Enschede, Netherlands
Enschede, Netherlands

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Tabak M.,Telemedicine Group | Tabak M.,University of Twente | Vollenbroek-Hutten M.M.R.,Telemedicine Group | Vollenbroek-Hutten M.M.R.,University of Twente | And 5 more authors.
Clinical Rehabilitation | Year: 2014

Objective: First, to investigate the effects of a telerehabilitation intervention on health status and activity level of patients with Chronic Obstructive Pulmonary Disease (COPD), compared to usual care. Second, to investigate how patients comply with the intervention and whether compliance is related to treatment outcomes. Design: a randomized controlled pilot trial Subjects: Thirty-four patients diagnosed with COPD. Intervention: The telerehabilitation application consists of an activity coach (3D-accelerometer with smartphone) for ambulant activity registration and real-time feedback, complemented by a web portal with a symptom diary for self-treatment of exacerbations. The intervention group used the application for 4 weeks. The control group received usual care. Main measures: Activity level measured by a pedometer (in steps/day), health status by the Clinical COPD Questionnaire at baseline and after intervention. Compliance was expressed as the time the activity coach was worn. Results: Fourteen intervention and 16 control patients completed the study. Activity level (steps/day) was not significantly affected by the intervention over time. There was a non-significant difference in improvement in health status between the intervention (-0.34±0.55) and control group (0.02±0.57, p=0.10). Health status significantly improved within the intervention group (p=0.05). The activity coach was used more than prescribed (108%) and compliance was related to the increase in activity level for the first two feedback weeks (r=0.62, p=0.03). Conclusions: This pilot study shows the potential of the telerehabilitation intervention: compliance with the activity coach was high, which directly related to an improvement in activity levels. © 2013 The Author(s).


Tabak M.,Telemedicine Group | Tabak M.,University of Twente | Brusse-Keizer M.,Spectrum | van der Valk P.,Spectrum | And 4 more authors.
International Journal of COPD | Year: 2014

The objective of this pilot study was to investigate the use of and satisfaction with a chronic obstructive pulmonary disease (COPD) telehealth program applied in both primary and secondary care. The program consisted of four modules: 1) activity coach for ambulant activity monitoring and real-time coaching of daily activity behavior, 2) web-based exercise program for home exercising, 3) self-management of COPD exacerbations via a triage diary on the web portal, including self-treatment of exacerbations, and 4) teleconsultation. Twenty-nine COPD patients were randomly assigned to either the intervention group (telehealth program for 9 months) or the control group (usual care). Page hits on the web portal showed the use of the program, and the Client Satisfaction Questionnaire showed satisfaction with received care. The telehealth program with decision support showed good satisfaction (mean 26.4, maximum score 32). The program was accessed on 86% of the treatment days, especially the diary. Patient adherence with the exercise scheme was low (21%). Health care providers seem to play an important role in patients' adherence to telehealth in usual care. Future research should focus on full-scale implementation in daily care and investigating technological advances, like gaming, to increase adherence. © 2014 Tabak et al.


op den Akker H.,Telemedicine Group | Jones V.M.,University of Twente | Hermens H.J.,Telemedicine Group
User Modeling and User-Adapted Interaction | Year: 2014

Technology mediated healthcare services designed to stimulate patients’ self-efficacy are widely regarded as a promising paradigm to reduce the burden on the healthcare system. The promotion of healthy, active living is a topic of growing interest in research and business. Recent advances in wireless sensor technology and the widespread availability of smartphones have made it possible to monitor and coach users continuously during daily life activities. Physical activity monitoring systems are frequently designed for use over long periods of time placing usability, acceptance and effectiveness in terms of compliance high on the list of design priorities to achieve sustainable behavioral change. Tailoring, or the process of adjusting the system’s behavior to individuals in a specific context, is an emerging topic of interest within the field. In this article we report a survey of tailoring techniques currently employed in state of the art real time physical activity coaching systems. We present a survey of state of the art activity coaching systems as well as a conceptual framework which identifies seven important tailoring concepts that are currently in use and how they relate to each other. A detailed analysis of current use of tailoring techniques in real time physical activity coaching applications is presented. According to the literature, tailoring is currently used only sparsely in this field. We underline the need to increase adoption of tailoring methods that are based on available theories, and call for innovative evaluation methods to demonstrate the effectiveness of individual tailoring approaches. © 2014, Springer Science+Business Media Dordrecht.


Van Der Geest T.,University of Twente | Ramey J.,University of Washington | Rosenbaum S.,TecEd Inc. | Van Velsen L.,Telemedicine Group
IEEE Transactions on Professional Communication | Year: 2013

June 2013 issue of IEEE Transactions on Professional Communication features a special section on 'Designing a Better User Experience for Self-Service Systems'. Self-service systems offers the users the benefit of 24/7 access to an ever-growing range of services and perhaps also a strong sense of autonomy and fulfillment. Three papers in this section approach the design of the user experience of self-service systems in an integrated way and show the readership of this journal what methods and techniques can be used in this type of design process. These are, 'Identifying User Experience Factors for Mobile Incident Reporting in Urban Contexts,' by Bach, Bernhaupt, and Winckler, 'Improving User Experience for Passenger Information Systems. Prototypes and Reference Objects,' by Wirtz and Jakobs, and in 'A User-Centered Design Approach to Self-Service Ticket Vending Machines,' by Siebenhandl, Schreder, Smuc, Mayr, and Nagl.


Tabak M.,Telemedicine Group | Tabak M.,University of Twente | Op den Akker H.,Telemedicine Group | Op den Akker H.,University of Twente | And 2 more authors.
Patient Education and Counseling | Year: 2014

Objective: To investigate how COPD patients respond to motivational cues that aim to improve activity behavior and how these responses are related to cue- and context characteristics. In addition, to explore whether activity can be increased and better distributed over the day by providing such cues. Methods: Fifteen COPD patients participated. Patients used an activity sensor with a smartphone for four weeks, at least four days/week. Patients received motivational cues every 2. h with advice on how to improve their activity, on top of real-time visual feedback. The response was calculated by the amount of activity 30. min before and after a cue. Results: In total, 1488 cues were generated. The amount of activity significantly decreased in the 30. min after a discouraging cue (p< 0.001) and significantly increased (p< 0.05) in the 10. min after an encouraging cue. The activity level increased with 13% in the intervention period compared to corrected baseline (p= 0.008). The activity was not more balanced over the day. Conclusions: COPD patients significantly change their activity level in response to motivational cues, based on continuous ambulatory assessment of activity levels. Practice implications: Motivational cues could be a valuable component of telemedicine interventions that aim to improve activity behavior. © 2013 Elsevier Ireland Ltd.


Timmerman J.G.,Telemedicine Group | Dekker-van Weering M.G.,Telemedicine Group | Tonis T.M.,Telemedicine Group | Hermens H.J.,Telemedicine Group | Vollenbroek-Hutten M.M.,Telemedicine Group
European journal of oncology nursing : the official journal of European Oncology Nursing Society | Year: 2015

PURPOSE: This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue.METHOD: Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0-10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS).RESULTS: Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations.CONCLUSIONS: This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue. Copyright © 2014 Elsevier Ltd. All rights reserved.


PubMed | Telemedicine group and Netherlands Cancer Institute
Type: | Journal: BMC health services research | Year: 2016

Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs).A user-centered design approach was used. Through semi-structured interviews (n=10 LC patients and 6 HCPs), focus groups (n=5 HCPs), and scenarios (n=5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs.The developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71% of LC patients and 78% of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score=70, range 35-95) was rated acceptable.A telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine.


PubMed | Waag Society, Telemedicine group and Roessingh Center for Rehabilitation
Type: | Journal: BMC medical informatics and decision making | Year: 2016

For many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the patient and the healthcare professional.We held two focus groups with patients (total n=15) and two with healthcare professionals (total n=13) in which we discussed when trust matters, what makes up trust in a rehabilitation portal, what effect specific design cues have, and how much the participants trust the use of activity sensor data for informing treatment.Trust in a rehabilitation portal is the sum of trust in different factors. These factors and what makes up these factors differ for patients and healthcare professionals. For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy, while for healthcare professionals, a larger and different set of issues play a role, including technical reliability and a transparent data storage policy. Healthcare professionals distrust activity sensor data for informing patient treatment, as they think that sensors are unable to record the whole range of movements that patients make (e.g., walking and ironing clothes).The set of factors that affect trust in a rehabilitation portal are different from the sets that have been found for other contexts, like eCommerce. Trust in telemedicine technology should be studied as a separate subject to inform the design of reliable interventions.


PubMed | Telemedicine Group
Type: Journal Article | Journal: Sensors (Basel, Switzerland) | Year: 2015

Measuring sedentary behaviour and physical activity with wearable sensors provides detailed information on activity patterns and can serve health interventions. At the basis of activity analysis stands the ability to distinguish sedentary from active time. As there is no consensus regarding the optimal cut-point for classifying sedentary behaviour, we studied the consequences of using different cut-points for this type of analysis. We conducted a battery of sitting and walking activities with 14 office workers, wearing the Promove 3D activity sensor to determine the optimal cut-point (in counts per minute (ms(-2))) for classifying sedentary behaviour. Then, 27 office workers wore the sensor for five days. We evaluated the sensitivity of five sedentary pattern measures for various sedentary cut-points and found an optimal cut-point for sedentary behaviour of 1660 10(-3) ms(-2). Total sedentary time was not sensitive to cut-point changes within 10% of this optimal cut-point; other sedentary pattern measures were not sensitive to changes within the 20% interval. The results from studies analyzing sedentary patterns, using different cut-points, can be compared within these boundaries. Furthermore, commercial, hip-worn activity trackers can implement feedback and interventions on sedentary behaviour patterns, using these cut-points.


PubMed | Telemedicine Group
Type: Journal Article | Journal: Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology | Year: 2015

Chronic conditions cannot be cured but daily behavior has a major effect on the severity of secondary problems and quality of life. Changing behavior however requires intensive support in daily life, which is not feasible with a human coach. A new coaching approach - so-called Personal Coaching Systems (PCSs) - use on-body sensing, combined with smart reasoning and context-aware feedback to support users in developing and maintaining a healthier behavior. Three different PCSs will be used to illustrate the different aspects of this approach: (1) Treatment of neck/shoulder pain. EMG patterns of the Trapezius muscles are used to estimate their level of relaxation. Personal vibrotactile feedback is given, to create awareness and enable learning when muscles are insufficiently relaxed. (2) Promoting a healthy activity pattern. Using a 3D accelerometer to measure activity and a smartphone to provide feedback. Timing and content of the feedback are adapted real-time, using machine-learning techniques, to optimize adherence. (3) Management of stress during daily living. The level of stress is quantified using a personal model involving a combination of different sensor signals (EMG, ECG, skin conductance, respiration). Results show that Personal Coaching Systems are feasible and a promising and challenging way forward to coach people with chronic conditions.

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