Original article
Patients' perspective and usability of innovation technology in a new rehabilitation pathway: An exploratory study in patients with multiple sclerosis

https://doi.org/10.1016/j.msard.2020.102312Get rights and content

Highlights

  • Technological innovations may offer a valuable way to improve neurorehabilitation outcomes.

  • Patients with MS lack of dedicated neurorehab pathways.

  • Robotic and VR devices usability is high, according to patients with MS.

  • Our innovative path may improve functional outcomes in MS.

  • Nurses may have a pivotal role in managing patients with MS through innovation technology.

Abstract

Introduction: Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system, which causes sensori-motor and cognitive disabilities, as well as neuropsychiatric abnormalities. Technological innovations could offer a valuable way to improve neurorehabilitation outcomes. Aim of the study is to assess the feasibility and usability of new rehabilitation technologies as perceived by patients suffering from MS. Materials and Methods: MS inpatients attending the Robotic and Behavioral Neurorehabilitation Service of the IRCCS Centro Neurolesi Bonino Pulejo (Messina, Italy) from February 2017 to April 2019, were enrolled in this exploratory study. The patients were submitted to a personalized rehabilitation treatment using robotics (such as Lokomat, Geosystem, Ekso, Armeo) and virtual reality (i.e. BTS-Nirvana, CAREN, VRRS), following a dedicated innovative pathway. Results: All patients completed the study. Significant pre-post-treatment differences were found in the perception of patients' quality of life, regarding both physical and mental items (p<0,001), as well as in the achievement of the therapeutic goal. Finally, we observed that patients declared a high usability of the robotic devices, and that rehabilitation with the new devices was well tolerated. Conclusions: our results support the idea that neurorehabilitation using innovation technologies can be useful for the commitment and motivation during the rehabilitation process, with possible positive effects on the functional and psychological outcomes of patients with MS.

Introduction

Multiple sclerosis (MS) is an inflammatory neurodegenerative disease with autoimmune demyelinating lesions of the central nervous system, involving the white matter of the cerebral hemispheres, brainstem, cerebellum, spinal cord, and optic nerves. The onset of MS depends on certain factors, such as environment and ethnicity, exposure to infectious agents, and genetic predisposition [Ghasemi et al., 2017; Katz Sand, 2015]. The disease prevalence varies from 15 to 250/100,000 inhabitants, and can occur at any age, even if it is diagnosed mainly between 20 and 40 years. Women are more often affected than men. It is estimated that two million people worldwide suffer from MS, which is therefore one of the most common causes of neurological disability in young adults. Clinically, MS becomes chronic and progressively worsen over time, leading to cumulative motor disability (i.e., weakness, spasticity, and tremor), sensory disturbances (i.e., numbness, pain), visual dysfunctions (i.e., diplopia and optic neuritis), sphincter dysfunction, cognitive deficits (i.e., mainly in attention, procession speed, memory and learning), as well as neuropsychiatric and behavioral symptoms [Katz Sand, 2015; Milo and Miller, 2014]. The main MS therapies, including drugs (immunosuppressants, immunomodulators, corticosteroids), conventional physiotherapy (stretching and aquatic exercises, manually assisted) and cognitive rehabilitation, are aimed to slow down the course of the disease and manage the symptoms.

In recent years, it has been shown that technological innovations, such as robotics, computerized cognitive training, and virtual reality (VR), alone or combined, can offer a cost-effective way to improve the neurorehabilitation outcomes [Burridge and Hughes, 2010; Calabrò et al., 2016; Maggio et al., 2018a; De Luca et al., 2018; Maresca et al., 2018]. In fact, some studies have highlighted that intense and repetitive training in a personalized interactive context leads to promising results regarding functional recovery in patients with various neurological diseases, including MS [Calabrò et al., 2017a; Maggio et al., 2019a, b, c]. In particular, patients obtain improvements in motor/cognitive outcomes, with a positive perception of their own performance, as compared to traditional trainings [Maggio et al., 2019d; Holden, 2005; Bryanton et al., 2006; Novak and Riener, 2013]. In fact, the new technologies allow the patient to better perceive both his/her goals, as well as physical and mental well-being, through the augmented feedback that helps the patients to develop the knowledge of results and knowledge of the quality of the movements (i.e. knowledge of the performance) [Maggio et al., 2019e; Maggio et al., 2018b]. Thus, innovation technology could let the patients take responsibility for their own rehabilitation and increase the compliance with long-term care. However, the tools are not yet widespread due to the lack of research involving the usability and feasibility of new technologies, besides the relatively high costs of some devices [Burridge and Hughes, 2010]. For this reason, the aim of this exploratory study is to evaluate the usability and feasibility of the new rehabilitation technologies as perceived by MS patients.

Section snippets

Study design and population

MS inpatients attending the Robotic and Behavioral Neurorehabilitation Service of the IRCCS Centro Neurolesi Bonino-Pulejo (Messina, Italy) from February 2017 to April 2019, were enrolled in this exploratory study. Initially, we included 90 patients who met the study criteria: six of these (4.4%) were excluded because they did not complete the rehabilitation program, probably due to the fatigue experienced during the rehabilitation sessions with the robotic devices.

The final sample consisted of

Results

All patients completed the study without any significant side effect. The results of the Wilcoxon's tests showed statistically significant differences in all the domains we evaluated (Table 3). Indeed, significant pre-post-treatment differences were found in the perception of patients' quality of life, concerning both physical (MSQOL Phys: p <0.001) and mental items (MSQOL Ment: p < 0.001), as well as in the perception of the achievement of the therapeutic goal. In particular, we observed that

Discussion

To the best of our knowledge, this is the first study that evaluates the role of a novel rehabilitation path using multiple innovative devices within a patient-centered perspective. Indeed, thanks to the use of the GAS, the achievement of the rehabilitation outcomes were agreed with the patients, who, at the end of their training, also evaluated the usability of the devices. In particular, we found that patients with MS had a good usability of the robotic and/or VR devices (SUS mean ± SD: 82.83

Declaration of Competing Interest

The authors state neither conflicts of interest nor financial support.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent

Informed consent was obtained from all parties involved in the research for participation in the study and publication of the results.

CRediT authorship contribution statement

Alfredo Manuli: Conceptualization, Methodology, Writing - original draft. Maria Grazia Maggio: Conceptualization, Methodology, Writing - original draft. Daniele Tripoli: Conceptualization, Writing - review & editing. Martina Gullì: Writing - original draft. Antonino Cannavò: Formal analysis, Investigation. Gianluca La Rosa: Writing - review & editing. Francesca Sciarrone: Writing - review & editing. Giuseppe Avena: Formal analysis, Investigation. Rocco Salvatore Calabrò: Methodology,

Aknowledgement

The authors wish to thank Prof Andrea Longo for English editing

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