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Hassett L1,2, van den Berg M3, Lindley R4, Crotty M3, McCluskey A2,5, van der Ploeg H1,6, Smith S7, Schurr K5, Sherrington C1, Amount Research Team -1
1The University of Sydney, School of Public Health, Faculty of Medicine & Health, Sydney, Australia, 2The University of Sydney, Faculty of Health Sciences, Sydney, Australia, 3Flinders University, Adelaide, Australia, 4The University of Sydney, Faculty of Medicine & Health, Sydney, Australia, 5The StrokeEd Collaboration, Sydney, Australia, 6Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands, 7Southern Cross University, Coffs Harbour, Australia
Background: The need for rehabilitation is growing although there are limited resources to meet this demand. Digitally-enabled rehabilitation may be an affordable way to deliver rehabilitation and lead to better outcomes; however this has not been tested in large pragmatic trials.
Purpose: The primary aim of the Activity and MObility UsiNg Technology (AMOUNT) trial was to test the effectiveness of tailored prescription of affordable devices to improve mobility and physical activity in addition to usual care in people with mobility limitations undertaking aged care and neurological rehabilitation in comparison to usual care alone.
Methods: AMOUNT was a pragmatic, assessor-blinded, parallel-group randomised trial. In addition to usual care, the intervention group used devices including virtual reality videogames, activity monitors and handheld computer devices for 6 months. A physiotherapist prescribed these devices using a protocol which matched games/exercises from the devices to target specific mobility limitations and increase physical activity. Participants were supervised using the devices in the inpatient setting, taught to use the devices and were then discharged home to use the devices ≥ 5 days a week for the remainder of the trial. A physiotherapist supported post-hospital use using a health coaching approach via phone, email, videoconference and limited home-visits. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. Linear models assessed the effect of group allocation with baseline scores entered as covariates.
Results: Three hundred participants were recruited (mean age 74, SD 14; 50% female; 54% neurological condition causing activity limitation). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting use of 2 (SD 1) devices post-hospital discharge. All available devices were used and six of the devices were used across care settings. Mobility improved significantly in the intervention group compared to the control group from baseline to 6 months (mean between-group difference 0.2 points; 95% CI 0.1 to 0.3; p= 0.006), however upright time was similar between groups at 6 months (mean between-group difference -0.2, 95%CI -2.7 to 2.3; p=0.87). Secondary outcomes of mobility also favoured the intervention group as did other aspects of physical activity (e.g. self-reported physical activity), particularly for younger participants. Overall, participants in the intervention group rated usability of devices above average and rated enjoyment as high at all timepoints.
Conclusion(s): The AMOUNT intervention resulted in significant and clinically important improvements in mobility and self-reported time spent walking that were not accompanied by significant changes in upright time.
Implications: Our findings suggest that digitally-enabled rehabilitation, supported by physiotherapists, is feasible, acceptable and can improve mobility outcomes. The success of the intervention in improving mobility is likely due to personalisation of the intervention focused on the quality and quantity of practise.
Keywords: rehabilitation, technology, mobility
Funding acknowledgements: This work was supported by an Australian National Health and Medical Research Council Project Grant (APP1063751)
Purpose: The primary aim of the Activity and MObility UsiNg Technology (AMOUNT) trial was to test the effectiveness of tailored prescription of affordable devices to improve mobility and physical activity in addition to usual care in people with mobility limitations undertaking aged care and neurological rehabilitation in comparison to usual care alone.
Methods: AMOUNT was a pragmatic, assessor-blinded, parallel-group randomised trial. In addition to usual care, the intervention group used devices including virtual reality videogames, activity monitors and handheld computer devices for 6 months. A physiotherapist prescribed these devices using a protocol which matched games/exercises from the devices to target specific mobility limitations and increase physical activity. Participants were supervised using the devices in the inpatient setting, taught to use the devices and were then discharged home to use the devices ≥ 5 days a week for the remainder of the trial. A physiotherapist supported post-hospital use using a health coaching approach via phone, email, videoconference and limited home-visits. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. Linear models assessed the effect of group allocation with baseline scores entered as covariates.
Results: Three hundred participants were recruited (mean age 74, SD 14; 50% female; 54% neurological condition causing activity limitation). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting use of 2 (SD 1) devices post-hospital discharge. All available devices were used and six of the devices were used across care settings. Mobility improved significantly in the intervention group compared to the control group from baseline to 6 months (mean between-group difference 0.2 points; 95% CI 0.1 to 0.3; p= 0.006), however upright time was similar between groups at 6 months (mean between-group difference -0.2, 95%CI -2.7 to 2.3; p=0.87). Secondary outcomes of mobility also favoured the intervention group as did other aspects of physical activity (e.g. self-reported physical activity), particularly for younger participants. Overall, participants in the intervention group rated usability of devices above average and rated enjoyment as high at all timepoints.
Conclusion(s): The AMOUNT intervention resulted in significant and clinically important improvements in mobility and self-reported time spent walking that were not accompanied by significant changes in upright time.
Implications: Our findings suggest that digitally-enabled rehabilitation, supported by physiotherapists, is feasible, acceptable and can improve mobility outcomes. The success of the intervention in improving mobility is likely due to personalisation of the intervention focused on the quality and quantity of practise.
Keywords: rehabilitation, technology, mobility
Funding acknowledgements: This work was supported by an Australian National Health and Medical Research Council Project Grant (APP1063751)
Topic: Disability & rehabilitation; Robotics & technology; Neurology
Ethics approval required: Yes
Institution: SAHS & SWSLHD
Ethics committee: SAC HREC & SWSLHD HREC
Ethics number: 529.13 & HREC/13/SAC/359
All authors, affiliations and abstracts have been published as submitted.
