Home-based Therapy Research Articles

A research model to explain acceptance of speech therapy devices by senior aphasia patients

In addition to health-related impairments of age such as poor health, cognitive disorders, and frailty, aging people also face the risk of encountering situations that can lead to social exclusion and have significant negative consequences for their independence and quality of life. The home healthcare initiative intends to reduce healthcare costs, enhance healthcare quality, and increase patient independence. Information technologies like healthcare smart-home-solutions become a significant role in this effort. For these to be successful and ensure the users’ acceptance, the focus must be on them. Although particularly older adults could benefit from eHealth, they often feel unable to use the technologies. Drawing on the technology acceptance model and health belief model, we seek to understand if older people would use smart-home-environments for home-based therapy. This paper presents a research model on eHealth adoption in a speech therapy context.

Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways.

ContextToo many people living with chronic kidney disease are opting for and starting on hospital‐based dialysis compared to a home‐based kidney replacement therapy. Dialysis services are becoming financially unsustainable.ObjectiveThis study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability.DesignA 2‐year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public.Setting and ParticipantsA national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study.FindingsCoproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies.Discussion and ConclusionsPatient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services.Patient or Public ContributionInvolved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.

Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME II).

We have developed a passive and lightweight wearable hand exoskeleton (HandSOME II) that improves range of motion and functional task practice in laboratory testing. For this longitudinal study, we recruited 15 individuals with chronic stroke and asked them to use the device at home for 1.5 h per weekday for 8 weeks. Subjects visited the clinic once per week to report progress and troubleshoot problems. Subjects were then given the HandSOME II for the next 3 months, and asked to continue to use it, but without any scheduled contact with the project team. Clinical evaluations and biomechanical testing was performed before and after the 8 week intervention and at the 3 month followup. EEG measures were taken before and after the 8 weeks of training to examine any recovery associated brain reorganization. Ten subjects completed the study. After 8 weeks of training, functional ability (Action Research Arm Test), flexor tone (Modified Ashworth Test), and real world use of the impaired limb (Motor Activity Log) improved significantly (p < 0.05). Gains in real world use were retained at the 3-month followup (p = 0.005). At both post-training and followup time points, biomechanical testing found significant gains in finger ROM and hand displacement in a reaching task (p < 0.05). Baseline functional connectivity correlated with gains in motor function, while changes in EEG functional connectivity paralleled changes in motor recovery. HandSOME II is a low-cost, home-based intervention that elicits brain plasticity and can improve functional motor outcomes in the chronic stroke population.

605. Rates of Patient Satisfaction with Home-Based Outpatient Antimicrobial Therapy (OPAT)

Abstract Background The use of home-based outpatient parenteral antimicrobial therapy (OPAT) is well established. Studies by the National Home Infusion Foundation (NHIF) show that 1.4 million patients receive OPAT each year.1 With patient satisfaction a priority, NHIF developed, validated, and reliability tested the Uniform Patient Satisfaction Survey for Home Infusion Providers in 2017.2 Medicare patients are the fasting growing segment in the US and account for a disproportionate share of health care usage. Determining older patient satisfaction is imperative because patients who are more satisfied are more compliant with treatment3 and tend to return for continued care.4 Accordingly, the purpose of this study was to determine the level of home-based OPAT patient satisfaction and if a significant difference (p = ≤ .05) exists between the 0-64 and 65+ age groups. Methods 2019 and 2020 OPAT survey data (n=5,559) was used in this study. Top box percent, typically used in health care patient satisfaction, was calculated for each survey question. Data was summarized using 7 composite categories formed from the 22 survey questions. Differences (p = ≤ .05) between the age groups was also calculated. Results Mean patient age was 64.31 (SD=14.78), 54.99% were 65+ years old, and 58.85% were male. OPAT patients gave high marks to their home infusion service (Table 1). The highest top box % for the composite scores was “Patient instructions” which averaged 98.91%. The most common healthcare satisfaction question “I was satisfied with the overall quality of the services provided” showed significant difference between the age groups (p = .002) with the 0-64 groups being more satisfied than the 65+ (Exhibit 1). Table 1. OPAT Patient Satisfaction Survey Composite Scores: Percent of Patients Selecting Top-Box Score (n= 5,559) Exhibit 1. Level (%) of Agreement to “I was satisfied with the overall quality of the services provided” by Age Group (n = 5,559) Conclusion Analysis of each survey question shows the 65+ patients are less satisfied than younger patients on the following: being informed of side effects, explanation of financial responsibilities, and the helpfulness of the billing staff. Even though the scores are high for both age groups, additional research needs to be conducted to determine why scores for the 65+ age group are lower, and changes needed for improvement. Knowing the level of OPAT patient satisfaction will benefit infectious disease physicians, providers, prescribers, payers, and regulators as they evaluate how to expand home-based services. Disclosures All Authors: No reported disclosures

The development of a home-based therapeutic platform for multiple myeloma

Background Multiple Myeloma (MM) accounts for 1-2% of all malignancies but is the second commonest haematological malignancy. It is characterized by a proliferation of malignant plasma cells. The treatment paradigm of MM in Australia is traditionally hospital-based, complex and costly. While MM comprises 1-2% of cancer diagnoses, it appears in the top ten cancer diagnoses requiring hospital admission. The cumulative time spent receiving treatment is a significant burden for patients. The ability to receive treatment at home and maximize time away from hospital-based settings is a key preference for patients receiving anticancer therapies over a prolonged period of time. Methods The Peter MacCallum Cancer Centre and Royal Melbourne Hospital’s combined Clinical Hematology Unit has collaborated with their Hospital in the Home departments to develop several innovative programs to address this. Results We describe our current active programs and potential developments in home-based MM therapy. Conclusion We have enabled large numbers of patients to receive complex therapies in their own home and the COVID-19 pandemic has increased the pace of the roll out without any compromise in safety. We anticipate that the next raft of immunotherapies will be able to transition into the @Home treatment setting in the coming years.

アフターコロナを展望した在宅園芸療法プログラムによる心理的効果

アフターコロナを展望した在宅園芸療法プログラムによる心理的効果

A new wearable stretch sensor array for 3D spine model visualization during therapeutic exercise

Mobile visualization of the spine during therapeutic exercise may unlock the potential benefits of biofeedback for home-based therapy and fitness programs. In this paper we present the design and validation of a new approach to wearable sensors to close the digital-physical gap between sensor data and 3D spine posture by supporting animation of a customizable 3D thoracolumbar spine model that may eventually enable a mobile, virtual reality (VR) visual biofeedback. First, we propose a linear model of the dependency between four stretch signals from the dorsal surface and the angular positions of the thoracolumbar spine on the sagittal, coronal, and transverse planes. We then describe validation experiments and demonstrate the concept by animating the spine model with monoaxial, biaxial and tri-axial motions. The linear model was validated using a 3-way comparison of exercise video, sensor signals, and spine model animation. The computed angular positions were consistent with the video recording, and the animation of the model was visually accurate with a mean absolute error of 3.62 ° for single axis motions and 8.74 ° for dual axis motions. At the end, we provide a discussion on improvements to the linear model performance for cross-axial interactions, plus an outlook of future work.

Extracellular Vesicles and Their Relationship with the Heart-Kidney Axis, Uremia and Peritoneal Dialysis.

Cardiorenal syndrome (CRS) is described as primary dysfunction in the heart culminating in renal injury or vice versa. CRS can be classified into five groups, and uremic toxin (UT) accumulation is observed in all types of CRS. Protein-bound uremic toxin (PBUT) accumulation is responsible for permanent damage to the renal tissue, and mainly occurs in CRS types 3 and 4, thus compromising renal function directly leading to a reduction in the glomerular filtration rate (GFR) and/or subsequent proteinuria. With this decrease in GFR, patients may need renal replacement therapy (RRT), such as peritoneal dialysis (PD). PD is a high-quality and home-based dialysis therapy for patients with end-stage renal disease (ESRD) and is based on the semi-permeable characteristics of the peritoneum. These patients are exposed to factors which may cause several modifications on the peritoneal membrane. The presence of UT may harm the peritoneum membrane, which in turn can lead to the formation of extracellular vesicles (EVs). EVs are released by almost all cell types and contain lipids, nucleic acids, metabolites, membrane proteins, and cytosolic components from their cell origin. Our research group previously demonstrated that the EVs can be related to endothelial dysfunction and are formed when UTs are in contact with the endothelial monolayer. In this scenario, this review explores the mechanisms of EV formation in CRS, uremia, the peritoneum, and as potential biomarkers in peritoneal dialysis.

Real-Time Limb Motion Tracking with a Single IMU Sensor for Physical Therapy Exercises.

Limb exercises are common in physical therapy to improve range of motion (RoM), strength, and flexibility of the arm/leg. To improve therapy outcomes and reduce cost, motion tracking systems have been used to monitor the user's movements when performing the exercises and provide guidance. Traditional motion tracking systems are based on either cameras or inertial measurement unit (IMU) sensors. Camera-based systems face problems caused by occlusion and lighting. Traditional IMU-based systems require at least two IMU sensors to track the motion of the entire limb, which is not convenient for use. In this paper, we propose a novel limb motion tracking system that uses a single 9-axis IMU sensor that is worn on the distal end joint of the limb (i.e., wrist for the arm or ankle for the leg). Limb motion tracking using a single IMU sensor is a challenging problem because 1) the noisy IMU data will cause drift problem when estimating position from the acceleration data, 2) the single IMU sensor measures the motion of only one joint but the limb motion consists of motion from multiple joints. To solve these problems, we propose a recurrent neural network (RNN) model to estimate the 3D positions of the distal end joint as well as the other joints of the limb (e.g., elbow or knee) from the noisy IMU data in real time. Our proposed approach achieves high accuracy with a median error of 7.2/7.1 cm for the wrist/elbow joint in leave-one-subject-out cross validation when tracking the arm motion, outperforming the state-of-the-art approach by more than 10%. In addition, the proposed model is lightweight, enabling real-time applications on mobile devices.Clinical relevance- This work has great potential to improve limb exercises monitoring and RoM measurement in home-based physical therapy. It is also cost effective and can be made available widely for immediate application.

A tracking device for a wearable high-DOF passive hand exoskeleton.

In previous work, we developed an exoskeleton (HandSOME II) that allows movement at 15 hand degrees of freedom (DOF) and is intended for take-home use. An activity tracking device was developed in order to track index finger movement with a pair of magnetometers and magnet. The goal was to detect grip attempts by the individual. Machine learning was utilized to estimate angles for metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints at the index finger. Testing was performed with healthy control and individuals with stroke.Clinical Relevance- This device and method of data collection during daily activities might be useful for stroke rehabilitation and compliance with home-based therapy programs.

Home-Based Physical Activity in Patients With Type 2 Diabetes Mellitus: A Scoping Review.

To promote optimal healthcare delivery in type 2 diabetes mellitus (T2DM) following the outbreak of coronavirus disease 2019, adopting home-based physical activity (PA) is being seriously considered. Therefore, this study aims to outline the characteristics of exercise protocols for home-based PA and the challenges and limitations in implementing home-based PA in patients with T2DM. This scoping review was carried out by identifying eligible studies in six different databases (Scopus, Cochrane Library, SpringerLink, ProQuest, Science Direct, and Google Scholar). The keywords used in the search strategies were: home-based physical activity, home-based exercise therapy, home-based physical exercise, home-based exercise, home-based exercise training, diabetes mellitus, and T2DM. Two reviewers independently screened all full-text articles to find articles that met the eligibility requirements. A total of 443 articles were identified in the search. Approximately 342 articles were excluded by screening titles and abstracts, which led to the selection of 44 articles relevant to the current study. Further screening of the full-text led to the subsequent removal of 34 other articles, leading to 10 studies that were eligible for data extraction. This review suggested that the exercise protocols for home-based PA include resistance exercise using free weight and own body weight with a frequency of two to three sessions per week at moderate intensity, along with aerobic exercise (particularly walking) with a frequency of three to five times per week at moderate intensity. A combination of resistance and aerobic exercise showed more significant benefits of PA in patients with T2DM. More studies regarding home-based PA in T2DM patients with metabolic disorders are warranted.

Comparison of the Efficacy of Dextrose Prolotherapy and Ozone in Patients with Knee Osteoarthritis: A Randomized Cross-Sectional Study

This study aimed to compare the effectiveness of dextrose prolotherapy, ozone therapy, and home exercise programs in patients with knee osteoarthritis. Seventy-five patients with knee osteoarthritis were divided into three groups, with 25 in each group. At week 0 (baseline), week 3, and week 6, 12.5% dextrose (intraarticular and periarticular) was administered to the dextrose prolotherapy group. At week 0 (baseline), week 1, and week 2 15 μg/mL ozone (intraarticular and periarticular) was administered to the ozone therapy group. Both groups were also given a home exercise program. The third group was given a home-based exercise therapy program for 12 weeks. All groups were evaluated for VAS, WOMAC, TUG, ROM-active, and ROM-passive values at weeks 0 (baseline), 6, and 12. Ozone therapy more effectively improved VAS scores than dextrose prolotherapy and VAS and WOMAC scores than home-based exercise therapy in the 6th week. Ozone therapy also more effectively improved VAS and WOMAC-stiffness scores than dextrose prolotherapy and VAS, WOMAC, and ROM-active scores than home-based exercise therapy in the 12th week. Both dextrose prolotherapy and ozone therapy are effective in knee osteoarthritis treatment. Ozone therapy should be used in suitable cases rather than dextrose prolotherapy.

Combining Virtual Reality and Behavioral Health to Promote Pain Resiliency: Analysis of a Novel BioPsychoSocial Modality for Solving Pain in the Workplace.

BackgroundThe use of virtual reality in treating pain symptoms is a new and emerging modality that has gained more traction, especially in light of the COVID-19 pandemic, which has led to a rise in the remote care of patients. Our study tested the effectiveness of a home-based pain relief program that utilized virtual reality and behavioral health for treating acute and chronic pain.Study DesignRetrospective Cohort Study.MethodsDue to the remote nature of the pain clinic during the COVID-19 pandemic, patients with work-related injuries were considered for inclusion in a 90-day Harvard MedTech Vx Pain Relief Program, which consisted of home-based virtual reality therapy (VRT) and tailored behavioral therapy that was conducted through phone consultations. Both the VRT and behavioral therapy focused on the specific workplace injury and centered around setting three personal goals for each patient that were considered meaningful to them. The progress towards achieving these goals was then tracked. The primary outcome of the retrospective analysis was pain scores after completion of home-based VRT. Secondary outcomes included: change in opioid therapy (opioid consumption), psychological awareness/perception of pain, level of immersion, and overall improvement/achievement in patient goals.ResultsA total of 36 patients (16 male and 20 female) with acute and chronic pain secondary to workplace injuries were included; these injuries severely limited their activities of daily living and reduced their quality of life. During the course of VRT and after completion of the 90-day program, patients experienced a substantial immediate and legacy pain relief. Specifically, patients reported an average 40% reduction in pain while utilizing the program and an additional 2.8 h of continued pain relief at the conclusion of 90 days. Further, 69% of patients also reported either a decrease in opioid use or complete cessation after VRT. The majority of patients also reported reduced depression, fatigue, and sleep disturbance.ConclusionsThe Harvard MedTech Vx Therapy appears to be an effective tool in the treatment of pain and the psycho-social issues associated with pain. This translates into a greater degree of pain resiliency and an overall improvement in general wellness and improved workplace functionality.

Effect of Multicomponent Home-Based Training on Gait and Muscle Strength Performance in Older Adults With Hip Fracture

Research Objectives To investigate the effect of a specific multicomponent home-based physical therapy intervention on gait and muscle strength. Design Single-blinded randomized controlled trial. Setting General community. Participants Thirty-four older adults post hip fracture were randomly assigned to either experimental group (n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or control group (n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). Interventions Experimental group received multi-component home-based physical therapy focused on lower extremity strength, endurance, balance, and function for community ambulation; control group received non-specific multi-component home-based physical therapy including active joint movement and TENS. Both groups received 32-40 training sessions for 16 weeks. Main Outcome Measures Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16-weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. Results At 16-weeks, both groups demonstrated a significant increase in usual walking speed (experimental group: 0.15m/s [95%CI: 0.02-0.27], p=0.003; control group: 0.17m/s [95%CI: 0.03-0.31], p=0.002). Knee extensor normalized peak torque (fractured side) increased in the experimental group (difference 0.9% [0.0% to 1.7%], p=0.001). However, there were no significant differences in time-course change between the groups for measured outcomes. The increase in usual walking speed correlated with the baseline TMT-B score (r=-0.371, p=0.037), and an increase in fast walking speed was associated with improved muscle strength in the fractured limb (r=0.446, p=0.001). However, those correlations diminished when adjusted by age. Conclusions Specific home-based multicomponent physical therapy is associated with improved muscle strength and gait speed in older adults after hip fracture surgery. Intervention targeting modifiable factors such as cognition and muscle strength may assist gait recovery after hip fracture surgery. Author(s) Disclosuress The study was supported by NIH, grant no. P30 AG028747, R21 HD043269, R01 AG029315, R37 AG09901, and T32 AG00262; NIDILRR, grant no. 90AR5028.

Designing an app for home-based enriched Music-supported Therapy in the rehabilitation of patients with chronic stroke: a pilot feasibility study

ABSTRACT Objective After completing formal stroke rehabilitation programs, most patients do not achieve full upper limb motor function recovery. Music-supported Therapy (MST) can improve motor functionality post stroke through musical training. We designed a home-based enriched Music-supported Therapy (eMST) program to provide patients with chronic stroke the opportunity of continuing rehabilitation by themselves. We developed an app to conduct the eMST sessions at home with a MIDI-piano and percussion instruments. Here, we tested the feasibility of the eMST intervention using the novel app. Method This is a pilot study where five patients with chronic stroke underwent a 10-week intervention of 3 sessions per week. Patients answered feasibility questionnaires throughout the intervention to modify aspects of the rehabilitation program and the app according to their feedback. Upper limb motor functions were evaluated pre- and post-intervention as well as speed and force tapping during daily piano performance. Results Patients clinically improved in upper limb motor function achieving the Minimal Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) in most of motor tests. The app received high usability ratings post-intervention. Conclusion The eMST program is a feasible intervention for patients with chronic stroke and its efficacy should be assessed in a clinical trial.

Efficacy of five-flash intense pulsed light therapy technique in patients with meibomian gland dysfunction

ABSTRACT Clinical relevance Meibomian gland dysfunction is the main cause of evaporative dry eye disease and can lead to ocular discomfort and ocular surface damage. Early diagnosis and management of this condition can prevent its impact on patients ‘visual health and quality of life. Background In the last decade, intense pulsed light therapy (IPL) has been introduced as a therapeutic option for patients with meibomian gland dysfunction (MGD). Various treatment modalities and protocols have been reported to increase the efficacy of this technique. This study aimed to assess the efficacy of a novel five-flash IPL technique in combination with home-based therapy and to compare it with conventional home care alone in patients with MGD. Methods In a randomised controlled trial, 100 symptomatic MGD patients were enrolled. The treatment group underwent three sessions of a five-flash IPL therapy. For all participants, eyelid warming, lid hygiene and lubricant therapy was prescribed. Ocular surface parameters were compared for control and treatment groups. Results Ocular Surface Disease Index (OSDI), non-invasive keratograph tear break up time (NIKBUT), fluorescein TBUT, MG expressibility, meibum quality and tear osmolarity were improved at follow up visits in both groups (p < 0.05). On day 75, NIKBUT was significantly higher in the IPL group (p = 0.045). The IPL treatment effect was not statistically significant (p > 0.05), except for bulbar and limbal hyperaemia (p = 0.02 and p = 0.02). In both groups, younger patients showed more improvement in NIKBUT (p = 0.02, r = −0.32; p < 0.001, r = −0.52). Conclusion IPL therapy combined with conventional home-based therapy, and home care alone are both effective for patients with MGD. IPL may have an additional role in the improvement of ocular hyperaemia.

Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke

Purpose To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. Method Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. Results All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. Conclusions All participants, regardless of home-based program, adhered to the prescribed dosage and significantly improved over time. Despite no between-group differences, effect size and 95% confidence interval data suggest that UMT may be more beneficial for individuals with moderate-to-severe arm impairment as compared to BMT or TOT. ClinicalTrials.gov: #NCT02780440 Implications for Rehabilitation Home-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke. Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.

Development of a Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury: Two Case Studies.

Background and Objectives: Fatigue and sleep disturbance negatively impact quality of life following brain injury and there are no established treatments. Building on research showing efficacy of blue light therapy delivered via a lightbox in reducing fatigue and daytime sleepiness after traumatic brain injury (TBI), this paper describes the development and implementation of a novel in-home light therapy to alleviate fatigue and sleep disturbance in two case studies.Methods: During the 8-week lighting intervention, participants' home lighting was adjusted to provide high intensity, blue-enriched (high melanopic) light all day as a stimulant and dimmer, blue-depleted (low melanopic) light for 3 h before sleep as a soporific. The sham 8-week control condition resembled participants' usual (baseline) lighting conditions (3,000–4,000 K all day). Lighting conditions were crossed-over. Outcomes were measures of fatigue, subjective daytime sleepiness, sleep quality, insomnia symptoms, psychomotor vigilance and mood. Case study participants were a 35-year old male (5 years post-TBI), and a 46-year-old female (22 years post-TBI).Results: The relative proportion of melanopic lux was greater in Treatment lighting than Control during daytime, and lower during evenings. Participants found treatment to be feasible to implement, and was well-tolerated with no serious side effects noted. Self-reported compliance was >70%. Both cases demonstrated reduced fatigue, sleep disturbance and insomnia symptoms during the treatment lighting intervention. Case 2 additionally showed reductions in daytime sleepiness and depressive symptoms. As expected, symptoms trended toward baseline levels during the control condition.Discussion: Treatment was positively received and compliance rates were high, with no problematic side-effects. Participants expressed interest in continuing the ambient light therapy in their daily lives.Conclusions: These cases studies demonstrate the acceptability and feasibility of implementing a personalized in-home dynamic light treatment for TBI patients, with evidence for efficacy in reducing fatigue and sleep disturbance.Clinical Trial Registration:www.anzctr.org.au, identifier: ACTRN12617000866303.

Abstract 117: Effect Of Home-Based Leg Heat Therapy On Walking Performance In Symptomatic Peripheral Artery Disease: A Pilot Randomized Clinical Trial

Introduction: Few non-invasive therapies currently exist to improve functional performance and restore quality of life in people with lower extremity peripheral artery disease (PAD). We previously demonstrated that supervised leg heat therapy using tube-lined trousers perfused with warm water elicited a clinically meaningful improvement in perceived physical functioning in patients with PAD. Hypothesis: We tested the hypothesis that unsupervised, home-based leg HT is safe and well-tolerated and improves walking performance in patients with symptomatic PAD. Methods: Thirty-four participants with an ankle-brachial index (ABI) values &lt; 0.90 and a history of claudication were randomized into one of two groups: those receiving leg HT (n=18) or those receiving a sham treatment (n=16). Patients in both groups were provided with identical water-circulating trousers and a portable heating pump and were asked to apply the therapy daily (7 days/week, 90 min per session) for 8 consecutive weeks. The pump given to participants in the HT group circulated water at 43°C through the trousers, while in the sham group the pump circulated water at 33°C. The primary study outcome was the change in 6-min walk distance from baseline to 8 weeks. Results: Among the thirty-four patients enrolled in the study, 3 were excluded for failing to comply with study procedures and 1 voluntarily withdrew. One patient in the sham-treated group could not complete the 8-week assessment due to the COVID-19 pandemic. Overall, participants completed 96±4% of the required treatment sessions (Control: 97±4%, HT:96±3%). Further, no serious adverse reactions to treatment were observed. Changes in 6-minute walk distance between baseline and the 8-week follow-up were compared between groups using the Wilcoxon rank sum test, since the data distribution was non-normal. The change in 6-minute walk distance was significantly higher (p=0.029) in the group exposed to HT (n=15; median: 21.3; 25%,75% percentiles: 10.0,42.3) as compared to the control group (n=14; median: -0.91; 25%,75% percentiles: -5.7,14.3). Conclusions: These preliminary results suggest that home-based leg HT for 8 weeks promotes clinically meaningful changes in 6-minute walk distance in patients with symptomatic PAD.

Adherence to Home-Based Swallowing Therapy Using a Mobile System in Head and Neck Cancer Survivors.

Purpose A large knowledge gap related to dysphagia treatment adherence was identified by a recent systematic review: Few existing studies report on adherence, and current adherence tracking relies heavily on patient self-report. This study aimed to report weekly adherence and dysphagia-specific quality of life following home-based swallowing therapy in head and neck cancer (HNC). Method This was a quasi-experimental pretest-posttest design. Patients who were at least 3 months post-HNC treatment were enrolled in swallowing therapy using a mobile health (mHealth) swallowing system equipped with surface electromyography (sEMG) biofeedback. Participants completed a home dysphagia exercise program across 6 weeks, with a target of 72 swallows per day split between three different exercise types. Adherence was calculated as percent trials completed of trials prescribed. The M. D. Anderson Dysphagia Inventory (MDADI) was administered before and after therapy. Results Twenty participants (75% male), with an average age of 61.9 years (SD = 8.5), completed the study. The majority had surgery ± adjuvant (chemo)radiation therapy for oral (10%), oropharyngeal (80%), or other (10%) cancers. Using an intention-to-treat analysis, adherence to the exercise regimen remained high from 84% in Week 1 to 72% in Week 6. Radiation therapy, time since cancer treatment, medical difficulties, and technical difficulties were all found to be predictive of poorer adherence at Week 6. A statistically significant improvement was found for composite, emotional, and physical MDADI subscales. Conclusions When using an mHealth system with sEMG biofeedback, adherence rates to home-based swallowing exercise remained at or above 72% over a 6-week treatment period. Dysphagia-specific quality of life improved following this 6-week treatment program.