Home-Based Telerehabilitation Exercise Programs for People Living with a Moderate or Severe Traumatic Brain Injury
Notice bibliographique
Résumé
Background: People who have experienced a moderate or severe traumatic brain injury (TBI) will most likely live with motor and cognitive deficits including balance and poor mobility. These deficits may lead to limitations in activity participation, life satisfaction, and may increase the risk of falls. Improving access to rehabilitation care in the chronic phase of recovery is essential to prevent ongoing health issues. However, geographical restrictions, cost of transportation, or recently the COVID-19 pandemic restrictions may limit access to rehabilitation services. Telerehabilitation could serve as an alternative method to provide rehabilitation care while increasing access. Objectives: The overall objective of this dissertation was to understand the implementation of high-intensity telerehabilitation exercise programs for people living with a moderate or severe TBI and their family partners. This was accomplished by 1) determining the feasibility of using telerehabilitation, 2) investigating the effectiveness of high-intensity home-based telerehabilitation exercise programs on physical activity, functional mobility and dynamic balance, 3) understanding the perspectives and lived experiences of completing a telerehabilitation program, and 4) exploring how interpersonal behaviours can influence practice and be perceived in a telerehabilitation setting. Methodology: Influenced by a people-centered approach and explained by the Self-Determination Theory, this dissertation followed a mixed-method alternating single-subject design methodology. Five dyads composed of five persons living with a moderate or severe TBI and their family partners completed two high-intensity telerehabilitation programs remotely supervised, daily and weekly. The feasibility and effectiveness of the telerehabilitation programs were measured from a quantitative and qualitative perspective to replicate the clinical realities and understand all perspectives. Results: In this dissertation, the feasibility of using telerehabilitation with this population was highlighted by reporting high adherence, high usability, active engagement and safety. The effectiveness on physical activity levels, functional mobility, dynamic balance and concerns with falling was also demonstrated with no differences between the daily and weekly remote supervision schedule. The dyads described being highly satisfied, engaged, and enjoyed the remotely supervised exercise programs. The individuals with the TBI perceived more supportive behaviours than thwarting behaviours from the physiotherapist. Conclusion: This dissertation advances knowledge on telerehabilitation implementation for people living with cognitive and motor deficits following a TBI. High-intensity home-based telerehabilitation programs were shown to be feasible and effective. I introduced the importance of assessing needs-supportive and needs-thwarting interpersonal behaviours in the telerehabilitation context. Integrating these novel telerehabilitation concepts within emerging telerehabilitation models of care could significantly impact long-lasting positive health outcomes for individuals living with a moderate or severe TBI.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».