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Digital technology includes the use of computers, mobile phones, computer games or console games, wearable technology or other devices to either support rehabilitation assessments and intervention, provide new types of interventions or to help people help themselves.  Research into digital technology for rehabilitation has to not only consider the technology itself but also how people interact with it and how it links to non-digital aspects of healthcare services. 

Smart phone apps for self-management of rheumatoid arthritis

The management of rheumatoid arthritis (RA) has transformed in recent decades so the inflammatory arthritis is often well controlled with medications used in a treat-to-target strategy. This “T2T” strategy requires measurement of RA disease activity using validated measures and increasing treatment until disease remission or at least a low disease activity state is achieved. Currently the RA activity is determined during clinic visits however these are currently at arbitrary intervals so people are may be seen when they are well and appointments are not always available when people have increased arthritis activity and need medical help. Some data suggest the assessment of RA activity by people with RA correlates fairly well with the assessment of disease activity by health professionals. RTRU academic, Dr Rebecca Grainger, has begun to explore the possibility of the assessment and monitoring of RA being led by the person with the disease rather than the health system. In this new tech world, a phone app seem to be a good option to try. Dr Grainger, in collaboration with her colleagues in RTRU, Hutt Hospital, and the Department of Information Science at University of Otago, first conducted a systematic review of all apps that could enable measurement of RA disease activity by people with RA and for those data to be transmitted to their rheumatology team for monitoring.  They found the 19 potentially useable app, but no apps used all the required validated instruments and allowed for data transmission. 

Next steps in this research has been to involve people with RA and rheumatology health professionals to identify required features and functionality of an app for RA disease activity measurement, along with barriers to uptake and advantages of remote monitoring approach. With this information, Dr Grainger’s team has built an app and currently planning how this may be integrated into clinical practice. In parallel with this with, they have also co-designed with people with RA a training package of videos to teach joint count techniques. This will be evaluated in clinics in Wellington, Christchurch and Dunedin in late 2017. Their goal is to enable people with RA to engage in their health care in ways that works for them while still providing appropriate assessment and oversight.

Tablet apps to support shared-decision making in goal setting for rehabilitation

In collaboration with Dr Kounosuke Tomori (Tokyo University of Technology, Japan) and Professor Kayoko Takahashi (Kitasato University, Japan), Associate Professor William Levack has been working on the development of an English-language version of Dr Tomori's iPad application: The Aid of Decision-making in Occupational Choice (ADOC).  ADOC makes use of images and text to encourage rehabilitation patients to get more involved the goal setting process, and to guide the establishment of goals around the activity and participation domains of the International Classification of Functioning Disability & Health.  ADOC also can be used to score a person's level of satisfaction with their current performance in a goal area, which can be monitored and recorded over time.  While extensively studied in Japan, ADOC required significant modification before it could be used in English-language countries. These modifications have included changes to the text-based content of ADOC (to reflect common activities and social roles in English-language countries) and to the images in ADOC.  Research to date has included an international Delphi-style consensus project to establish the content of the English-language version of ADOC and a small study to check rehabilitation patients' perspectives on what the images in ADOC are supposed to represent (publication pending).  Dr Levack has also been involved in publication of work on a Japanese application for ADOC tailored for people with upper limb impairments.

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