Suero Pineda A1, Blanquero Villar J2, Rodríguez Sánchez-Laulhé P1, García Frasquet MDlÁ3, Díaz Nieto de los Bernardos MI3, Rodrigues-Piñero Duran M4
1FISEVI, Seville, Spain, 2University of Seville, Physiotherapy Department, Seville, Spain, 3Hospital Universitario Virgen Macarena, Hand Surgery Department, Seville, Spain, 4Hospital Universitario Virgen Macarena, Rehabilitation Department, Seville, Spain

Background: Therapeutic exercise is one of the fundamental approaches in physiotherapy treatment. In hand, wrist and fingers rehabilitation, physiotherapy treatment must include an individualized home exercises program (HEP) but to implement effective and efficient HEP is complex, due to the impossibility to monitor patients development and adherence.

Purpose: To develop a digital solution to provide patients with individualized and guided HEP which also implement patient´s development control and adherence control. This solution should be scalable and appropriated for Andalusian Public Health System (APHS).

Methods: We established three phases in order to validate the development by experts and patients to achieve a TRL 6.
Phase 1: expert panel (physiotherapist, hand surgeons and rehabilitators) validated the hypothesis and identified the needs. TRL 1 - 2.
Phase 1.2: a team of three engineers developed the prototype based on expert panel´s report in Ionic Framework, which allows the development of hybrid applications for iOS and Android. TRL 2.
Phase 2: expert panel checked over the prototype, validated it and proposed functionalities to develop the minimum valuable product (MVP). TRL 3-4.
Phase 2.1: the engineers´ team developed the MVP according the conclusions obtained in phase 2. TRL 4.
Phase 3: expert panel´s physiotherapists fulfilled a proof of concept with patients in Hospital Virgen Macarena and Virgen del Rocío. They gathered patients experience feedback and clinical results to report it to the rest of panel expert and to engineers´ team. TRL 5-6.
Phase 3.1: Rehand final product was developed including a tablet app for patients and a dashboard for therapist. TRL 6.

Results: In phase 1 expert panel validated the need of support for HEP. Consulting scientific literature and their expertise in hand surgery and hand therapy determined that application format suits appropriately. Currently scientific literature supports the potential of apps for hand therapy, especially for therapeutic intervention to improve neuromuscular control and proprioceptive sense. They dismissed hardware format because of cost-effectivity factors in the development of the device and its use by the vast amount of patients in APHS. In phase 2 expert panel reviewed most important hand functionalities and sensorimotor approach to determine functionalities and exercises that must be included. Finally, in phase 3 results were leaded by patients and therapist. Patient´s experience point out usability needs. Seven inches tablet screen was select as the minimum size required by patients and therapist. Therapist indicated the need of a web dashboard to control patient´s development and adherence.

Conclusion(s): ReHand achieved TRL 6 and the result was an innovative and scalable digital solution for physiotherapists to put into to clinical practice individualized and controlled home exercise programs. The next steps aim to increase TRL and implement it in physiotherapy diary clinical practice in Andalusian Public Health System Hospitals. Currently, ReHand has received founds from APHS to develop a multicenter trial with more than 660 patients.

Implications: ReHand is the frist based evidence tablet application develop to help physiotherapists to implement individualized and controlled home.

Keywords: hand therapy, app, home exercises programs

Funding acknowledgements: Health innovation funds from Andalusian Public Health System.

Topic: Robotics & technology; Musculoskeletal: upper limb; Research methodology & knowledge translation

Ethics approval required: Yes
Institution: Andalusian Public Health System and Junta de Andalucía
Ethics committee: Biomedical Research Ethics Committee of Andalusia
Ethics number: 25852

All authors, affiliations and abstracts have been published as submitted.

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