JMIR Rehabilitation and Assistive Technologies

Fidelity of an Online Telecoaching Community-Based Exercise Intervention Among Adults Living With HIV in Toronto, Ontario, Canada: Observational Longitudinal Study

2026-09-03T11:45:03-04:00

Background: Community-based exercise (CBE) can prevent and mitigate disability and improve health outcomes in people aging with HIV; however, engagement in exercise can vary. Objective: This study aims to describe the fidelity of implementation (FOI) of an online telecoaching CBE intervention with adults living with HIV. Methods: We conducted an observational longitudinal study involving a 6-month online CBE intervention involving thrice-weekly 60-minute exercise sessions; online biweekly supervised one-on-one exercise sessions with a personal trainer (13 sessions); and online monthly group educational sessions. We assessed fidelity using (1) online structured interviews with participants living with HIV at months 2 and 6, comprising 20 fidelity items on trainer performance, participant engagement, and exercise experiences; and (2) coaching logs completed by personal trainers after biweekly training sessions (frequency, intensity, time, and type of physical activity during supervised sessions and self-reported physical activity in the prior week). We considered FOI criteria to be met if ≥80% of the participants living with HIV: (1) attended ≥80% of training sessions (11 of 13 sessions); (2) engaged in thrice-weekly exercise the week of the personal training session ≥80% of the time over the 6-month intervention, as reported on the coaching logs; (3) reported “complete criteria met” for ≥80% of the fidelity items (≥16 of 20 items) at month 2 and month 6, as reported from the interviews; and (4) engaged in a combination of aerobic, strength, balance, and flexibility exercise ≥80% of the time over the 6-month intervention, as reported in the coaching logs. Results: A total of 29 of 32 participants completed at least 1 fidelity interview; 69% (22/32) were male. FOI was met for 1 of our 4 criteria among the 18 participants who completed the intervention and FOI assessment at month 6, specifically criterion 1, whereby 83% (15/18; 95% CI 66%-100%) of participants attended ≥80% of the 13 coaching sessions. For criterion 2, 50% (9/18; 95% CI 27%-73%) of participants engaged in thrice-weekly exercise in the week of the personal training session ≥80% of the time over the 6-month intervention; criterion 3: ≥80% of participants reported criteria as “completely met” for 70% (14/20 items; 95% CI 50%-89%) of items at month 2 (n=27 participants) and 30% (6/20 items; 95% CI 10%-50%) of items at month 6 (n=18 participants); and criterion 4: 22% (4/18; 95% CI 3%-41%) of participants engaged in a combination of all 4 exercise types ≥80% of the time. Barriers to engagement included scheduling issues, lack of interest, technology problems, and episodic disability. Conclusions: FOI was achieved for supervised components of the CBE intervention and less so with independent exercise. Health and rehabilitation providers should tailor exercise interventions to personal preferences and abilities to improve engagement among adults living with HIV.

Intelligent Robot-Aided, Task-Oriented Physiotherapy Method for Upper Limb Rehabilitation: Development and Usability Study

2026-09-01T15:30:13-04:00

Background: Task-oriented rehabilitation supported by exoskeletons has the potential to increase therapy intensity, personalization, and accessibility. However, to achieve fully automatic treatment, robotized systems need to analyze therapy in a more complex way than only based on reference trajectories following. Objective: This study aimed to investigate the effects of an intelligent, context-aware control algorithm for an upper limb rehabilitation exoskeleton on patients’ musculoskeletal engagement, compared with constant-admittance robot-assisted therapy, and conventional physiotherapist-guided treatment. Methods: A single-session experimental study was conducted with 34 adult participants performing 6 activities of daily living under 3 therapy modes: robot-assisted therapy with constant admittance, robot-assisted therapy with an intelligent assist-as-needed algorithm, and physiotherapist-guided therapy. Muscle activity was assessed using surface electromyography of 8 upper limb muscle groups, while joint kinematics were recorded using inertial measurement units. Metrics included electromyography power, muscle activation time, joint range of motion, and Burst Duration Similarity Indices. Statistical comparisons were performed using the test and the Mann-Whitney test depending on data normality. Results: Results indicate that the intelligent control strategy engages the musculoskeletal system at least as effectively as constant-admittance control across all exercises. At the same time, more motion control is given to the patient, which is consistent with the principles of neuroplastic motor learning. Compared with physiotherapist-guided therapy, robot-assisted treatment with intelligent control elicited significantly higher and more consistent muscular engagement. Intelligent assistance also modified joint-level motion patterns by reducing compensatory movements, particularly in shoulder-elbow coupling, while maintaining functional task execution. Muscle activation timing patterns during intelligent robot-assisted therapy were more consistent with robotic control than with manual therapy, reflecting altered movement strategies. Conclusions: These findings demonstrate that context-aware, intelligent control in rehabilitation exoskeletons can promote active patient participation, reduce compensatory behaviors, and maintain physiologically meaningful muscle engagement. The proposed approach exceeds the results of recent similar studies, being a promising step toward effective, minimally supervised, and task-oriented rehabilitation.

Stakeholder Perspectives on Facilitators of and Barriers to the Implementation of Internet of Things–Equipped Powered Wheelchairs in Sweden: Qualitative Case Study

2026-08-28T16:30:14-04:00

Background: The implementation of Internet of Things (IoT) technologies to proactively monitor the functioning of assistive products remains underexplored, particularly in public assistive technology services. Objective: This qualitative single-case study investigated how a public assistive technology provider in Sweden implemented IoT-equipped assistive products. Methods: The implementation process was mapped, and a thematic analysis of interviews with 6 participants representing key organizational roles was conducted. Results: The process comprised 9 major events involving 4 main stakeholders. The findings included 4 themes of facilitators and 5 themes of barriers, which were synthesized into three meta-themes: (1) system-level structures that enable and constrain implementation, (2) tensions between technological potential and the challenges of realizing it, and (3) relational and cultural dynamics that balance trust with caution. Conclusions: The findings underscore the importance of using a sociotechnical framework to guide the implementation of IoT in assistive technology services. Such a framework supports a holistic approach that integrates user needs, privacy considerations, and regulatory requirements, while drawing on leadership, technical expertise, and collaboration to address legal, organizational, technical, and user-related challenges. The implications for health care technology implementation are that organizations should adopt sociotechnical implementation strategies that account for legal, organizational, technical, and user-related considerations.

Addendum: Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study

2026-08-27T15:30:02-04:00

Digital Aids for Social Media in Adults With Traumatic Brain Injury: Longitudinal Evaluation Study

2026-08-26T14:00:02-04:00

Background: Digital social media aids are features that enhance accessibility to social media for users with disabilities. One group of adults with disabilities who have reported barriers to social media access is adults with traumatic brain injury (TBI). Results of previous studies showed that adults with TBI want to engage in social media but encounter significant barriers to doing so, due in large part to TBI-related cognitive and communication challenges. We previously collaborated with adults with TBI to develop 5 aids to increase social media access. Aids were implemented as Chrome extensions that modified user interface functions and visuals on Facebook. The present study was the next step: testing the use of the 5 aids by a novel group of adults with TBI longitudinally and in naturalistic settings. Objective: This study aimed to determine (1) how participants perceived each aid (ie, in terms of satisfaction, usability, likes, and dislikes), (2) how aids influenced participants’ well-being, and (3) which aid features participants rated as most and least useful. Methods: We recruited 39 adult Facebook users with TBI to take part in an approximately 1-month-long within-subject evaluation study of Facebook browser aids. Each aid was used for 3 days, followed by an evaluation and a subsequent 2-day no-aid use period. Participants evaluated each of the 5 unique browser aids in a randomized order. Results: Users reported the aids to be beneficial, especially aids that reduced visual clutter and information overload. Users also reported increased life satisfaction after using the aids (P=.02). Conclusions: These results provide proof of concept for the types of digital aids that could improve access to social media for users with TBI. We advocate including aids like these across all social media platforms so users with TBI can access the benefits of engagement in social media with fewer barriers.

Effects of Using a Lumbar-Type Hybrid Assistive Limb by Older Adults With Frailty on Exercise Self-Efficacy: Retrospective Analysis Based on the Kanagawa Prospective ME-BYO Cohort Study

2026-08-24T16:45:11-04:00

Background: Improving exercise self-efficacy (ESE) is a key strategy for promoting sustained physical activity among older adults with frailty. The lumbar-type Hybrid Assistive Limb (HAL), a wearable device that supports voluntary movement through bioelectric signals, may facilitate mastery experiences in individuals with low baseline self-efficacy via adjustable assistance. However, its effects on ESE remain unclear. Objective: This study evaluated the effects of lumbar-type HAL exercise on ESE in older adults with frailty and examined whether responsiveness differed according to baseline readiness for exercise. Methods: A retrospective pooled analysis was conducted using data from 2 prospective studies of a lumbar-type HAL–based frailty prevention program: a feasibility study (n=20) and a randomized controlled trial (RCT; n=76; lumbar-type HAL group: n=38; waitlist control: n=38). Participants aged 50 to 84 years performed sit-to-stand and squat exercises using the lumbar-type HAL twice weekly. ESE was assessed using a validated 4-item questionnaire (range 4‐20). The prespecified primary analysis examined within-person changes in ESE in the lumbar-type HAL group (2-tailed paired test; n=96). A secondary analysis compared changes in ESE between the lumbar-type HAL and waitlist control groups in the RCT using the Welch test and baseline-adjusted analysis of covariance. A prespecified subgroup analysis compared participants in stages 1 to 4 of the transtheoretical model of behavior change (exercise habit not established) with those in stage 5 (maintenance). All statistical tests were 2 sided, with significance at <.05. Results: The primary pooled paired analysis demonstrated a significant increase in ESE of 1.05 points (95% CI 0.41-1.69; =.002). The subgroup analysis was also significant: those in stages 1 to 4 (n=56) improved by 1.73 points vs 0.05 points for those in stage 5 (n=38), a difference of 1.68 points (95% CI 0.41-2.95; =.01). The largest within-group improvement was observed in stage 1 (precontemplation: +3.50 points, 95% CI 0.27-6.73; =.04; Cohen =1.14); 4 of 6 participants improved and none deteriorated. In the secondary RCT between-group comparison, the lumbar-type HAL group showed a directionally favorable improvement (between-group difference=1.21 points, 95% CI −0.33 to 2.75; =.12; Cohen =0.36). The subgroup differences were 2.10 points in stages 1 to 4 (=.07; Cohen =0.58) and 0.02 points in stage 5 (=.99). Sensitivity analyses confirmed robustness to source-related heterogeneity (heterogeneity test: =.74; source-adjusted regression: =.76). Conclusions: The pooled analysis demonstrated significant within-person improvement in ESE among older adults with frailty following lumbar-type HAL training, with the greatest improvement in individuals without established exercise habits. The RCT indicated a favorable but inconclusive between-group effect, and adequately powered confirmatory RCTs remain necessary. The exploratory response among precontemplators—typically difficult to engage in interventions—suggests that HAL-supported mastery experiences may support disengaged older adults at high risk of frailty in starting physical exercise. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000037911; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043213 and UMIN000042352; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048345

Goal Setting During Telerehabilitation in Japan: Qualitative Study of Occupational Therapists’ and Physical Therapists’ Experiences Using Reflexive Thematic Analysis

2026-08-21T14:15:10-04:00

Background: Telerehabilitation expanded rapidly during the COVID-19 pandemic and is increasingly used alongside, or as an alternative to, in-person rehabilitation. Goal setting is a core component of client-centered rehabilitation; however, how therapists conduct goal setting remotely remains poorly understood, particularly in East Asian contexts. To our knowledge, no qualitative study has specifically examined remote goal setting in telerehabilitation in Japan, where remote delivery was not yet routine when these data were collected. Objective: This qualitative study aimed to explore how Japanese occupational therapists and physical therapists experienced negotiating and adapting rehabilitation goals during telerehabilitation, including how remote delivery shaped assessment, collaboration, and the purposes assigned to goals. Methods: Individual semistructured interviews (18‐51 minutes; mean 32 minutes) were conducted via Zoom (Zoom Communications, Inc) in Japanese with 9 therapists (7 occupational therapists and 2 physical therapists; 7 male and 2 female; aged 29‐43 years) who had direct experience of remote goal setting. Participants were recruited by purposive and snowball sampling from 9 different workplaces across Japan, including metropolitan areas such as Tokyo and regional areas such as Hokkaido and Nagasaki, and worked in hospital, private-practice, community-based, and academic settings. Data were analyzed using reflexive thematic analysis within a contextualist epistemology, following Braun and Clarke. Trustworthiness was considered using Nowell and colleagues’ criteria, and reporting followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results: Four themes were constructed: (1) losing touch: uncertainty in remote assessment and goal setting (9/9 participants); (2) from direct intervention to coaching-oriented goal setting (8/9 participants); (3) at home, at ease: needs that surface in clients’ own environments (6/9 participants); and (4) when continuity becomes the goal (6/9 participants). Therapists described remote goal setting as shaped by both constraint and possibility. Partial bodily, nonverbal, and contextual information reduced their confidence in assessment and goal negotiation, and they responded through preparation, visual resources, self-monitoring tools, and collaboration with clients and families. Sessions conducted in clients’ own environments appeared to support comfort and sometimes made everyday needs more visible. When in-person care was unavailable or insufficient, therapists sometimes broadened goals from functional improvement alone to include continuity, ongoing monitoring, and prevention of disengagement. Conclusions: In these therapists’ accounts, remote goal setting was not simply a diminished version of in-person practice but a distinct clinical process requiring deliberate preparation, collaborative communication, and management of uncertainty. Hybrid pathways may combine in-person assessment, when hands-on examination is needed, with continued remote negotiation, monitoring, and revision of goals. Further research should incorporate clients’ and families’ perspectives and evaluate hybrid models of goal setting across diverse rehabilitation populations.

Impact of Emerging Technologies on Outpatient Care Quality: Mixed Methods Study

2026-08-19T14:30:16-04:00

Background: Digital transformation in health care, including telemedicine, wearable devices, robotic process automation (RPA), and electronic medical records (EMRs), is reshaping outpatient care delivery. However, consolidated evidence on how these technologies influence patient care quality (PCQ) remains limited. Objective: This study evaluated the impact of emerging digital health technologies on PCQ dimensions in outpatient clinics through a systematic literature review combined with expert perspectives. Methods: A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines was conducted across ABI/INFORM, ScienceDirect, MEDLINE, and Google Scholar to identify studies published between 2017 and 2022. Studies examining digital technologies and their effects on outpatient PCQ were included. After screening and eligibility assessment, 53 studies were retained for synthesis. In parallel, semistructured interviews were conducted with 19 subject matter experts from public health, health informatics, and outpatient clinical practice. Findings were thematically analyzed using SERVQUAL (Service Quality Model) dimensions: responsiveness, reliability, empathy, communication, and tangibles, and triangulated across both datasets. Results: RPA led to substantial reductions in waiting times, while telemedicine improved accessibility and continuity of care, as highlighted by 14 of 19 experts. Wearable devices enhanced remote monitoring and patient engagement but required adequate digital literacy. Several studies (n=7) reported that EMR usability challenges negatively affected patient-physician communication. Overall, improvements were most evident in responsiveness and communication, while empathy and patient-centeredness remained comparatively weaker without targeted training and workflow adjustments. Conclusions: Emerging digital health technologies can enhance outpatient PCQ, particularly in operational efficiency, access to care, and communication. This review is innovative in that it integrates evidence across telemedicine, wearable monitoring, RPA, and EMRs within a unified SERVQUAL framework, offering practical guidance for implementing patient-centered digital health strategies in outpatient settings.

Deep Learning–Based Automated Clinical Gait Assessment From Kinematic Data in People With Stroke: Development and Validation Study

2026-08-19T13:30:14-04:00

Background: Gait impairment is a prevalent sequela of stroke. Although observational gait analysis remains a standard clinical practice for assessing neuromotor impairments in people with stroke, it is prone to subjective bias. Consequently, objective assessment is required to inform effective rehabilitation protocols. Objective: This study aimed to validate a deep learning framework for automating clinical gait assessment using kinematic data. Methods: This study was conducted in a university-affiliated gait analysis laboratory. Kinematic data were collected from 51 individuals with hemiparetic stroke and 18 healthy controls using wearable inertial measurement units, and video recordings were obtained for the Wisconsin Gait Scale (WGS) scoring. WGS scores, rated by 2 experienced physiotherapists, were used to establish the expert reference standard. A statistical graph convolutional network (STAT-GCN), incorporating a STAT-Attention Head module, was developed to predict WGS items 2 to 14 from kinematic data. Model evaluation was performed using a stratified, participant-level 5-fold cross-validation protocol, with all gait cycles from the same participant kept within the same fold. Model performance was assessed at the participant level using exact accuracy, mean absolute error, and weighted κ metrics. A descriptive comparison involving 4 final-year physiotherapy students was also conducted. Results: Among participants with stroke, STAT-GCN achieved an overall exact accuracy of 75.42% for WGS items 2 to 14, with a mean absolute error of 0.290 score levels. Across the participant-level 5-fold cross-validation test sets, STAT-GCN achieved a mean exact accuracy of 75.64% (SD 6.58%), whereas the 4 student evaluators achieved mean accuracies ranging from 56.19% (SD 7.03%) to 67.09% (SD 4.03%). Conclusions: The proposed STAT-GCN framework demonstrated reasonable preliminary performance for automated WGS item prediction in individuals with stroke. The results suggest that kinematic data–driven models may support more standardized gait assessment, but performance should be interpreted cautiously given the limited sample size, class imbalance across WGS score items, and absence of external validation. Further studies with larger and more clinically diverse stroke cohorts are needed before clinical implementation.

Ecological Momentary Assessment of Daily Activities in Individuals With Neurological Disorders: Scoping Review

2026-08-14T16:00:20-04:00

Background: Daily activities shape individuals’ health and well-being, reflecting functioning and lived health. For people with neurological conditions, these activities are often disrupted, affecting autonomy and quality of life. Traditional assessments miss subtle, real-time fluctuations, whereas ecological momentary assessment (EMA) captures moment-to-moment activity within natural contexts, offering insight into person-environment-occupation interactions. Despite its growing use, it remains unclear how EMA protocols conceptualize daily activities and integrate person-environment-occupation dimensions in applications for neurological populations. Objective: This scoping review aims to map the existing literature on the use of EMA to capture daily activities, ranging from basic self-care to more complex activities, in individuals with neurological disorders. Methods: A scoping review was conducted to map studies using EMA to capture daily activities in adults with neurological conditions, with a specific focus on content and practical application. A total of 341 articles were identified. Results: A total of 20 studies using EMA to assess daily activities in neurological populations were included; most were observational, with 2 longitudinal studies and 2 randomized controlled trials. Daily activity questions and response formats varied, often using multiple-choice lists; only 1 study allowed open-ended responses. In addition to daily activity questions, EMA captured person (physical, affective, and cognitive), environment (physical and social), and occupation domains, as well as motivation and EMA disturbance. Protocols differed in setting, schedule, technology, and adherence, with most reporting completion rates above 70%. Conclusions: EMA captures daily activities in neurological populations and demonstrates generally high adherence despite variability in study designs, questions, and technologies. The findings suggest that the phrasing of EMA items, the predominance of closed-response formats, and the narrow focus on the verb “doing” limit the depth and nuance of the data collected, often overlooking important aspects of performance, engagement, or both in daily activities.