roessingh Research and Development, Enschede, the Netherlands
Category 3: Sensor based technology Green: reference Blue: measured activity 9 Roessingh Research and Development, Enschede, the Netherlands
Compliance to activity coaching system 35 30 Numer of patients 25 20 started 15 completed 10 5 0 week 1 week 2 week 3 week 4 Duration of use 10 Roessingh Research and Development, Enschede, the Netherlands
Next step: Personalized feedback Self – efficacy People with low levels of self efficacy do not change their activity pattern Δ Self-efficacy Success Vicarious Verbal Physiological experience feedback persuasion states Reinoud Achterkamp 11 Roessingh Research and Development, Enschede, the Netherlands
Next step: Personalized feedback Stage of change People in different stages of change show different problems in their activity behavior - Level of activity - Balancing activity patterns Reinoud Achterkamp 12 Roessingh Research and Development, Enschede, the Netherlands
Next step: blended care programs Target group: Cancer RCT with 330 patients survivors Blended care program: - Activity coaching - behavioral change models - implemented in 9 weeks first line fysiotherapy - Weekly coaching by e-mail Marije Wolvers Fieke Everts 13 Roessingh Research and Development, Enschede, the Netherlands
Category 4: Exercise applications Exercise-based telerehabilitation service 14 Roessingh Research and Development, Enschede, the Netherlands
Category 4: Exercise applications • Exercise scheme • Program made by therapist for each individual patient • Patient logs in at home with password to own exercise scheme (video, sproken word, text) • Communication via chat 15 Roessingh Research and Development, Enschede, the Netherlands
Experience gained in clinical practice • Evidence gained – European project Clear (ICT-PSP) – Dutch Project Telerevalidatie.nl • Implementation performed sofar – Regional project CoCo – Dutch Project Tele-Nu Roessingh Research and Development, Enschede, the Netherlands
(2008-2012) 800-1000 patients NL Chronic pain PL COPD/ASTMA Orthopedic: Knee / hip replacement IT ES CVA TBI Dementia Roessingh Research and Development, Enschede, the Netherlands
(2008-2012) Netherlands: Roessingh Research and Development, Enschede, the Netherlands
(2008-2012) • User satisfaction is good • CLEAR as partial replacement: – As effective as conventional care • CLEAR as addition – Not more effective than conventional care CLEAR as replacement CLEAR as addition COPD CLBP COPD WAD CRQ RDQ CRQ PDI CLEAR group 62% 63% 77% 42% (n=26) (n=32) (n=13) (n=12) Control group 76% 41% 74% 47% (n=21) (n=34) (n=23) (n=19) p=0.389 p=0.053 p=0.951 p=0.638 Roessingh Research and Development, Enschede, the Netherlands
(2011-2013) • Implementation and evaluation in 3 different rehabilitation centres across the Netherlands in 5 different patient groups - Artrosis - Parkinsons - COPD - Astma - Chronic pain - About 100 patients are treated - Business models and cases are calculated to investigate sustainable implementation using the framework developed earlier 20 Roessingh Research and Development, Enschede, the Netherlands
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