Telerehabilitation System Research Articles

Effectiveness of In-Home, Augmented Reality-Based Telerehabilitation After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

New digital technology-based rehabilitation may be a viable option for patients after anterior cruciate ligament reconstruction (ACLR), with advantages such as easy access to treatment and learning as well as cost-effectiveness. To investigate the effects of an augmented reality (AR)-based, telerehabilitation system in patients after ACLR compared with a brochure-based rehabilitation program in terms of patient-reported outcomes and functional performance measures. Randomized controlled trial; Level of evidence, 2. This was a multicenter, assessor-blinded study. Enrolled participants were allocated randomly to either the intervention group, who underwent AR-based telerehabilitation system, or to the control group, who underwent a brochure-based rehabilitation program with a self-log. Both groups performed the same postoperative rehabilitation exercise protocol. Subjective knee function was assessed using the International Knee Documentation Committee (IKDC) as the primary outcome; secondary outcomes were a numeric rating scale for pain, the EuroQol 5-Dimension 5-Level, isometric knee strength, range of motion, and the single-leg hop test. The intervention group also completed a satisfaction survey. Follow-up was conducted at 2, 6, 12, and 24 weeks postoperatively. A total of 28 patients were enrolled in each group; 1 patient in the control group was lost to follow-up. Patients in both groups demonstrated improvement on all outcomes over time. There were no significant between-group differences in the IKDC score from baseline to 12 weeks postoperatively. The intervention group saw a greater increase in the relative isometric strength of the quadriceps on the involved limb at 6, 12, and 24 weeks postoperatively (P < .05 for all). No significant group differences were observed in the remaining secondary outcomes. Study findings indicated that patients who underwent AR-based telerehabilitation in the early rehabilitation phase after ACLR demonstrated similar improvements as those who followed a brochure-based rehabilitation program and had a quicker recovery of knee extensor strength. NCT04513327 (ClinicalTrials.gov identifier).

Feasibility and acceptability of the HOLObalance telerehabilitation system compared with standard care for older adults at risk of falls: the HOLOBalance assessor blinded pilot randomised controlled study.

Falls have high socioeconomic costs. Information and communication technologies may support provision and monitoring of multisensory (MSR) physiotherapy programmes. The HOLOBalance platform used augmented reality holograms to provide patient-centred, individualised MSR. To determine the platform's safety, acceptability and feasibility, investigate functional gait and dynamic balance benefits and provide data for a definitive trial. Single-blinded pilot randomised controlled feasibility study. Interventions were conducted at clinical sites or participants' homes in three European countries. Community-dwelling older adults (median age 73years; 64.2% female) at risk of falls were enrolled (May 2020-August 2021). Participants were randomised to an 8-week clinic or home-based telerehabilitation MSR or OTAGO (control group) programme. Compliance, satisfaction, and adverse events determined feasibility. Clinical outcomes, assessed (blinded) within one-week prior to and post-intervention, included functional gait assessment (FGA), Mini BESTest and cognitive function. Randomisation to completion rate was 76.15% with 109 participants recruited (n = 289 screened). Drop-out rate was similar between groups. Adverse events were reported (n = 3) in the control group. Sixty-nine percent would recommend the HOLOBalance intervention. Findings were similar for the home and clinic-based arms of each intervention; data was combined for analysis. FGA (95%CI [1.63, 4.19]) and Mini-BESTest (95%CI [1.46, 3.93]) showed greater improvement in the HOLOBalance group with a clinically meaningful change of 4/30 noted for the FGA. HOLObalance was feasible to implement and acceptable to older adults at risk of falls, with FGA and Mini-BEST improvements exceeding those for the OTAGO programme. A definitive trial is warranted.

Identifying data elements and key features to design a telerehabilitation system for speech and language disorders in children with hearing impairments in Iran: A cross-sectional study.

Designing and implementing telerehabilitation systems would require the identification of data elements to meet disabled people's needs. An in-depth study on the identification and validation of data elements can help design and implement telerehabilitation systems successfully. Therefore, this study aimed to identify and validate data elements to design a telerehabilitation system for the speech and language disorders of hearing-impaired children in Iran. This descriptive cross-sectional study was conducted in three steps including literature review, focused group discussion, and Delphi technique implementation to extract and validate data elements. In the first step, the literature on electronic databases was reviewed to extract the data elements of telerehabilitation systems, and nine studies were selected based on the inclusion criteria. In the second step, a focused group discussion was held to review and classify the extracted data elements. Finally, the Delphi technique was employed to validate the drafted data elements. In total, 352 data elements were extracted from the literature review. Finally, 102 data elements in 10 categories (Demographic and Clinical information of the disabled person, Clinical history, Demographic information of the provider, Customization of exercises, Reminders, Online and offline counseling, and training, Reporting, Key features of the system, Evaluation of the progress of the disabled person) were classified and validated by experts as essential data elements to design a telerehabilitation system for the speech and language disorders of hearing-impaired children. The necessary data elements were proposed as the foundations to design a telerehabilitation system for the speech and language disorders of hearing-impaired children. These data elements help design and implement telerehabilitation systems successfully so that such systems can easily be provided for children with hearing disabilities.

Theoretical Aspects of Transdisciplinarity in Telerehabilitation

This article explores the theoretical aspects of transdisciplinary research, with a specific focus on its application to telerehabilitation. The integration of multiple disciplines – ranging from medicine, digital health, and informatics to engineering and the social sciences – is increasingly necessary to address the complex challenges of delivering effective remote rehabilitation services. The article begins by outlining the conceptual framework, distinguishing between disciplinary, interdisciplinary, multidisciplinary, and transdisciplinary approaches, and highlighting the importance of transcending traditional disciplinary boundaries. The theoretical foundations discussed provide a basis for understanding how the convergence of diverse fields can lead to innovative solutions in telerehabilitation. The integration of disciplines is examined in detail, illustrating how collaborative efforts across medicine, technology, and behavioral sciences can enhance patient outcomes, improve accessibility, and foster the development of personalized rehabilitation plans. The article also covers the practical implications for clinical practice, emphasizing the need for a more collaborative model of care delivery and the potential for cost-effective, scalable solutions. Looking toward the future, the article identifies key areas for research, including the development of advanced technologies, exploration of new therapeutic modalities, and consideration of ethical and social impacts. The need for standardization and interoperability in telerehabilitation systems is also underscored, as these will be critical to ensuring the seamless integration of various technologies and platforms.

EvolvRehab–MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study

IntroductionStroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb...

Lessons learned from investigating patients’ and physiotherapists’ perspectives on the design of a telerehabilitation platform

Purpose Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient’s and physiotherapist’s perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. Methods The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. Results Patients’ and physiotherapists’ perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients’ home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. Conclusions Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

Towards a Patient-Centered Design of a Cancer Telerehabilitation System.

Successful implementation of telehealth platforms requires a detailed understanding of patient's needs, preferences, and attitudes toward a home-based platform. The goal of this study was to identify patient-centered characteristics of a cancer rehabilitation system based on cognitive evaluation of user interface and semi-structured qualitative interviews. Quantitative and qualitative feedback from 29 patients with metastatic urogenital cancer was collected after using a cancer telerehabilitation system. Heuristic evaluation, cognitive walkthrough, and analysis of qualitative interviews demonstrated a high level of support for the concept of home-based cancer telerehabilitation by cancer patients. Post-task surveys demonstrated sufficient usability and satisfaction scores from the participants. The patients provided valuable and insightful comments on how to further improve the functionality and interface of the platform. Further improvement of the system usability, consistency, and accessibility based on the patient-centered design principles will significantly facilitate the implementation of cancer telerehabilitation in clinical practice.

Configuration of a telerehabilitation system to deliver a comprehensive aphasia therapy program via telerehabilitation (TeleCHAT): A human-centred design approach

ABSTRACT The delivery of Intensive Comprehensive Aphasia Programs (ICAPs) via telerehabilitation is a potential solution to the ongoing geographical, transport, and mobility barriers that people with aphasia (PWA) face in accessing this service model. To ensure the ICAP retains its evidence-based elements, configuration of the telerehabilitation system requires consideration of user and therapy task requirements. The human-centred design (HCD) process incorporates user and task considerations when developing technological systems. Therefore, the aim of this study was to use the HCD process to translate the Comprehensive High-dose Aphasia Therapy (CHAT) program for delivery via telerehabilitation (TeleCHAT). Methods The HCD translation process used consisted of five iterative stages. Relevant literature was reviewed, and speech-language pathologists (SLPs) experienced in delivering ICAPs were consulted to understand the therapy context. Researchers gathered therapy task and user requirements of PWA, support people (SP) and SLPs to engage in therapy. Technology that met user and therapy task requirements were identified and a preliminary technology configuration was tested in a simulated environment. The finalised system was tested in a pilot trial of TeleCHAT with a cohort of four PWA, two SPs, and two SLPs. Feedback and technical and user issues were collated from users and analysed to inform improvements to the TeleCHAT configuration and protocol. Results User and therapy task requirements to deliver TeleCHAT were identified with consideration of communication and participation supports for PWA. The configured technology system comprised of Zoom© as the videoconferencing platform of choice, and additional critical technical functions including screen and audio sharing of therapy content, and multi-point interaction using remote control and annotation tools. Simulation testing and a pilot trial of the configuration confirmed system operability and identified modifications to optimise functioning. Conclusion The HCD framework was used to successfully configure an optimal technology system for the delivery of TeleCHAT. The HCD framework can be used by clinicians to identify patient needs and configure optimal telerehabilitation systems for delivery of complex interventions.

Significant Cost Savings and Improved Early Clinical Outcomes in Medicare Patients Utilizing a Clinician-Controlled Telerehabilitation System Following Total Knee Arthroplasty

BackgroundThe costs and benefits of different rehabilitation protocols following total knee arthroplasty are unclear. The emergence of telerehabilitation has introduced the potential for enhanced patient convenience and cost reduction. The purpose of this study was to assess the cost difference between standard physical therapy (SPT) and a telerehabilitation home-based clinician-controlled therapy system (HCTS). MethodsA prospectively enrolled, consecutive series of 109 Medicare patients who received SPT were compared to 101 Medicare patients who were treated with a HCTS. The analysis focused on total rehabilitation costs and the assessment of outcome measures: knee range of motion, visual analog scale pain levels, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement. ResultsThe HCTS group demonstrated not only statistically significantly lower average costs but also faster and sustained knee range of motion improvements. Furthermore, in comparison to SPT, the HCTS group exhibited superior visual analog scale pain scores and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement functional scores at all assessment points postoperatively, which were statistically significant (all P < .001) and surpassed the minimal clinically important difference thresholds. ConclusionsThe HCTS used in this study exhibited a remarkable cost-saving advantage of $2,460 per patient compared to standard therapy. As approximately 500,000 primary total knee arthroplasties in the United States are covered by Medicare annually, a switch to HCTS could yield total cost savings of more than $1.23 billion per year for our taxpayer-funded health care system. Furthermore, the HCTS cohort demonstrated superior functional outcomes and improved pain scores across all assessment time points, exceeding the minimal clinically important difference.

Assessing Patient Perspectives on Pulmonary Telerehabilitation Using Thematic Analysis of Semi-Structured Qualitative Interviews.

The study was aimed at exploring patients' experiences after the completion of a 12-month pulmonary telerehabilitation (PR) program. Semi-structured qualitative interviews were conducted with 16 COPD patients. The interviews were analyzed using a thematic approach to identify patterns and themes. The patients exhibited high acceptability and satisfaction with the remote PR program and provided valuable input for its improvement. These insights will be used for the implementation of a patient-centered COPD telerehabilitation system.

'Smart reminder': A feasibility pilot study on the effects of a wearable device treatment on the hemiplegic upper limb in persons with stroke.

Emerging literature suggests that wearable devices offer a promising option for self-directed home-based upper limb training for persons with stroke. However, little research is available to explore integrating smartphone applications with wearable devices to provide upper limb telerehabilitation to stroke survivors at home. This study examined the feasibility and potential therapeutic effects of a wearable device integrated with a smartphone-based telerehabilitation system to provide upper limb rehabilitation to stroke survivors at home. Twelve stroke survivors from community support groups participated in a treatment consisting of 4-week telerehabilitation using a wearable device and 4-week conventional therapy successively in a single-blind, randomised crossover study. A 3-week washout period was administered between the two 4-week treatments. The primary outcome measures were the Fugl Meyer Assessment, the Action Research Arm Test, and the active range of motion (ROM) of the upper limb. Secondary outcome measures included the Motor Activity Log and exercise adherence. Results showed that the active ROM of participants' hemiplegic shoulder improved more significantly after 4 weeks of telerehabilitation with the wearable device than with conventional therapy. No significant differences were found in other outcome measures. A 4-week telerehabilitation programme using a wearable device improves the hemiplegic upper limb in community-dwelling stroke survivors and may be feasible as an effective intervention for self-directed upper limb rehabilitation at home.

Technological advances in lower-limb tele-rehabilitation: A review of literature.

Tele-rehabilitation is a healthcare practice that leverages technology to provide rehabilitation services remotely to individuals in their own homes or other locations. With advancements in remote monitoring and Artificial Intelligence, automatic tele-rehabilitation systems that can measure joint angles, recognize exercises, and provide feedback based on movement analysis are being developed. Such platforms can offer valuable information to clinicians for improved care planning. However, with various methods and sensors being used, understanding their pros, cons, and performance is important. This paper reviews and compares the performance of recent vision-based, wearable, and pressure-sensing technologies used in lower limb tele-rehabilitation systems over the past 10years (from 2014 to 2023). We selected studies that were published in English and focused on joint angle estimation, activity recognition, and exercise assessment. Vision-based approaches were the most common, accounting for 42% of studies. Wearable technology followed at approximately 37%, and pressure-sensing technology appeared in 21% of studies. Identified gaps include a lack of uniformity in reported performance metrics and evaluation methods, a need for cross-subject validation, inadequate testing with patients and older adults, restricted sets of exercises evaluated, and a scarcity of comprehensive datasets on lower limb exercises, especially those involving movements while lying down.

Usability of a telerehabilitation program for patients with musculoskeletal or oncological diseases: A mixed-methods evaluation / Benutzerfreundlichkeit eines Telerehabilitations-Programmes für Patient*innen mit muskuloskelettalen oder onkologischen Erkrankungen: Eine Mixed-Methods Evaluation

Abstract Purpose Telerehabilitation may stabilize the results of a previous phase 2 rehabilitation program through remote rehabilitation sessions. We evaluated a new telerehabilitation service (PV RehaTRAIN®) during its initial implementation, focusing on its usability both from the perspective of patients with musculoskeletal or oncological diseases and the interdisciplinary treatment team. Methods The evaluation followed a convergent mixed-methods design. After separate qualitative and quantitative analyses of the multi-perspective findings from interviews, focus groups and questionnaires, we interpreted the results collectively and equally. Results Overall, the results indicate high acceptance of and satisfaction with the new telerehabilitation service, especially from the patients’ perspective and regarding educational and individual counselling sessions. However, the treatment team identified a need for further didactic training to enable them to realize their full professional potential in a telerehabilitation setting. Conclusion The new telerehabilitation service PV RehaTRAIN® may bridge gaps in health care for patients who do not have access to conventional phase 3 rehabilitation infrastructure or prefer remote services that are readily integrated into their everyday lives. Members of the interdisciplinary treatment team offering telerehabilitation for the first time need adequate technical and especially setting-specific didactic training. Increased participation of treatment teams when refining telerehabilitation systems may minimize problems in early implementation phases and contribute to the quality of care.

Telerehabilitation use and experiences in occupational and physical therapy through the early stages of the COVID-19 pandemic.

Telehealth has helped to increase access to rehabilitative services such as occupational and physical therapy. The early COVID-19 pandemic amplified the need for remote access to care, and the rapid implementation of telehealth systems provided a unique opportunity to learn from clinicians' experiences adopting telehealth for telerehabilitation applications. To understand these experiences, a self-administered online survey was conducted to capture perspectives on ease of telerehabilitation use and adoption from occupational and physical therapists. The survey captured retrospective views on telerehabilitation use pre-pandemic as well as real-time perspectives on telerehabilitation during the early stages of the pandemic (July to August 2020). The survey gathered information on clinician demographics (N = 109), clinicians' experiences with adopting or utilizing telerehabilitation systems, and their perceptions on remotely performing cognitive, emotional, and physical assessments via video-conferencing (a common mode of telehealth). Responses demonstrated a modest increase in telerehabilitation as a care setting (rate increase from 3.4% to 19.3%), and telerehabilitation was more generally tried during the early stages of the pandemic (41 clinicians explicitly reported telerehabilitation use). However, technology access and acceptance remained low, with 38 clinicians (35%) expressing concerns that technology was ineffective or impractical, unavailable, not covered by insurance, or not desired by their patients. Video-conferencing technology was perceived as generally ill-equipped to support clinicians in performing remote assessment tasks. Physical assessment tasks were considered particularly difficult, with 55% of clinicians rating their ability to perform these tasks in the range of moderately difficult to unable to perform. To address these difficulties and better augment clinical care, clinicians require more robust assessment methods that may combine video, mobile, and wearable technologies that would be accessible to a patient at home. When designing future telerehabilitation tools, information captured through these modes must be task-relevant, standardized, and understandable to a remote clinician.

Proposal of a game streaming based framework for a telerehabilitation system

Proposal of a game streaming based framework for a telerehabilitation system

Utilizing the intelligence edge framework for robotic upper limb rehabilitation in home

Robotic devices are gaining popularity for the physical rehabilitation of stroke survivors. Transition of these robotic systems from research labs to the clinical setting has been successful, however, providing robot-assisted rehabilitation in home settings remains to be achieved. In addition to ensure safety to the users, other important issues that need to be addressed are the real time monitoring of the installed instruments, remote supervision by a therapist, optimal data transmission and processing. The goal of this paper is to advance the current state of robot-assisted in-home rehabilitation. A state-of-the-art approach to implement a novel paradigm for home-based training of stroke survivors in the context of an upper limb rehabilitation robot system is presented in this paper. First, a cost effective and easy-to-wear upper limb robotic orthosis for home settings is introduced. Then, a framework of the internet of robotics things (IoRT) is discussed together with its implementation. Experimental results are included from a proof-of-concept study demonstrating that the means of absolute errors in predicting wrist, elbow and shoulder angles are 0.89180,2.67530 and 8.02580, respectively. These experimental results demonstrate the feasibility of a safe home-based training paradigm for stroke survivors. The proposed framework will help overcome the technological barriers, being relevant for IT experts in health-related domains and pave the way to setting up a telerehabilitation system increasing implementation of home-based robotic rehabilitation. The proposed novel framework includes:•A low-cost and easy to wear upper limb robotic orthosis which is suitable for use at home.•A paradigm of IoRT which is used in conjunction with the robotic orthosis for home-based rehabilitation.•A machine learning-based protocol which combines and analyse the data from robot sensors for efficient and quick decision making.

IoT framework of telerehabilitation system with wearable sensors for diabetes mellitus patients

Physical activity is commonly used as a treatment for diabetes patients, although its effectiveness in improving cognitive functions such as learning, thinking, remembering, and decision making is not clear. Regular exercise can gradually improve metabolic abnormalities associated with pre-diabetes and assist patients with type-2 diabetes (T2D) in managing their pharmacological treatment. The usage of mobile health (mHealth) as a tool to help diabetes patients with their diabetes self-management have been demonstrated in previous studies and it can lead to reductions in glycosylated hemoglobin (HbA1c) levels. Heart rate readings during physical activity is beneficial for healthcare professionals (HCP) to ensure appropriate intensity levels for their patients is achieved. Additionally, the list of the tailored physical activities is long, and it is quite challenging for the T2D patients to remember. Therefore, Tele-DM is proposed, consisting of a smartwatch and mobile application that enable remote physiotherapy sessions for T2D patients. The smartwatch transfers the heart rate data to Tele-DM through Google Fit database. The system provides tailored exercise programs to help patients reduce their weight and HbA1c levels. With the ability to facilitate two-way communication between HCP and T2D patients, the Tele-DM system is designed to enable an effective remote rehabilitation process.

Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study.

Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identified as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals.

Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub® platform

Purpose After a total knee arthroplasty (TKA), ensuring rehabilitation is continued at home is essential for a successful recovery. The aim of this randomized clinical trial (NCT04155957) was to demonstrate the safety and efficacy of an interactive telerehabilitation system (ReHub®) to guide and provide feedback during exercise in the postoperative period of a fast-track TKA program. Methods Fifty-two patients who underwent TKA were randomized to intervention (N = 26) or control (N = 26). Upon discharge, they followed a 4-week plan of 5 daily exercises and up to 10 physiotherapy home visits. The intervention group performed exercises with ReHub® autonomously, control did not use any auxiliary device. Data were collected 1) on the day of discharge, 2) after 2 weeks and 3) after 4 weeks. Results Telerehabilitation patients showed higher adherence to exercise (p = 0.002) and greater quadriceps strength (p = 0.028). No significant differences between groups were found in other outcomes. Only 1 adverse event was linked to ReHub®. Patients gave the platform high System Usability Scale scores (83/100). Conclusion Interactive telerehabilitation with ReHub® during a post-TKA exercise program is effective, safe, and well-received by patients. It provides real-time performance feedback and ensures communication. Quadriceps strength and adherence to the exercise plan are improved with ReHub®.

Formal verification of a telerehabilitation system through an abstraction and refinement approach using Uppaal

AbstractFormal methods are proven techniques that provide a rigorous mathematical basis to software development. In particular, they allow the quality of development to be effectively improved by making accurate and explicit modelling, so that anomalies like ambiguities and incompleteness are identified in the early phases of the software development process. Semi‐formal UML models and formal Timed Automata models are used to design a telerehabilitation system through a practical approach based on abstraction and refinement. The formal verification of expected properties of the system is performed by the Uppaal tool. The motivation of this work is threefold: (i) showing the usefulness of formal methods to satisfy the validation needs of a medical telerehabilitation system; (ii) demonstrating our approach of system analysis through refinements to guide the development of a complex system; and (iii) highlighting, from a real‐life experience, the usefulness of models to involve the stakeholders all along the design of a system, from requirements to detailed specifications.