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BackgroundMotion sensitivity after vestibular disorders is associated with symptoms of nausea, dizziness, and imbalance in busy environments. Dizziness and imbalance are reported in places such as supermarkets and shopping malls which have unstable visual backgrounds; however, the mechanism of motion sensitivity is poorly understood. ObjectiveThe main aim of this exploratory observational study is to investigate visual fixations and postural sway in response to increasingly complex visual environments in healthy adults and adults with motion sensitivity. MethodsA total of 20 healthy adults and 20 adults with motion sensitivity will be recruited for this study. Visual fixations, postural sway, and body kinematics will be measured with a mobile eye tracker device, force plate, and 3D motion capture system, respectively. Participants will be exposed to experimental tasks requiring visual fixation on letters, projected on a range of backgrounds on a large screen during quiet stance. Descriptive statistics (mean and standard deviation) will be calculated for each of the variables. One-way independent-measures analyses of variance will be performed to investigate the differences between groups for all variables. ResultsData collection was started in May 2019 and was completed by February 2020. It was approved by Health and Disability Ethics Committees, Ministry of Health, New Zealand on November 2, 2018 (Ethics ref: 18/CEN/193). We are currently processing the data and will begin data analysis in July 2020. We expect the results to be available for publication by the end of 2020. The trial was funded by the Neurology Special Interest Group, Physiotherapy New Zealand, and the Eisdell Moore Centre in November 2018. ConclusionsThis study will provide a detailed investigation of visual fixations in response to increasingly complex visual environments. Investigating characteristics of visual fixations in healthy adults and those with motion sensitivity will provide insight into this disabling condition and may inform the development of new intervention strategies which explicitly cater to the needs of this population. Trial RegistrationAustralian New Zealand Clinical Trials Registry, ACTRN12619000254190; https://tinyurl.com/yxbn7nks International Registered Report Identifier (IRRID)PRR1-10.2196/16805

BackgroundAs many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. ObjectiveThis study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. MethodsA multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a “Planned Nudge” to the odds of affected limb movement during the observation period following “No Nudge.” ResultsThe primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P

BackgroundPulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. ObjectiveThe objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. MethodsA mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. ResultsAcross all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. ConclusionsThese formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population.

BackgroundThe number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation.ObjectiveTo investigate whether ACTIV improved physical function compared with usual care.MethodsThis 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants' homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control.ResultsA total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P = .07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P = .04). Improvements in physical function were not maintained at the 12-month follow-up.ConclusionsACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.