JMIR Rehabilitation and Assistive Technologies

User Satisfaction With Assistive, Rehabilitation, and Training Technologies: Questionnaire Development and Content Validation Study

2026-09-25T15:15:11-04:00

Background: According to human-centered design principles, user experience and user satisfaction are key aspects when developing or providing patients and clients with assistive, rehabilitation, or training technologies. Existing tools for assessing user experience and satisfaction are often either too narrow (developed for specific technologies) or too broad, failing to capture all relevant aspects of the technology being evaluated. Objective: The main objective of this study was to present the development process and content validation of a questionnaire that, following further validation steps, could be useful for researchers and developers in assessing the satisfaction of direct end users with assistive, rehabilitation, and training technologies. Methods: The development of the User Satisfaction Questionnaire for Assistive, Rehabilitation, and Training Technologies (U-ART-Q) followed a multistep process: (1) literature review, (2) domain definition and item generation, (3) expert consultation, (4) linguistic validation, and (5) content validation. Initially, 72 items were generated and organized into 7 domains. After expert review and linguistic validation, the questionnaire underwent content validation by 8 experts in physiotherapy, kinesiology, and ergonomics. Each item was rated for relevance using a 4-point Likert-type scale. The content validity ratio (CVR) and item-level content validity index (I-CVI) were calculated, and items below the accepted thresholds were removed or further revised. Results: Expert consultation resulted in the removal or merging of 20 items to improve clarity and reduce redundancy. Of the 52 items evaluated during content validation, 44 met the CVR and I-CVI criteria (CVR >0.75 and I-CVI >0.78). Eight items required additional review, and 2 items were ultimately removed. The final questionnaire comprises 10 initial screening questions and 50 content-valid items across 7 domains: design, comfort, effectiveness and usefulness, service, treatment or exercise, overall impressions, and safety. The overall average content validity index was 0.915, providing evidence of strong content validity. A macro-enabled Excel tool was developed to automate item selection and generate a PDF version of the questionnaire based on initial screening responses. Conclusions: The U-ART-Q is a newly developed instrument for assessing user satisfaction with assistive, rehabilitation, and training technologies. Further research will focus on psychometric evaluation, reliability testing, and multilingual validation to determine whether the U-ART-Q can provide a standardized method for assessing user satisfaction. Once fully evaluated, the questionnaire could support both developmental usability testing and postmarket evaluation, facilitating evidence-based decision-making and guiding future product improvement.

Participant-Reported Reductions in Falls and Fall-Related Injuries Associated With Variable-Friction Footwear: Retrospective Pre-Post Survey Study

2026-09-22T14:45:10-04:00

Background: Falls represent a critical public health burden in older adults and individuals with neurological disabilities, but evidence for passive footwear-based fall prevention strategies remains limited. Objective: This study aimed to evaluate changes in fall frequency and fall-related outcomes following adoption of variable-friction (VF) footwear. Methods: This retrospective pre-post observational study used self-reported survey data collected from community-dwelling adults aged 18 years or older who had worn VF footwear for 3 months or longer. Participants were recruited from a convenience sample of 14,570 invited customers who purchased the device through an electronic survey platform. Outcomes included self-reported fall frequency, injurious falls, fall mechanisms, fall-related health care use (including medical visits, urgent care, and hospitalization), and assistive device use, assessed before and during VF footwear use. Results: A total of 706 participants completed the survey, yielding 705 participants with usable data for analysis (4.8% response rate). Mean monthly participant-reported falls decreased from 2.4 (SD 4.3) before VF use to 0.3 (SD 1.9) during VF use (87.1% reduction; Wilcoxon signed-rank test, <.001). The proportion reporting zero falls increased from 22.7% to 84.4%. Among participants with at least 1 fall before VF use (n=545), 95.4% (n=520) reported a reduction, including 80.7% (n=440) reporting zero falls during VF use. Injurious falls decreased by 93.2% (<.001). Participants requiring medical attention decreased from 192 (27.2%) to 12 (1.7%; 93.8% reduction; <.001), and hospital or urgent care visits decreased from 131 (18.6%) to 10 (1.4%; 92.4% reduction; <.001). Trip-related falls decreased from 52.3% to 31.5% of reported mechanisms among participants who reported a fall mechanism in both periods (<.001). Assistive device use decreased from 70.8% to 16.6% (<.001). Mean annualized insurance-related fall costs decreased from US $5946.2 to US $45.7 per person-year (99.2% reduction) across the full cohort. Conclusions: VF footwear use was associated with substantial reductions in self-reported falls, injurious falls, and fall-related health care use. Reductions in trip-related falls are consistent with the proposed biomechanical mechanism of the device. Given the low survey response rate and potential for self-selection bias, these findings should be considered preliminary. Prospective controlled studies are needed to confirm these findings.

Leisure-Time Physical Activity Interventions for Health Promotion in Individuals With Rett Syndrome: Scoping Review

2026-09-21T17:30:02-04:00

Background: While half of individuals with Rett syndrome (RTT) are older than 50 years, research shows that they have low levels of physical activity, especially for those of advanced age and poor ambulation. Despite this evidence, recent studies underscore the potential of leisure-time physical activity interventions to improve health outcomes and quality of life for individuals with RTT. Objective: This scoping review aimed to summarize the state of the science regarding physical activity interventions for individuals with RTT and their families across the life span; map the extent, range, and nature of research activity in telehealth; and describe outcomes targeted by interventions with a focus on health-related fitness. Methods: Systematic searches were performed in the MEDLINE, Scopus, Google Scholar, and CINAHL Plus databases. The data charted from eligible studies included specific details about the participants, study design, setting, intervention characteristics, outcomes, and relevant key findings. Inclusion criteria were (1) original, peer-reviewed research; (2) full-text articles in English; (3) studies reporting a leisure-time physical activity intervention; and (4) a sample of individuals with RTT and/or caregivers. Results: A total of 23 studies enrolled 200 participants in total (mean age 13, SD 7, range 2-48 years). Participants were all female individuals, and studies included mostly those who were ambulatory. RTT severity was reported in less than half (9/23, 39%) of the studies; however, participants with mild to severe scores were represented. Most of the studies (20/23, 87%) used a case study design or single-group repeated measures, and only 13% (3/23) were randomized trials. The focus was primarily on gross motor function, walking ability, and physical activity outcomes. In total, 39% (9/23) of the interventions implemented telehealth into their design, primarily using remote video calls between a physical therapist and the participants’ parents. Conclusions: The findings of this review provide a foundation for designing evidence-based, scalable physical activity programs tailored to the unique needs of individuals with RTT. The integration of telehealth strategies offers a promising avenue for enhancing accessibility and caregiver engagement. Trial Registration:

Remote Therapeutic Monitoring Use Among Commercially Insured and Medicare Advantage Patients

2026-09-21T16:45:10-04:00

This national study found that remote therapeutic monitoring use increased rapidly between 2022 and 2024 but remained low overall, varied by insurance type and clinician specialty, and was concentrated among patients with musculoskeletal conditions.

Delivering Virtual Group Interventions for Youth With Persisting Symptoms After Concussion (Move&Connect-Youth) and Their Caregivers (Move&Connect-Caregivers): Fidelity and Engagement Evaluation

2026-09-21T15:30:12-04:00

Background: Youth with persisting symptoms after concussion (PSaC) can experience ongoing physical, cognitive, and emotional challenges, and their caregivers experience increased stress. There are currently limited interventions that support youth with PSaC or their caregivers. is a virtual group program with 2 parallel interventions: () and (). includes concussion education, active rehabilitation, and goal setting. uses psychoeducation and practical tools to promote family communication and problem solving. Objective: Within the context of a broader pilot study of and , we completed a fidelity and engagement evaluation with the objectives of (1) evaluating intervention fidelity and (2) exploring facilitators and barriers to youth and caregiver engagement. Methods: and were delivered virtually using Zoom Healthcare and ran in parallel. Youth with PSaC and caregivers were recruited from a children’s rehabilitation hospital in Ontario, Canada. Intervention fidelity was evaluated according to the 5 principles of fidelity from Bellg et al: design, training, delivery, receipt, and enactment. Intervention delivery, attendance, and engagement ratings were monitored through weekly logs and field notes. Participants completed exit satisfaction surveys, and a subset of youth and caregivers completed semistructured interviews to understand facilitators and barriers to engagement. Descriptive statistics were used to analyze logs and surveys. Directed content analysis, guided by a motivational framework, and inductive coding to identify barriers and facilitators to engagement were applied to qualitative data. Results: A total of 34 youth (age: mean 15.1, SD 2.28 years) and 36 caregivers (age: mean 48.9, SD 5.92 years) participated in 10 and 9 groups, respectively. Most youth identified as girls (24/34, 71%), and most caregivers identified as mothers (30/36, 83%). Clinician facilitators adhered to the components of the intervention protocols between 92% and 97% of the time in and 82% and 93% of the time in . The majority of youth (22/34, 65%) and caregivers (24/36, 67%) attended 5 or more sessions. In addition, 82% (28/34) of youth and 94% (34/36) of caregivers agreed they would recommend the interventions to others. Qualitative findings revealed youth engagement was supported by motivation, comfort in the virtual setting, interactive intervention components, feelings of trust, and diverse and modifiable exercises. Barriers to youth engagement included ongoing symptoms, discrepancies between exercises and physical abilities, and previous knowledge of education. Caregiver engagement was facilitated by perceived benefits of , emotional connection and validation, and comfort and convenience of the virtual setting. Barriers to caregiver engagement included stress, competing scheduling demands, and limited reminders or access to intervention materials. Conclusions: The pilot study of and was conducted with high delivery adherence. Exit satisfaction surveys combined with qualitative data revealed high levels of caregiver satisfaction and engagement, whereas youth satisfaction and engagement had some variability, particularly related to the exercise. Findings demonstrate important implications for delivering virtual group interventions for youth with PSaC and their caregivers. Trial Registration: ClinicalTrials.gov NCT05631301; https://clinicaltrials.gov/study/NCT05631301

Scientific and Technological Developments in Brain-Computer Interfaces: Dual Bibliometric Analysis of Articles and Patents

2026-09-10T13:30:15-04:00

Background: Brain-computer interface (BCI) technology is undergoing rapid translation from laboratory research to clinical applications, heralding a fundamental restructuring of human-machine relationships, with profound societal implications. Existing bibliometric analyses of this domain have exclusively relied on scholarly article databases, critically overlooking patent data that is essential for capturing the full spectrum of technological innovation in this highly translational field. Objective: This study aims to investigate the overall scientific and technological trajectories, key research drivers (journals, institutions, countries, and funding agencies), as well as research topics and trends in the BCI field through a comprehensive analysis of scientific and technical literature (articles and patents). Methods: BCI-related articles (11,346) and granted patents (1551) published from 2015 to 2025 were retrieved from the Web of Science (WOS) and the incoPat database, respectively. VOSviewer, CiteSpace (Dr Chaomei Chen), Microsoft Excel, and InCites (Clarivate) were used to summarize bibliometric features. Additionally, the Disruptive Index was calculated to characterize the developmental trajectory of scientific and technological advancements in BCIs. Results: The number of BCI articles and patents has been continuously increasing over the past decade. The published the largest number of BCI articles. The Chinese Academy of Sciences ranked first in article output, while the University of California System achieved the greatest citation impact, and Tianjin University from China led in patent filings. At the country level, China dominated article output and patent filings, whereas the United States attained the highest article citation impact and the most extensive international patent portfolios. The National Natural Science Foundation of China (NSFC) was the most prolific funding agency for BCI articles. Disruptive Index analysis revealed that BCI scientific research (article-based) maintained sustained growth in disruptiveness, whereas technological development (patent-based) demonstrated a pattern of fluctuation rather than consistent growth during the observation period. A total of 5 major research topics were identified, with neural interfaces and motor control attracting the greatest attention. In parallel, the leading technology categories were computer input or output interface devices (IPC: G06F3) and diagnostic measurement and human identification (IPC: A61B5). Citation analysis revealed an average knowledge transfer lag of 8.8 years, alongside limited bidirectional article-patent linkages. Conclusions: This study reveals a rapidly expanding yet strategically differentiated global BCI landscape dominated by China and the United States, with the former leading in output volume and the latter achieving the highest citation impact and international patent portfolios. BCI scientific research maintains active disruptive potential, whereas technological development lacks a commensurate upward trajectory; this asynchrony, compounded by prolonged knowledge transfer lag and weak article-patent linkages, points to translational challenges that require strengthened mechanisms for converting scientific discovery into technical innovations.

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