1,721,015 research outputs found
An AI-Based Telerehabilitation Solution to Improve Mobility in People With Multiple Sclerosis: Protocol for an Implementation and Evaluation Study (The PLATINUMS Project) (Preprint)
No full textBackground: Multiple sclerosis (MS) is a chronic, progressive, and neurodegenerative disease affecting more than 2.8 million people globally. Mobility impairments are among the most significant challenges faced by people with MS, leading to physical inactivity, deconditioning, and disability progression (for some, even irreversible disability). This negatively impacts mental health, social participation, and quality of life while placing a considerable economic burden on society. Exercise can improve mobility and mitigate disability progression, but facility-based options are often inaccessible, especially for those in remote areas. Telerehabilitation offers a promising alternative, but current systems are limited by complexity and hardware requirements. Objective: The PLATINUMS (Implementation of an Advanced Telerehabilitation Solution for People With Multiple Sclerosis) project proposes an AI-driven telerehabilitation system to deliver accessible, cost-effective, and home-based exercise therapy for people with MS. Methods: The PLATINUMS project begins with working package (WP) 1, focusing on obtaining ethical approval and recruiting staff. Following this, WP2 involves a 4-week system feasibility and usability study (n=40) to assess and refine the digital platform. WP3 comprises a validity study (n=60) to evaluate remote mobility tests via the system, such as the Short Physical Performance Battery (SPPB), functional reach, and sit-to-stand tests, to ensure their reliability for use in WP4, the feasibility multicenter randomized controlled trial (RCT). The 10-week multicenter feasibility RCT will be conducted in MS centers across Denmark, Ireland, Israel, and Italy, with 96 participants varying in disability levels. The primary objective is to evaluate the efficacy of the AI-powered telerehabilitation system on mobility outcomes compared to usual care. Finally, WP5 will assess the cost-effectiveness of the telerehabilitation system by analyzing implementation costs, adherence, and use of health care. The PLATINUMS project aims to revolutionize exercise therapy for people with MS by demonstrating the feasibility, validity, and preliminary efficacy of the AI-driven telerehabilitation system. This approach addresses barriers such as accessibility, privacy, and standardization while promoting patient and therapist acceptance. Results: Funding for the PLATINUMS project was obtained in February 2024. WP2 data collection began in April 2025 across 4 European sites. WP3 is scheduled to launch in July 2025, with WP4 (the feasibility RCT) planned for January 2026. Initial WP2 results are expected by October 2025, with first publications anticipated in mid-2026. Conclusions: The PLATINUMS project is expected to generate critical insights into the feasibility, usability, and preliminary efficacy of an AI-based telerehabilitation system for people with MS. By leveraging widely available technology and real-time feedback, the system addresses key barriers to traditional rehabilitation. Findings from this protocol may inform future large-scale trials and support the broader implementation of digital health solutions in neurological rehabilitation. International registered report identifier (irrid): PRR1-10.2196/75983
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Use of the mini-BESTest to measure balance in people with multiple sclerosis
No full textBalance impairments are common in Multiple Sclerosis (MS). The Berg Balance
Scale (BBS) is widely used measure of balance in People with MS (PwMS), however
it may not capture all domains of balance. The novel Mini-BESTest (MBT) assesses
additional balance domains but relatively little research has been carried out
investigating its use in PwMS. Therefore, we aimed to investigate the inter-rater
reliability of the MBT and also to compare it to the BBS, as a measure of balance post
treatment, in ambulatory PwMS.
Fifty-two PwMS receiving out-patient physiotherapy were included. All mobilised
independently with or without an aid and gave demographic details, prior to
completion of the MBT with two different raters. Participants then completed the
BBS and five other secondary measures before and after 8 weeks of routine
physiotherapy.
For the inter-rater reliability analysis of the MBT, the intra class correlation
coefficient was high, the standard error of the measure was less than 10% of the scale,
and the Minimal Detectable Change (MDC) was 7. Reasons for a higher MDC in this
study compared to other studies may be the difference in populations investigated,
sample sizes used, means reported or the difference in experience or number of raters
used, for the MBT
Using pre and post treatment data for the BBS and MBT, the MBT demonstrated less
ceiling effects, larger effect sizes, higher standard response mean values and higher
correlation coefficients for each secondary measure after treatment.
These data suggests there is a strong agreement between two raters for the MBT and
also provides preliminary evidence that the MBT may be a better measurement for
detecting balance change in ambulatory PwMS, compared to the BBS
A qualitative investigation into how physiotherapists currently review people with Multiple Sclerosis and their opinions of telephone reviews in this population
No full textBackground: Guidelines recommend people with Multiple Sclerosis (PwMS) receive regular physiotherapy reviews (NICE, 2003). However little is known about how PwMS are currently reviewed. Reviews can be face-to-face, telephone or postal. The telephone is increasingly used to improve access to healthcare systems (Car, 2003). Yet no research is available on using telephone reviews with PwMS. Objectives: To explore: (i) how physiotherapists currently review PwMS and (ii) physiotherapists\u27 opinions of telephone reviews in this population. Methods: Three focus groups were conducted with physiotherapists working with PwMS in urban (n=4) and rural (n=2) primary care settings and an acute hospital (n=3). Sessions were audio-recorded, transcribed verbatim and thematic analysis was performed. Results: Physiotherapists conversed that reviewing PwMS is not regularly done due to service constraints and inconsistencies in patient review pathways. Despite this, service provision was enhanced mainly by MS Ireland. Telephone reviews were perceived as beneficial. However concerns regarding compromised quality of care arose due to loss of visual cues, patients\u27 ability to self-report and confidentiality issues. Concerns were allayed somewhat if a reliable self-reporting patient was chosen, reviews were structured and based on function. Conclusion: Physiotherapists are not regularly reviewing PwMS due to cutbacks in health services and problems with patient pathways. Due to the current economic climate further research is best aimed at refining patient pathways. Used appropriately, telephone reviews with PwMS have the potential to beneficial. Further research is required to ascertain benefits in reality and to ensure the safety of telephone reviews in this population
A survey of the current physiotherapy management of people with multiple sclerosis
No full textBackground: It is estimated that there are over 7,000 people with MS living in Ireland (MS Society 2008). Guidelines and evidence highlight the many benefits to be gained from physiotherapy interventions. However with limited resources (Coote et al 2010) and services for people with MS (PwMS), it is imperative physiotherapy management is effective, appropriate and evidence based.
Objectives: To determine what criteria physiotherapists frequently include in subjective and objective assessment for PwMS.
To examine the frequency of use of treatments and the use of evidence based practice in treatment choice.
Methods: A self-report e-survey was developed and distributed via email to all group members of Physiotherapists with an Interest in MS, Chartered Physiotherapists in Neurology and Gerontology, and Chartered Physiotherapists in Community Care. A survey link was placed in Firsthand and on primary investigators web-page. Data was analysed using descriptive statistics and likert scales.
Results: Only 65% of therapists were aware of clinical guidelines for MS. Current MS problems, medical history and active and passive range of movement; were the most frequently assessed domains. The top three treatments used were; patient education, balance and strengthening exercises. Respondents relied heavily on original training (19%) for choosing treatment techniques. Reading research (6%) or reviews (4%) were the least influential.
Conclusion: A comprehensive assessment is important in MS management and physiotherapists frequently assess an extensive range of factors. Physiotherapists use a wide variety of treatment techniques when treating PwMS and the importance of exercise and education is evident. Despite reference to clinical guidelines, a lack of evidence based practice was prevalent within this population sample
Objective measurement of physical activity in a multiple sclerosis population
No full textMultiple Sclerosis (MS) is a demyelinating neurodegenerative disease of the central nervous system. Gait impairment is among the most common symptoms. As a result, people with MS are more at risk of developing hypokinetic diseases. The promotion and maintenance of regular physical activity (PA) in persons with MS (PwMS) is of key importance in preventing secondary cardiovascular conditions and maintaining functional independence. A key issue in the research around PA and PwMS relates to the need for a objective measurement tool with strong psychometric properties which is capable of measuring both PA and energy expenditure.
Following a review of the literature, a number of gaps in the research were identified. An initial review of the literature identified the conceptual and
measurement difficulties associated with PA and the current level of knowledge in
relation to PA and MS. This thesis aimed to address these gaps by establishing the
criterion validity of two activity monitors - the ActivPAL (AP) and the Sensewear
Armband (SWA) - as a measure of PA and energy expenditure in thirty PwMS.
Finally, this thesis aimed to compare the energy expenditure between healthy
individuals and PwMS during activities of daily living (ADL).
The literature review found that PA is a multidimensional and complex concept. Although PA itself is not a quantifiable scientific unit, PA consists of numerous measureable parameters which can be utilized as proxy measures of PA.
Defining an appropriate research question is of key importance in choosing the optimal PA measurement tool. The measurement of PA in PwMS is effected by alterations in movement patterns and varying energy cost of movement. To date only two accelerometers-the TriTrac RT3 and the ActiGraph- have been examined in terms of reliability and convergent validity in PwMS, however, the optimal measurement tool remains unknown. There is a need to establish the criterion
validity of activity monitors in PwMS to determine the optimal measurement tool.
This study found that the SWA was a valid measure of PA- step count and energy expenditure- in PwMS as indicated by Intraclass Correlation Coefficient
(ICC) values and Bland and Altman analysis. The validity of the SWA was affected
by level of gait impairment for step count. The SWA demonstrated an ICC of 0.837
for PwMS with minimal gait impairment (MSA) and 0.441 for PwMS who used a bilateral walking aid (MSB). The ActivPAL was found to be a valid measure of steps during walking tasks for the total group (ICC for walking: 0.883) but not during mixed upper and lower limb ADL (ICC for folding laundry: 0.275). The SWA provided a valid measure of energy expenditure during ADL with an ICC value of
0.799 for MSA subgroup (mean difference: 16.51 kilocalories) and an ICC of 0.708
for MSB subgroup (mean difference: 5.79 kilocalories). However it overestimated
energy expenditure during high intensity ADL and underestimated energy expenditure during low intensity ADL. PwMS who used a bilateral walking aid had greater energy expenditure per step during ADL than healthy individuals (p<0.001).
In conclusion, future research should utilize the SWA as a measure of PA, if
measuring both steps and energy expenditure are the parameters of interest. Future
research should investigate the causative factors for the increased energy cost for
PwMS during ADL, the long-term activity patterns of PwMS and the efficacy of
exercise interventions for modifying long-term PA patterns in PwM
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Physiotherapy interventions for non-ambulatory people with multiple sclerosis
No full textThis thesis is comprised of three papers that aim to examine the literature surrounding physiotherapy interventions in non-ambulatory people with Multiple Sclerosis (PwMS), to gather information from a pilot scheme of the Exercise Buddy system in community physiotherapy and to evaluate the system formally.
Multiple Sclerosis (MS) is an inflammatory neurological disease that has a considerable physical and psychological impact on those affected. Approximately one quarter of PwMS are non-ambulatory, but the amount of physiotherapy received by this population is limited. An Exercise Buddy system is where professional carers are employed to conduct home exercise programmes with PwMS under the guidance of physiotherapists, and may augment the amount of physiotherapy currently received by a non-ambulatory subgroup.
A systematic review on physical rehabilitation interventions in non-ambulatory PwMS was carried out that found very little high quality studies for this population. A series of semi-structured interviews were then carried out with the participants of a pilot scheme of the Exercise Buddy system. The system was found to have excellent potential to benefit PwMS and their carers both physically and psychologically, and that adequate communication and training of Exercise Buddies were crucial to the success of the system. A randomised crossover trial of 29 non-ambulatory PwMS and their carers was carried out which found significant improvements in the physical and psychological self-perceived impact of MS in PwMS. Disability levels in PwMS were maintained and large dropout rates in carers made it difficult to make definite conclusions about the effect of either intervention.
The thesis concludes with a summary of the findings and a discussion of the implications of these papers for current practice and future research
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