Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 35 appraisals
ACS applied materials & interfaces
A High-Sensitivity MXene Tactile Sensor with Dynamic Point-Contact Networks for a Wearable Healthcare Device
The self-stacking of the MXene material can diminish its interlayer spacing and active surface area, thereby diminishing the sensitivity and response speed of pressure sensors. Here, we introduce a high-performance flexible tactile sensor utilizing a composite of MXene, polystyrene (PS) microspheres, and bacterial cellulose (BC). PS microspheres are integrated within the MXene nanosheet layers to mitigate the self-stacking. By employing an innovative point-to-point conductive network design, the self-aggregation issue of MXene materials is effectively mitigated, leading to the formation of dynamic point-contact structures among PS microspheres. This configuration notably enhances detection sensitivity within the low-pressure range to 568.8 kPa-1 (20-200 Pa). Furthermore, the incorporation of BC enhances the interfacial bonding strength through hydrogen bonding, thereby enhancing sensor stability. The sensor exhibits a rapid response time of 29 ms, a wide detection range of up to 0-50 kPa, a low limit of detection of 2 Pa, and consistent signal stability over 20,000 cycles. It has demonstrated the capability to monitor a broad spectrum of physiological activities, including joint movements, facial microexpressions, and radial pulse. Integration with wireless transmission technology enables remote health monitoring, flexible touch keyboard functionality, and human-computer interaction. Additionally, the electromyography (EMG) skin sensor based on the MXene/PS/BC (MPB) composite film accurately distinguishes muscle movements, gestures, acoustic vibrations, and facial microexpressions by detecting surface EMG signals. This comprehensive approach offers a comprehensive solution for wearable medical devices that combine high sensitivity with practicality.
30 May 2026
Read appraisal →BMJ open
Feasibility and acceptability of therapist-guided, asynchronous, internet-delivered trauma-focused CBT for adolescents with PTSD: a single-group feasibility trial in Sweden
OBJECTIVES: Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12 week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD and to explore preliminary changes in PTSD symptoms. DESIGN: Single-group feasibility trial. SETTING: Save the Children, Sweden. PARTICIPANTS: Twenty-two adolescents (13-17 years, 82% female) with primary PTSD. INTERVENTIONS: A 12 week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent-caregiver activities. OUTCOMES: Feasibility measures included recruitment pace, participant retention, treatment adherence (module completion) and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects and reported adverse events. Within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1 month follow-up (primary endpoint). RESULTS: Recruitment was completed after 7 months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen's d=1.27) and CATS-2 (Cohen's d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD. CONCLUSIONS: Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes. TRIAL REGISTRATION NUMBER: NCT06185244.
30 May 2026
Read appraisal →JMIR research protocols
Telehealth Versus In-Person Caregiver-Mediated Behavioral Treatment for Challenging Behaviors in Children With Autism Spectrum Disorder: Protocol for COACH (Caregiver Outreach for Autism Coaching at Home) Randomized Controlled Trial
BACKGROUND: Approximately 40%-60% of children diagnosed with autism spectrum disorder (ASD) exhibit challenging behaviors such as aggression, elopement, self-injury, and property destruction that can endanger the health and safety of the child or others, often cause significant distress for families, and hinder the child's developmental progress. Although behavioral treatments grounded in the principles of applied behavior analysis have been shown to effectively reduce or eliminate these behaviors, significant gaps remain in how to deliver these interventions equitably. OBJECTIVE: This study aims to compare the efficacy of delivering in-person versus telehealth caregiver-mediated behavioral treatment for challenging behaviors in children with ASD. METHODS: The Caregiver Outreach for Autism Coaching at Home trial is a single-site, multiarm, parallel-group randomized controlled trial to evaluate the efficacy of delivering caregiver-mediated behavioral treatment for children with ASD who exhibit challenging behaviors. We aim to recruit 90 caregiver-child dyads with children with ASD aged 2 years, 0 months to 7 years, 11 months from metropolitan, suburban, and rural areas across New Mexico and the neighboring El Paso, Texas region. Following a practical functional assessment to identify the potential social-environmental variables maintaining the child's challenging behavior, caregiver-child dyads will be randomized into one of three parallel treatment arms: (1) caregiver-mediated behavioral treatment delivered via telehealth, (2) caregiver-mediated behavioral treatment delivered in person, or (3) caregiver online psychoeducation. Interventions will be delivered by clinicians in weekly 1-hour sessions in the home setting over 12 weeks. RESULTS: The study was funded in May 2022, and recruitment began in January 2024. As of March 2026, 81 caregiver-child dyads have been enrolled, with equal allocation across the 3 study groups (27 per group). Recruitment is expected to conclude in October 2026, with data analysis planned for Winter 2026 through Spring 2027. CONCLUSIONS: This study will address a critical gap in the scientific literature on scalable, family-centered approaches to safely and effectively reduce challenging behavior in children with ASD and decrease caregiver stress. Findings may inform best practices and payer policy for telehealth-delivered behavioral interventions targeting child safety and caregiver well-being.
29 May 2026
Read appraisal →JMIR aging
e-Counseling for Fall Prevention in Older Adults: Scoping Review
BACKGROUND: Falls are a major contributor to injury, disability, and mortality among older adults worldwide. Digital health-based e-counseling has emerged as a scalable strategy to support fall prevention by addressing physical, behavioral, and cognitive risk factors. OBJECTIVE: This scoping review aimed to map the scope, characteristics, and outcomes of e-counseling interventions for fall prevention among adults aged 60 years or older. METHODS: Guided by Arksey and O'Malley's framework and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we searched PubMed, ScienceDirect, CINAHL, and ProQuest for studies published between January 2019 and May 2025. Eligible studies evaluated digital or telehealth-based counseling interventions for fall prevention. Data were synthesized descriptively, and methodological quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: A total of 13 studies were included, comprising randomized controlled trials, feasibility studies, qualitative research, and retrospective cohorts conducted across Asia, Europe, and North America. e-Counseling modalities included virtual reality, mobile health application, teleconsultations, and wearable-triggered feedback systems. Reported outcomes included reductions in fall incidence ranging from 15% to 90.9%, improvements in balance and mobility, increased fall risk awareness, and enhanced self-efficacy. Interventions incorporating cultural tailoring and digital literacy support demonstrated higher engagement and adherence. CONCLUSIONS: e-Counseling appears to be a promising and scalable approach for fall prevention in older adults, with benefits across physical and behavioral domains. Future research should focus on long-term effectiveness, equitable access in low- and middle-income settings, and integration into routine health care systems.
29 May 2026
Read appraisal →PloS one
Effectiveness of tele-rehabilitation using AI-guided exercise and pain neuroscience education for fibromyalgia (FIBROIA): Protocol for a randomized controlled trial
INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by widespread pain and cognitive dysfunction, with pharmacological treatments offering limited efficacy. Although Pain Neuroscience Education (PNE) and therapeutic exercise are evidence-based interventions, accessibility and adherence remain major challenges particularly in underserved regions such as Latin America. This trial investigates the effectiveness of a 12-week tele-rehabilitation program (FIBROIA) that integrates Artificial Intelligence (AI)-guided exercise with PNE to enhance access to comprehensive multimodal care. METHODS AND ANALYSIS: This multicentre, randomized, assessor-blinded, parallel-group controlled trial will enroll fifty adults meeting the 2016 ACR criteria for FM. Participants will be randomly assigned (1:1) to either the intervention group or enhanced usual care. The intervention consists of three personalized exercise sessions per week delivered through the Rehbody AI platform, which provides real-time biomechanical feedback, along with a weekly PNE module designed to reconceptualize pain. The primary outcome is the change in pain intensity, measured using the Visual Analogue Scale (VAS), at week 13 (±7 days), immediately following completion of the 12-week program. Secondary outcomes include the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), lower-limb strength assessed by the 30-Second Sit-to-Stand test, and health-related quality of life measured with the EQ-5D-3L. Statistical analyses will follow an intention-to-treat (ITT) framework. DISCUSSION: The FIBROIA protocol addresses the urgent need for scalable, evidence-based interventions in resource-limited settings. By combining AI-driven biomechanical feedback with cognitive reappraisal through PNE, this study seeks to reduce fear-avoidance behaviors and improve exercise adherence. This integrative approach aims to overcome the limitations of passive tele-rehabilitation by simulating asynchronous professional supervision, thereby ensuring both safety and technical precision in movement execution. CONCLUSIONS: If effective, this protocol will offer a robust, technology-enabled framework for remote FM management. The results could help establish a new clinical standard for accessible, patient-centered rehabilitation, bridging the gap between high-level evidence and real-world practice across diverse socioeconomic contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT06672419.
24 May 2026
Read appraisal →Journal of medical systems
RetCond: A Conditional Diffusion Model for Self-Explanatory Multi-Class Fundus Image Classification
Vision impairment remains a major global health challenge, and early diagnosis of retinal diseases is essential to prevent avoidable vision loss. Color fundus photography is widely used for retinal assessment, but manual interpretation is time-consuming and prone to inter-clinician variability. Although deep learning has improved automated retinal disease detection, most classification models lack transparency. We introduce RetCond, a self-explanatory generative classifier designed to provide both accurate predictions and counterfactual visual explanations. RetCond is a diffusion model repurposed as a classifier whose generative capabilities enable counterfactual synthesis for built-in explanations. These counterfactual images depict the retinal changes associated with alternative diagnoses, offering insight into the model's decisions. We curated a diverse dataset of 19,565 images containing five retinal disease conditions to train and evaluate the model. Performance is assessed using standard classification metrics and by qualitatively and quantitatively evaluating the self-explanatory component. Comparisons are made against strong discriminative baselines. RetCond achieves a classification accuracy of 96.98%, comparable to RETFound (96.99%). In contrast to standard models, RetCond produces counterfactual images that highlight condition-specific retinal features, confirming its learned concepts and demonstrating its self-explanatory properties. These results show that RetCond matches state-of-the-art discriminative performance while addressing limitations of post-hoc interpretability techniques in standard deep learning models. RetCond, therefore, constitutes a contribution toward more trustworthy AI solutions in ophthalmology.
23 May 2026
Read appraisal →Journal of neurology
Effectiveness of telemedicine-based rehabilitation after stroke: a systematic review
BACKGROUND: Access to timely post-acute stroke rehabilitation remains inconsistent, contributing to persistent disability despite advances in acute stroke care. Telemedicine has been proposed as a strategy to improve continuity and access to rehabilitation services, but its effectiveness across functional domains remains incompletely defined. OBJECTIVE: To evaluate the effectiveness of telemedicine-delivered post-acute follow-up and rehabilitation on functional recovery and disability outcomes among adult stroke survivors. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched for studies published between January 2015 and December 2025. Eligible studies included adult stroke populations receiving telemedicine-based post-acute follow-up or rehabilitation and reporting functional, motor, balance, quality-of-life, or feasibility outcomes. Randomized controlled trials and observational studies were included. Risk of bias was assessed using validated tools, and findings were synthesized narratively without quantitative pooling due to heterogeneity. RESULTS: Twenty-eight studies comprising approximately 1237 participants were included. Telerehabilitation was associated with improvements in activities of daily living, although between-group differences varied across studies. Activities of daily living improved post-discharge (Barthel Index + 23.3 vs + 9.3; p < 0.001), and Functional Independence Measure scores increased in tele-CIMT and wearable-assisted interventions. Upper limb performance improved (WMFT time - 2.28 s; Box and Block Test + 5.57 vs 1.0; Nine-Hole Peg Test - 71.6 s; Jebsen-Taylor - 26.6 s). Spasticity decreased (MAS) with wrist improvements maintained at 6 months. Mobility and balance also improved, with intervention groups walking farther (6MWT 141.6 ± 8.7 m vs 129.5 ± 7.1 m; p < 0.001) and showing comparable improvements in BBS outcomes across groups. Technology-assisted telerehabilitation programs were more frequently associated with statistically significant improvements; however, these findings were not consistently superior to standard rehabilitation across all studies. Most randomized trials had some concerns for bias, and half of non-randomized studies were rated as serious risk, limiting overall certainty. CONCLUSIONS: Telemedicine-based post-acute stroke rehabilitation is feasible and associated with functional improvements comparable to in-person care. Reported adverse events were infrequent and generally minor, though safety outcomes were inconsistently measured across studies. High feasibility, adherence, and patient satisfaction support its role as a scalable component of post-stroke rehabilitation pathways.
23 May 2026
Read appraisal →JMIR human factors
Telemedicine Service Experience Questionnaire for Chinese Outpatients: Development and Validation Study
BACKGROUND: Telemedicine has rapidly expanded; however, standardized, telemedicine-specific patient-reported experience measures tailored to outpatient workflows are limited in many settings. OBJECTIVE: This study aimed to develop and psychometrically validate the Telemedicine Service Experience Questionnaire (TSEQ) for Chinese outpatients using telemedicine services. METHODS: We conducted a web-based survey among outpatients who completed a telemedicine consultation at Peking Union Medical College Hospital between July 1, 2021, to August 31, 2021, and who had used telemedicine services, using an adapted Chinese Patient Experience Questionnaire that encompasses 15 questions across 4 dimensions, to investigate patients' telemedicine consultation experiences. Item generation was informed by a literature review, workflow mapping, and expert review. We evaluated the factor structure using exploratory factor analysis and confirmatory factor analysis on the full sample with cross-validation. Reliability was assessed using Cronbach α and item-total correlations. RESULTS: In total, 3338 participants completed the survey (mean age 45.3, SD 17.8 y; n=2182, 65.4% female participants; n=1827, 54.8% with college education or above). The exploratory factor analysis of the final 14-item scale resulted in 4 factors. After scrutinizing the content, these factors were labeled "Service Efficiency," "Post-treatment," "Information Guidance," and "Humanistic Care," and they demonstrated good internal consistency (Cronbach α values of 0.876, 0.840, 0.962, and 0.876, respectively). Moreover, as the average variance extracted values were greater than 0.5 and the composite reliability values were greater than 0.7, the TSEQ scale has high convergent validity. Our findings suggest that the psychometric properties of the 14-item TSEQ are valid and reliable for assessing telemedicine service experience among Chinese outpatients. CONCLUSIONS: The TSEQ demonstrates a stable multidomain structure with satisfactory reliability and validity for evaluating outpatient telemedicine service experience in China. The instrument can support routine quality monitoring and guide targeted workflow improvements. Future studies should validate the TSEQ in multisite and postpandemic samples and examine measurement invariance across key subgroups.
22 May 2026
Read appraisal →JMIR mHealth and uHealth
mHealth-Supported Exercise Rehabilitation to Reverse Frailty After Autologous Transplantation in Multiple Myeloma: Randomized Controlled Trial
BACKGROUND: Frailty is highly prevalent in survivors of multiple myeloma (MM) after autologous hematopoietic cell transplantation and is associated with poor functional recovery and adverse clinical outcomes. Although exercise is known to improve physical function, traditional center-based rehabilitation models are often inaccessible to this population during early posttransplant recovery. Mobile health (mHealth)-supported exercise may offer a scalable alternative; however, evidence in hematologic malignancies remains limited. OBJECTIVE: This study aimed to evaluate the effects of a 16-week mHealth-supported exercise rehabilitation program on frailty phenotype and physical function in survivors of MM within 180 days after autologous hematopoietic cell transplantation. METHODS: In this single-center randomized controlled trial, participants who self-reported as prefrail or frail were randomized 1:1 to an mHealth-supported exercise group (n=16) or usual care control (n=16). Remote assessments were conducted at baseline (week 0), midpoint (week 9), and follow-up (week 17). The intervention consisted of 8 weeks of supervised tele-exercise (3 sessions/week, 50 minutes/session), followed by 8 weeks of independent home-based exercise using the same mHealth platform. Exercise intensity was prescribed using a repetitions-in-reserve-based rating of perceived exertion approach with symptom-guided progression. The primary outcome was change in the 5-component Fried frailty phenotype score (0-5). Secondary outcomes included Short Physical Performance Battery components, chair stand time, gait speed, and handgrip strength. Intention-to-treat analyses were conducted using generalized estimating equations to evaluate between-group differences over time. RESULTS: Participants had a mean age of 64.6 (SD 7.1) years and were enrolled a mean of 136 (SD 36.3) days posttransplant. At baseline, 94% (30/32) of participants were classified as frail. Adherence to the supervised sessions was 85% (326/384 sessions), and adherence during the unsupervised phase was 78% (298/384 sessions). The exercise group demonstrated a significantly greater reduction in frailty score compared with control from baseline to week 17 (P<.001). Between-group difference estimates showed a clinically meaningful improvement favoring exercise at both week 9 and week 17 (P<.001). Chair stand time improved significantly in the exercise group compared with control, with faster completion times observed at week 9 and sustained through week 17 (P=.002). Improvements in other Short Physical Performance Battery components and handgrip strength favored the exercise group but did not reach statistical significance. No serious adverse events occurred. CONCLUSIONS: A 16-week mHealth-supported, progressively prescribed exercise rehabilitation program was feasible, safe, and effective in reversing frailty phenotype and improving functional mobility in survivors of MM early after autologous transplantation. This approach provides a scalable model for delivering structured rehabilitation during a high-risk recovery window. Larger trials incorporating attention-matched controls and longer follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT05142371; https://clinicaltrials.gov/study/NCT05142371.
22 May 2026
Read appraisal →Journal of medical Internet research
Efficacy of Internet-Based Self-Help Interventions for Irritable Bowel Syndrome: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that reduces quality of life and causes a heavy medical burden. Internet-based self-help interventions are flexible and scalable, showing potential for IBS symptom improvement, but relevant evidence is fragmented and lacks systematic review. OBJECTIVE: This systematic review aimed to comprehensively evaluate the effects of internet-based self-help interventions on symptom severity, quality of life, and visceral sensitivity, as well as comorbid depressive and anxiety symptoms, in individuals with IBS. METHODS: Only randomized controlled trials evaluating internet-based self-help interventions for individuals with IBS were included. A literature search was conducted across PubMed, Embase, Web of Science, CINAHL Complete, PsycINFO, the Cochrane Library, and 4 Chinese databases on June 25, 2025, with an updated search on March 9, 2026. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were performed with the Hartung-Knapp-Sidik-Jonkman-adjusted random-effects model. Effect sizes were reported as standardized mean differences (SMDs) with 95% CIs, and evidence certainty was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. RESULTS: A total of 17 randomized controlled trials from 7 countries were included, involving 2289 participants (predominantly female). Compared with control groups, internet-based self-help interventions were associated with a statistically significant improvement in IBS symptom severity (SMD -0.52, 95% CI -0.78 to -0.26, 95% prediction interval [PI] -1.46 to 0.42), quality of life (SMD 0.57, 95% CI 0.23 to 0.90, 95% PI -0.41 to 1.54), visceral sensitivity (SMD -0.55, 95% CI -0.89 to -0.21, 95% PI -1.43 to 0.33), and depressive symptoms (SMD -0.14, 95% CI -0.27 to -0.01, 95% PI -0.27 to -0.01). However, no statistically significant improvement was observed in anxiety symptoms (SMD -0.03, 95% CI -0.34 to 0.27, 95% PI -0.78 to 0.71). The certainty of evidence was rated as moderate to very low for all outcomes. CONCLUSIONS: This review synthesizes the latest evidence on internet-based self-help interventions for individuals with IBS disease-specific and comorbid psychological symptoms. It stands out by encompassing a diverse range of such interventions and incorporating visceral sensitivity as a key outcome. In doing so, it establishes a more comprehensive multi-outcome evidence base for IBS digital interventions, advancing the field by clarifying the potential of these interventions as viable alternatives to conventional treatments. For real-world practice, these findings can inform targeted strategies for primary care and telemedicine platforms, especially in resource-limited regions. However, this review is limited by moderate bias risk, high heterogeneity, and moderate to very low GRADE evidence certainty. A wide 95% PI suggests that effect variability is linked to contextual and population factors, so findings should be interpreted cautiously. Future research should prioritize technical support, patients' digital health literacy, and standardized intervention protocols to further validate clinical utility.
22 May 2026
Read appraisal →Journal of the American Heart Association
Determinants of Successful Implementation: A Mixed-Methods Evaluation of a Team-Based Telehealth Hypertension Management Program for Underserved Patients
BACKGROUND: Hypertension management using home blood pressure monitoring-guided pharmacotherapy is more effective than clinic-based care, but the benefit is attenuated in underserved patients. We evaluated implementation determinants of a team-based telehealth hypertension management program providing home blood pressure monitoring-guided pharmacotherapy and self-management and social support. METHODS: We used Exploration, Preparation, Implementation and Sustainment, and Health Equity Implementation Frameworks for semistructured interviews and inductive/deductive coding using thematic analysis of qualitative data and quantitative analysis to evaluate team-based telehealth hypertension management program implementation facilitators, barriers, acceptability, appropriateness, and feasibility. We purposefully sampled 20 patients with hypertension and 16 clinic key players from 2 safety-net clinics in North Carolina. Quantitative measures were Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, Patient Assessment of Chronic Illness Care, Organizational Readiness for Implementing Change (all measures' score ranged 1-5; higher score is better). We used concurrent embedded mixed methods (qualitative + quantitative) for convergence and complementarity. RESULTS: Five qualitative themes emerged around (1) staffing barriers, coordinated teamwork, and friendly study tools; (2) the program's patient and provider centeredness; (3) ease of home blood pressure monitoring; (4) personalized, comprehensive self-management calls; and (5) social support. Patients and clinic key players found the program acceptable (mean±SD, 4.42±0.84 and 4.56±0.59), appropriate (4.42±0.86 and 4.61±0.50), and feasible (4.40±0.89 and 4.44±0.53), respectively. Patient Assessment of Chronic Illness Care and Organizational Readiness for Implementing Change scores were 4.22±1.01 and 4.11±0.78, respectively. CONCLUSIONS: Implementing a team-based telehealth hypertension management program depends on its tailoring to patients and providers and having their endorsement; a user-friendly and trust-promoting model; and having a viable financial plan. Future studies should assess clinical and cost effectiveness of the program. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05424744.
20 May 2026
Read appraisal →BMJ quality & safety
Patient safety measures for virtual consultations in primary care: a systematic review
OBJECTIVES: With the growing adoption of virtual consultations in primary care, the need for tailored metrics to evaluate their safety became increasingly urgent. This systematic review seeks to identify and review existing safety measures that could be used for safety evaluation of virtual consultations in primary care. METHODS: This has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and followed a published protocol. A systematic literature search was performed in Ovid MEDLINE/PubMed, Embase and Cochrane Library databases from 2014 to 2024. Studies comparing virtual consultations with face-to-face consultations in the primary care setting were included. An inductive thematic analysis was performed to systematically extract and group the safety measures into overarching themes, with a narrative synthesis to summarise the results. RESULTS: A total of 47 studies (31 experimental and 16 observational studies) were included (n=2 223 697 patients). All studies assessed the safety of virtual versus face-to-face consultations via one or both of the following domains: (1) factors that influence the safety of virtual consultations and (2) tangible outcomes of virtual care safety. The former were categorised into provider-related, patient-related and system-related factors. Tangible outcomes were evident through three subthemes-adverse events, health outcomes and patient perception of safety. CONCLUSIONS: This review provides a systematic synthesis of measures for the safety evaluation of virtual consultations. Further research into patient and physician perspectives is needed to identify aspects and indicators not captured in this study, followed by a consensus study to finalise safety metrics. Ultimately, having a robust methodology for safety evaluation of virtual consultations in place will enable safety monitoring, root cause analyses and safety improvement. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42023464878.
20 May 2026
Read appraisal →BMC endocrine disorders
Effects of digital and remote exercise interventions on HbA1c in type 2 diabetes: a systematic review and network meta-analysis
BACKGROUND: To compare the effects of different digitally and remotely deliveredexercise interventions on glycated hemoglobin (HbA1c) in adults with type 2diabetes mellitus (T2DM) using a network meta-analysis (NMA), and to clarifythe relative effectiveness of distinct delivery models. METHODS: A systematic review and network meta-analysis of randomized controlledtrials was conducted following PRISMA-NMA guidelines and prospectivelyregistered in PROSPERO (CRD420261288210). Major databases were searched frominception to November 11, 2025. Exercise-centered digital and remoteinterventions were categorized as digital exercise interventions (DEX),structured exercise prescription (SEP), multi-behavior lifestyle interventions(MBLI), and tele-exercise/tele-rehabilitation (TEX). The primary outcome waschange in HbA1c. RESULTS: Fifty-four RCTs were included. Compared with control, TEX demonstratedthe greatest reduction in HbA1c (MD -0.51%, 95% CrI -0.88 to -0.14), followedby MBLI (MD -0.32%, 95% CrI -0.51 to -0.13). SEP showed a non-significanttrend, and DEX did not significantly reduce HbA1c. SUCRA rankings favored TEX(0.87), followed by MBLI (0.66), SEP (0.62), and DEX (0.24). Subgroup analysessuggested that HbA1c reductions with TEX and MBLI were more evident among olderadults (≥60 years) and those with longer diabetes duration（>10 years）;however, network inconsistency was detected in these subgroups, and findingsshould be interpreted cautiously. CONCLUSIONS: Digitally and remotelydelivered exercise interventions differ in their effectiveness for HbA1ccontrol in T2DM. Interventions incorporating ongoing professional supervisionare associated with the most consistent glycemic benefits, whereas largelyautomated approaches show limited effects, highlighting the importance ofdelivery structure and supervision intensity.
15 May 2026
Read appraisal →European journal of pediatrics
Wheeze detection in real-world pediatric care: AI applied to smartphone lung auscultation.
UNLABELLED: Smartphone-based lung auscultation, combined with artificial intelligence (AI), may offer a promising alternative for pediatric respiratory telemonitoring. The aim of our study was to evaluate the performance of an AI model on wheeze detection from pediatric respiratory sounds recorded via smartphone. An observational cross-sectional study was conducted at the Pediatric Department of a Portuguese tertiary hospital, including children aged 0-17 years (pre-school, school-aged, and adolescent), with or without respiratory disease. Respiratory sounds were recorded at four locations using smartphone microphones and independently classified by at least 2 blinded annotators for quality and presence of wheezes. A hybrid convolutional-recurrent neural network (CNN + LSTM) trained on public electronic stethoscope databases was used to detect wheezes. AI model performance was assessed using positive predictive value, sensitivity, specificity, accuracy, and F1-score. A total of 217 children (59.9% male; median 10 [Q1-Q3 4.5-13] years) were included. From 2020 respiratory sound recordings, 1500 (74.3%) met quality criteria. Manual annotation identified 271 recordings with wheezes, whereas AI detected 217, most frequently in pre-school children (64.5% AI; 53.9% manual). The model achieved an overall accuracy of 87% (95% CI 86-89) and an F1-score of 61% (95% CI 56-66). The best accuracy was found in adolescents (92%, 95% CI 90-94) and the best global F1-score in pre-school children recordings (64%, 95% CI 58-71). CONCLUSION: This study supports the feasibility of AI-assisted analysis of smartphone-recorded pediatric respiratory sounds in real-world settings. Future multicenter studies with larger datasets and model fine-tuning using smartphone recordings are expected to improve AI model performance and generalizability. WHAT IS KNOWN: • Continuous monitoring of pediatric respiratory diseases is essential to improve outcomes and reduce healthcare and family burden. • Smartphone lung auscultation is feasible in children but AI wheeze detection models have only been applied to recordings from electronic stethoscopes. WHAT IS NEW: • First study applying an AI model to detect wheezes in smartphone-recorded lung sounds. • Quality recordings were obtained across all pediatric age groups and the AI model performance showed promising results, comparable to studies using electronic stethoscopes.
14 May 2026
Read appraisal →Journal of medical systems
Artificial Intelligence in Physical, Occupational and Neuro-Rehabilitation: Clinical Effectiveness, Prognostic Performance, and Pre-Implementation Feasibility - A Systematic Review
BACKGROUND: Global rehabilitation needs far exceed capacity, and artificial intelligence (AI) is proposed to extend access, personalise therapy, and support adherence. We aimed to synthesise evidence on clinical effectiveness, prognostic performance, and implementation feasibility of AI-enabled rehabilitation across conditions and care settings. METHODS: We conducted a mixed-methods systematic review of AI-enabled rehabilitation and rehabilitation-led prevention relevant to physiotherapy practice. MEDLINE, Embase, Web of Science, CINAHL, Scopus, and IEEE Xplore were searched. Methodological quality was appraised with MMAT and PROBAST + AI (prediction/diagnostic models), with a priori AI-reporting minimums checklist. Given heterogeneity, evidence was integrated via prespecified thematic synthesis. FINDINGS: Thirty studies from diverse regions met inclusion, comprising randomised trials, non-randomised comparisons, cohorts, surveys, qualitative work, and prediction/diagnostic models. Clinical effects were modest and heterogeneous. Most AI-enabled interventions were comparable to conventional rehabilitation; signals of benefit appeared in selected musculoskeletal and telerehabilitation contexts but rarely persisted beyond short follow-up. Internal validity was frequently limited by asymmetric adherence measurement objective telemetry in AI arms versus self-report or attendance in controls alongside low uptake and declining engagement over time. Safety and usability were generally favourable within short horizons, although surveillance and explicit attribution to AI components were inconsistently reported. Prognostic and adaptive models showed encouraging discrimination in development settings but lacked multicentre external validation, calibration, subgroup-error profiling, and prospective impact evaluation, leaving them unready for clinical use. Stakeholders reported willingness to adopt AI while highlighting gaps in training, governance and information technology support, costs, and digital equity. Overall certainty for comparative clinical outcomes was low to moderate, for models, very low. CONCLUSION: AI in rehabilitation presently acts more as a behavioural amplifier structuring home programmes and supporting execution than as a replacement for dose-matched therapist-delivered care. Credible scale-up should position AI as an adjunct and hinge on arm-symmetric capture of adherence and execution, clinically meaningful outcomes paired with verified behaviour change over treatment and longer-term follow-up, and model deployment only after transparent development, external validation with calibration and subgroup-error characterisation, and demonstration of clinical impact. Embedding equity and economic evaluation, together with living oversight and version control, will be essential to convert promising prototypes into trustworthy, durable, and widely accessible services.
14 May 2026
Read appraisal →Journal of medical Internet research
Efficacy, User Engagement, and Acceptability of Cognitive Behavioral Therapy-Oriented Psychological Chatbots for Adults With Depressive and/or Anxiety Symptoms: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Cognitive behavioral therapy (CBT) is the most examined psychotherapy for depression and anxiety, but delivery faces significant barriers such as limited access, cost, and time constraints. CBT-oriented psychological chatbots offer a promising means of addressing these challenges. Yet, their overall efficacy, user engagement, and acceptability have not been systematically synthesized. OBJECTIVE: This study aimed to evaluate the efficacy, user engagement, and acceptability of CBT-oriented chatbots for adults with depressive and/or anxiety symptoms. METHODS: A systematic search of 9 databases, including PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, WanFang, and VIP Databases, was conducted from inception to February 2026. Eligibility criteria included randomized controlled trials comparing CBT-oriented chatbots with control groups in adults with depressive and/or anxiety symptoms. Risk of bias (ROB) was assessed using the Cochrane ROB tool. Random-effects meta-analyses (Hartung-Knapp-Sidik-Jonkman adjustment) calculated pooled effect sizes (Hedges g), 95% CIs, and 95% prediction intervals (PIs). Heterogeneity was evaluated using the I² statistic, and Galbraith plots were used to identify outliers for subsequent sensitivity analyses. Subgroup and meta-regression analyses examined potential moderators. The certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data on user engagement and acceptability were extracted and synthesized using narrative and quantitative methods where available. RESULTS: Twenty-nine eligible randomized controlled trials were included. CBT-oriented psychological chatbots produced a moderate reduction in depressive symptoms at postintervention (g=-0.55, 95% CI -0.70 to -0.40, 95% PI -1.23 to 0.13) and a small reduction in anxiety symptoms (g=-0.26, 95% CI -0.37 to -0.14, 95% PI -0.67 to 0.15). At follow-up, effects were small for depression (g=-0.32, 95% CI -0.55 to -0.09, 95% PI -0.93 to 0.29) and nonsignificant for anxiety (g=-0.19, 95% CI -0.43 to 0.04, 95% PI -0.84 to 0.46). Subgroup and meta-regression analyses revealed that anxiety outcomes were significantly moderated by clinical profiles-showing distinct advantages for comorbid symptoms-and the proportion of female participants. The CBT-oriented chatbots received an adequate level of engagement that complied with digital intervention standards. Although user satisfaction ratings were generally favorable, technical limitations and repetitive interaction patterns remain to be addressed to enhance overall acceptability. Regarding the limitations of evidence, the overall certainty was rated as very low to low, predominantly driven by high ROB and substantial heterogeneity. CONCLUSIONS: This study innovatively isolates CBT-oriented chatbots from broader digital interventions, providing a precise, methodology-driven evaluation of theoretically grounded therapeutics. This review brings critical evidence to the field that these tools yield significant short-term relief, particularly for comorbid anxiety profiles. In the real world, CBT chatbots offer profound potential as scalable, low-barrier first-line tools. To sustain engagement, future developments must evolve from rigid rule-based scripts toward adaptive, large language model-driven architectures while ensuring clinical safety.
13 May 2026
Read appraisal →European journal of pediatrics
Diagnostic accuracy of artificial intelligence versus 263 pediatric clinicians for childhood exanthems
Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents (P = .001; ε2 = 0.13).Conclusions: AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight.
12 May 2026
Read appraisal →JMIR formative research
Older Adults' Experiences Navigating Setup of Digital Health Technology: Implementation Report
BACKGROUND: Digital health and connected technologies may support better health outcomes among older adults, including those with multiple chronic conditions or low engagement in health behaviors. However, initial experiences with technology, including during unboxing, setup, and first use, can influence emotional reactions and perceptions and can ultimately determine sustained, meaningful use. Older adults with low technology experience or poor health may be particularly vulnerable to frustration, stress, or abandonment of devices when early interactions are negative. OBJECTIVE: The purpose of this implementation study was to closely observe the initial engagements with a telehealth treatment app and connected blood pressure monitor (BPM) among a group of older adults with low prior technology use and reported low health behavior engagement. The goal was to identify setup "pain points" that may influence initial impressions and intention to use the technology over time. METHODS: A total of 24 older adults (aged ≥65 years) were recruited for a 4-week trial of a telehealth app. Participants were provided with a box containing a tablet preloaded with the app, paper instructions, and a BPM and cuff. Researchers first conducted in-home ethnographic interviews with participants to observe the unboxing and setup process, documenting experiences with reading instructions, using the BPM, and engaging with customer support. Weekly check-in calls and a final exit interview captured ongoing experiences and likelihood of continued use. Interview recordings were transcribed and independently coded, guided by the unified theory of acceptance and use of technology. RESULTS: Most of the sample were White (20/24, 83%) and female (14/24, 58%). Negative experiences with the app's customer support were the top challenge for participants, with representatives providing confusing steps or conflicting terminology. Other common challenges were understanding instructions, connecting to Bluetooth, and correctly using the BPM. While 67% (16/24) of the participants indicated that they were likely or very likely to continue to use the app after the study ended at the end of week 1, this number dropped to 54% (13/24) by the end of the 4 weeks. Participants who reported lower technology self-efficacy at the beginning of the study also experienced frustration, anxiety, and embarrassment as friction with the setup process continued. CONCLUSIONS: First impressions of digital health apps play a critical role in influencing older adults' emotions and perceptions regarding the technology and may impact the likelihood of longer-term engagement. Those with lower technology self-efficacy are particularly susceptible to experiencing negative emotions such as frustration, stress, or shame. Mobile health apps and interventions targeting older adults should incorporate simplified instructions with clear, consistent terminology and well-trained customer support staff to improve the onboarding experience.
11 May 2026
Read appraisal →Journal of affective disorders
Gaborformer: A method for depression detection through hybrid acoustic feature extraction and fusion
Depression, a complex and heterogeneous mental disorder, poses significant challenges for timely and effective detection, highlighting the need for advanced methodologies. Current technologies often fail to fully leverage deep learning's potential, potentially overlooking critical speech features. To address this, we propose Gaborformer, a novel framework for depression detection through hybrid acoustic feature extraction and fusion. Our approach introduces classified iterative neighborhood component analysis (CINCA) for feature selection, reducing dimensionality and extracting highly correlated depressive speech features. We design GaborNet, integrating learnable Gabor filters with CNN to fuse features, and incorporate a Conformer model to capture depression-related characteristics from high-dimensional signals. Extensive validation on the DAIC-WOZ and MODMA datasets demonstrates the efficacy of our approach, significantly outperforming previous studies. Our analysis underscores the importance of features such as MFCC and LSP in speech-based depression detection (SDD). Code is available at https://github.com/staygoldboy/gaborformer.
6 May 2026
Read appraisal →Social science & medicine (1982)
Imaginaries of digital health: Unpacking the platformization of mental health through users' practices
The platformization of healthcare is reshaping the organization of mental health services, redefining access, relationships, and meanings of care. This paper examines how users experience and negotiate the platformization of mental health through the case of Unobravo, an Italian digital platform offering online psychotherapy. Drawing on Science and Technology Studies and digital health literature, the study explores how platform imaginaries of efficiency, accessibility, and personalization are enacted and contested in everyday practices. Adopting a mixed-methods design, the research combines qualitative interviews (N = 12) with a quantitative survey (N = 3870) to analyse users' narratives and patterns of engagement. Findings reveal a persistent tension between the promise of algorithmic efficiency and the realities of situated practice. While users value the flexibility and accessibility provided by digital infrastructures, they also encounter infrastructural misalignments, such as unstable connections and opaque algorithmic matching processes. These challenges are addressed through practices of domestication that reconfigure the therapeutic setting, integrating care into mobile and domestic environments. By analysing user practices, the paper investigates how mental health is domesticated through digital platforms and shaped by platform imaginaries, reconfiguring the therapeutic setting as a datafied and everyday space.
4 May 2026
Read appraisal →Journal of medical Internet research
Application of Digital Health Technologies in Cardiac Rehabilitation for Patients With Coronary Heart Disease: Scoping Review
BACKGROUND: The high mortality and recurrence rates associated with coronary heart disease (CHD) impose substantial health care costs and economic burdens globally. Identifying effective interventions to improve patient outcomes is paramount. Digital health technologies (DHTs) offer novel solutions to overcome the challenge of low participation rates in traditional cardiac rehabilitation (CR). OBJECTIVE: This review aims to systematically map the scope of application, intervention objectives, and evaluation metrics of DHTs in CR for patients with CHD, thereby providing a structured evidence base for future research and practice. METHODS: This scoping review adheres to the Joanna Briggs Institute's methodology and is reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic search was conducted across 5 major databases, PubMed, Web of Science, Embase, Cochrane Library, and EBSCO, covering the period from inception to February 2026. Inclusion criteria were developed based on the participants, concept, and context framework. Studies focused on the application of various DHTs within CR settings for patients with CHD. Eligible literature comprised randomized controlled trials, quasi-randomized controlled trials, and longitudinal before-and-after studies published in peer-reviewed journals. Two researchers (XZ and ZL) independently conducted literature screening and data extraction. Findings were presented through a comprehensive narrative synthesis and evidence gap maps. RESULTS: A total of 43 studies were included, predominantly randomized controlled trials (n=40). Findings revealed (1) diverse technological formats, categorized into 3 main types: digital health tools, real-time remote support, and asynchronous communication. Multitechnology combined interventions have become the mainstream model (36/43, 83.7%). (2) Intervention objectives were multifaceted, consolidating into 4 dimensions: motivation and guidance, knowledge and skills, monitoring and security, and social and group dynamics. (3) Evaluation metrics were multidimensional, encompassing clinical physiological indicators, health behaviors, patient-reported outcomes, service use rates, and technological feasibility. DHTs demonstrated positive effects in improving short-term physiological function and health behaviors; however, evidence remains insufficient regarding their impact on long-term clinical outcomes such as reducing adverse events. CONCLUSIONS: The innovation of this scoping review lies in integrating highly heterogeneous evidence to reveal the field's evolution from isolated tools toward systematic, integrated solutions. Research confirms that DHTs effectively overcome temporal and spatial constraints, enhancing rehabilitation accessibility and engagement. They serve as crucial strategic tools for bridging geographical disparities in health care resources and advancing equity in cardiovascular health services. However, the evidence base remains limited, including insufficient long-term efficacy data and inadequate exploration of vulnerable populations such as older people and those with low digital literacy. Future research urgently requires large-scale, long-term follow-up clinical trials, alongside enhanced studies on adaptability for specific populations and considerations of health equity. This will propel digital CR toward greater scientific rigor, universal applicability, and precision.
3 May 2026
Read appraisal →JMIR research protocols
Geriatric Telemanagement of Health Conditions (GET HEALTH) in Nursing Home Residents Recently Discharged From the Hospital: Protocol for a Before-After Study
BACKGROUND: Nursing home (NH) residents have a high burden of multimorbidity and disability and are frequently hospitalized. Comprehensive geriatric assessment might reduce hospitalization. However, few geriatricians are working in NHs. Technology might be used to overcome this problem. OBJECTIVE: This study aims to verify if a geriatric telemanagement model improves patient outcomes in NH residents recently discharged from the hospital. METHODS: Clinical outcomes of NH residents recently discharged from the hospital are compared before and after the implementation of GTM, where a geriatrician evaluates each patient during televisits with NH staff and discusses the case with the general practitioner. NH residents aged ≥70 years readmitted to NHs after hospitalization in the 3 years prior to the COVID-19 pandemic (2017-2019) represent the control group enrolled in the retrospective preintervention phase. The primary outcome of the study is the hospital readmission rate during 6-month follow-up. Health technology assessment evaluates the cost-effectiveness of model implementation. RESULTS: A total of 333 NH residents were included in the preintervention retrospective study. Data collection started in February 2022 and was completed in February 2023. A total of 104 NH residents were recruited in the intervention study, from March 2024 to March 2025. Data analysis is currently in progress. CONCLUSIONS: Currently, NHs in Italy are striving to manage the complexity of older patients who are often hospitalized. A geriatric telemanagement model might reduce hospitalizations, and therefore negative outcomes, as well as health care costs in this vulnerable population.
3 May 2026
Read appraisal →Neurology
Hypnotic Cognitive Therapy for Chronic Pain in Spinal Cord Injury: A Randomized Controlled Trial
BACKGROUND AND OBJECTIVES: Chronic pain is highly prevalent, disabling, and difficult to treat in people with spinal cord injury (SCI). Our objective was to determine whether hypnotic cognitive therapy (HYP-CT) significantly reduces average pain intensity. METHODS: This single-blind, randomized, parallel-group trial investigated the efficacy of HYP-CT in treating moderate-to-severe chronic pain in community-residing adults with SCI. Participants were recruited nationwide through SCI organizations and randomized 1:1 to HYP-CT vs usual care (UC). We used computerized permuted block randomization with variable block sizes and stratified by sex and worst pain type. HYP-CT was delivered by a psychologist over the telephone or through Zoom and consisted of 6 weekly 60-minute sessions plus instructions to practice self-hypnosis daily independently by listening to session recordings. Controls were encouraged to continue current treatments or seek additional pain treatments. The primary outcome was average pain intensity assessed 4 times per week on a 0-10 numerical rating scale and averaged. The primary end point was at 6 weeks after randomization, with a follow-up assessment at 12 weeks. All outcomes were assessed through structured telephone interviews performed by blinded assessors. RESULTS: A total of 127 participants were randomized to HYP-CT (n = 64) vs UC (n = 63). Forty-eight percent were treated over the telephone and 52% through Zoom. The group was 42% female, had a mean age of 51.3 years (15.4 years after SCI), and had a mean baseline pain intensity of 5.93. The worst pain was neuropathic in 57% of cases. The primary outcome, average pain intensity, decreased more in the HYP-CT group compared with UC controls at 6 (-0.55, 95% CI -1.04 to -0.06) and 12 (-0.79, 95% CI -1.28 to -0.29) weeks. Depression declined significantly more in the HYP-CT vs UC groups at 6 and 12 weeks. Planned exploratory analyses suggested that the effect of HYP-CT on pain intensity was similar when delivered over the telephone vs through Zoom, and that pain intensity decreased more in those with all neuropathic pain vs those with mixed pain at 12 weeks. DISCUSSION: The study suggests that HYP-CT is an effective adjunctive treatment for SCI-related pain. Replication studies are needed. TRIAL REGISTRATION INFORMATION: The study was registered on ClinicalTrials.gov (NCT03857672) on February 28, 2019 and study enrollment commenced on April 24, 2019. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that, in patients with SCI, HYP-CT improves average pain intensity at 6 weeks compared with UC.
3 May 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Structural equation modeling of findings in pediatric tele-neuroradiology: a 2-year nationwide study of turnaround time predictors and clinical decision support
BACKGROUND: Pediatric neuroradiology faces significant workforce shortages, with teleradiology emerging as a vital solution. However, studies investigating findings and their operational impact from teleradiology centers remain limited. OBJECTIVES: To develop and validate structural equation models for identifying predictors of turnaround time and formulate recommendations for workflow optimization in pediatric tele-neuroradiology services. DESIGN: A retrospective cohort study following STROBE guidelines. SETTINGS: 107 hospitals across 17 states in the United States (US) via a teleradiology platform providing interpretation services through US board-certified radiologists. PATIENTS AND METHODS: We analyzed 9985 pediatric neuroradiology scans from 7958 patients (January 2023-December 2024). We utilized confirmatory factor analysis to validate findings structures, followed by structural equation modeling to predict turnaround times. Binary logistic regression models were developed with area-under-the-curve (AUC) estimation for performance assessment. Bootstrap validation with 5000 samples ensured model stability. MAIN OUTCOME MEASURES: Primary outcome was turnaround time. Secondary outcomes included requirements for multiple imaging studies, follow-up recommendations, and consultations. SAMPLE SIZE: A total of 9985 studies providing over 99% statistical power for detecting significant relationships. RESULTS: Factor analysis demonstrated a two-factor structure (trauma: α = 0.742, structural: α = 0.685). The structural model explained 7.8% of turnaround time variance, with computed tomography (CT) modality (β = -0.164), trauma score (β = 0.125), and structural score (β = 0.142) as significant predictors. Among immediate neurosurgical emergencies (n = 180, 1.8%), 89.4% achieved turnaround time within the 60-min benchmark for time-sensitive consultations. Prediction models demonstrated excellent discrimination: traumatic findings (AUC = 0.91), structural findings (AUC = 0.92), critical findings (AUC = 0.95), and a dedicated neurosurgical emergency model (AUC = 0.94, NPV = 0.996). A severity classification system showed strong validation against imaging needs (AUC = 0.76) and consultations (AUC = 0.89). CONCLUSIONS: Our study establishes a validated SEM framework for pediatric tele-neuroradiology with excellent predictive performance (AUC = 0.91-0.95). Among immediate neurosurgical emergencies (n = 180, 1.8%), 89.4% met the 60-min benchmark, and a dedicated emergency prediction model achieved AUC = 0.94. However, translation to improved neurosurgical care delivery and patient outcomes remains unvalidated, representing the next investigational priorities. LIMITATIONS: Retrospective design limits causal inference; a single platform may limit generalizability; the CT majority (96.8%) limits magnetic resonance imaging conclusions. Critically, post-diagnostic clinical outcomes, including neurosurgical consultations, interventions performed, and patient outcomes, were not tracked, precluding conclusions about whether documented operational efficiency translated to improved neurosurgical care delivery.
2 May 2026
Read appraisal →European journal of preventive cardiology
Economic evaluation of alternative cardiac rehabilitation programmes compared to centre-based cardiac rehabilitation programmes: a systematic review.
AIMS: Traditional centre-based cardiac rehabilitation (CBCR) has several drawbacks, including high costs, limited accessibility, and low utilisation rates. As a result, alternative cardiac rehabilitation programmes (ACRPs), such as home-based rehabilitation and telerehabilitation, have been developed. This systematic review aims to synthesise existing evidence on the economic evaluation of ACRPs compared to CBCR. METHODS AND RESULTS: We searched databases of MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and EconLit, as well as trials registers of Clinicaltrials.gov, International Clinical Trials Registry Platform, and EU Clinical Trials Register. The last search date was 20 March 2025. We included randomised controlled trials that directly compared ACRP with CBCR in terms of cost and effectiveness. Study quality was assessed using the Cochrane Risk of Bias tool and the Drummond 10-item checklist. Both qualitative and quantitative syntheses were conducted, with random-effects models applied in the meta-analysis. Thirteen studies met the inclusion criteria, comprising 2040 participants. Meta-analysis showed a non-significant trend favouring CBCR over ACRP for EQ-5D (SMD = -0.32; 95% CI: -0.71 to 0.06; I2 = 79%). For QALY, there was no difference between ACRP and CBCR (SMD = -0.02; 95% CI: -0.19 to 0.15; I2 = 0). Ten of the thirteen studies reported lower costs for ACRP compared with traditional CBCR. Three of five economic evaluations found ACRP to be cost-effective. CONCLUSION: ACRPs demonstrate cost-effectiveness comparable to traditional CBCR. This review highlights the potential of ACRPs, such as home-based rehabilitation and telerehabilitation, as solutions for broader implementation in CR practice. This study reviewed existing research to compare the cost and effectiveness of alternative cardiac rehabilitation programmes with traditional centre-based programmes.Alternative cardiac rehabilitation programmes provide similar health benefits to centre-based programmes.They are often less expensive, with most studies showing lower costs.
26 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews
BACKGROUND: Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews synthesizing evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four HPSR pillars identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery, financial, and governance arrangements; and implementation strategies. This overview addresses delivery arrangements, which Cochrane EPOC defines as how health services are organized and delivered, including who provides care, how care is coordinated and managed, and where services are provided. OBJECTIVES: This overview aimed to synthesize current evidence on delivery arrangements in rehabilitation from an HPSR perspective. Our series of four overviews has the following overarching objectives. • To offer a broad synthesis of existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. METHODS: We searched Epistemonikos Health Systems Evidence databases and EPOC Group systematic reviews with no language limitations to identify reviews published between 2015 and 17 November 2024. We included Cochrane systematic reviews (CSRs) and non-CSRs of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) evaluating the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to delivery arrangements as defined in the EPOC taxonomy. All four overview teams screened reviews and extracted data. We used AMSTAR 2 to critically appraise the reviews, and we analyzed the results descriptively. MAIN RESULTS: We included 25 systematic reviews. Three overlapped, and for 17 the AMSTAR 2 rating was low or critically low confidence. Five systematic reviews (2 CSRs and 3 non-CSRs) contributed to our synthesis. Most outcomes focused on patients, caregivers, or service use (e.g. access to rehabilitation). Equity-related outcomes were absent, and quality of care, adverse events, and our important outcomes were rarely reported. Below, we report the results of three of the five reviews judged to have moderate to high confidence for our outcomes of interest, in which authors conducted meta-analysis and assessed the certainty of the evidence. Who provides care One review analyzed advanced practice physiotherapy (APP) models, which may result in little to no difference in health-related outcomes measured by the Pain Disability Index and EuroQol 5-Dimension questionnaire after the intervention, compared with usual care in adults with spinal pain (standardized mean difference [SMD] 0.05, 95% confidence interval [CI] -0.32 to 0.42; 2 studies, 225 participants; low certainty). Information and communication technology We included two reviews in this category. One compared telerehabilitation with usual care in older adults, finding that telerehabilitation may have little or no effect on quality of life after seven to 20 weeks (SMD -0.09, 95% CI -0.23 to 0.40; 3 studies, 179 participants; low certainty). There was very low-certainty evidence on mobility after seven to 26 weeks (SMD 0.63, 95% CI -0.25 to 1.51; 5 studies, 302 participants), strength after 12 and 26 weeks (SMD 0.73, 95% CI -0.10 to 1.56; 4 studies, 226 participants), and balance after seven to 26 weeks (SMD 0.40, 95% CI -0.35 to 1.15; 3 studies, 199 participants). Another review on stroke survivors living in the community found that telerehabilitation compared with usual care probably has little or no effect on independence in activities of daily living (ADL) after 24 weeks (SMD 0.00, 95% CI -0.15 to 0.15; 2 studies, 661 participants; moderate certainty), self-reported quality of life after six to 24 weeks (SMD 0.03, 95% CI -0.14 to 0.20; 3 studies, 569 participants; moderate certainty), and depression after six to 24 weeks (SMD -0.04, 95% CI -0.19 to 0.11; 6 studies, 1145 participants; moderate certainty); and may have little or no effect on upper limb function after 12 weeks (SMD 0.33, 95% CI -0.21 to 0.87; 2 studies, 54 participants; low certainty) and mobility after six weeks (mean difference 0.01, 95% CI -0.12 to 0.14; 1 study; 144 participants; low certainty). This review also compared telerehabilitation with in-person rehabilitation and found that there may be little to no difference in independence in ADL, measured with the Modified Barthel Index at four to 12 weeks (MD 0.59, 95% CI -5.50 to 6.68; 2 studies, 75 participants; low certainty); balance, measured with the Berg Balance Scale at four to 12 weeks (MD 0.48, 95% CI -1.36 to 2.32; 3 studies, 106 participants; low certainty); and upper limb function, evaluated with the Fugl-Meyer Assessment (Upper Extremity) four weeks after intervention (MD 1.23, 95% CI -2.17 to 4.64; 3 studies, 170 participants; low certainty). AUTHORS' CONCLUSIONS: Current evidence on delivery arrangements in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Reviews covered five EPOC categories, but reliable evidence for our outcomes of interest was available for only two categories. Most evidence was on telerehabilitation. Compared with usual care, APP models may have little to no effect on health outcomes in adults with spinal pain. In people with stroke, telerehabilitation compared with usual care probably has little or no effect on independence in daily living, quality of life, and depression, and may have little to no effect on upper limb function and mobility. Compared with in-person care, telerehabilitation may have little to no effect on ADL, balance, and upper limb function. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews in HPSR should consider a broader range of study designs, such as observational, qualitative, and mixed-design evidence, to better capture evidence on delivery arrangements in rehabilitation. FUNDING: PC, CK, and SN were supported and funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. REGISTRATION: Protocol (2025): DOI 10.23736/S1973-9087.24.08833-6.
25 Apr 2026
Read appraisal →Journal of health organization and management
Implementing telemedicine for cancer care in European healthcare organizations: lessons from the eCAN Joint Action
PURPOSE: Telemedicine represents a promising innovation to complement conventional cancer care in Europe to improve treatment quality and patient outcomes. Funded between September 2022 and December 2024, the Joint Action "Strengthening eHealth including telemedicine and remote monitoring for health care systems for CANcer prevention and care" (eCAN JA) aimed to bring the benefits of telemedicine to cancer patients across the European Union (EU) Member States, with 35 partner organizations from 16 countries and explored its feasibility through multicenter clinical trials. This study sheds light on key factors to implement telemedicine services for cancer care in European healthcare organizations (HCOs) and offers a forward-looking perspective by conducting a foresight exercise as part of the Sustainability Work Package (WP4) of the eCAN JA. DESIGN/METHODOLOGY/APPROACH: Foresight is an umbrella term for innovative strategic planning, policy formulation and solution design methods that empower decision-makers. For our multi-country foresight study, we followed three sequential steps to gain qualitative and quantitative findings on the facilitators of telemedicine services for cancer patients in clinical settings, comprised of (1) literature review; (2) surveys to HCOs in different EU Member States and (3) a foresight workshop with survey respondents. FINDINGS: Telemedicine implementation in HCOs requires equipping healthcare professionals with the necessary skills, ensuring system compatibility and addressing resource constraints for hybrid care models for success. Future policies in the EU should focus on establishing telemedicine training for healthcare professionals and support interoperability as well as user-friendliness of telemedicine services in HCOs. Policies should also address clinical workload challenges, enable harmonized telemedicine protocols across Europe, provide incentives for implementation and invest in digital infrastructure in HCOs for a sustainable telemedicine adoption. ORIGINALITY/VALUE: To the best of our knowledge, this is the first study to conduct a foresight analysis on the feasibility of telemedicine for cancer care across different HCOs in EU Member States.
20 Apr 2026
Read appraisal →BMJ open
'It's not just diabetes': implementation enablers and barriers of an indigenous-focused virtual diabetes care clinic using the Consolidated Framework for Implementation Research (CFIR) - a qualitative assessment.
INTRODUCTION: Indigenous peoples living with diabetes face unique challenges accessing comprehensive specialty diabetes care. A small diabetes virtual care clinic oriented towards Indigenous individuals, and those in rural and remote communities, has provided care to over 400 individuals. OBJECTIVES: We characterised the distinguishing features of care provided at this clinic and used the Consolidated Framework for Implementation Research 2.0 (CFIR) to explore the enablers and barriers to implementing this model of care, from the perspective of the clinic's staff and providers. RESEARCH METHODS AND DESIGN: Guided by CFIR, we conducted eight semi-structured interviews with six clinic staff members. Deductive thematic analysis was used to identify relevant enablers and barriers. RESULTS: The aspirational features of care were cultural safety, comprehensiveness and virtual delivery. The implementation of this model of care was enabled by an internal culture of relational care; a nimble, resourceful, pragmatic and client-centred approach to virtual delivery; wayfinding and resources from key external organisations; community engagement and a small team of motivated and independent providers. Key barriers included the lack of physical interactions and uncertain or limited resources and funding. CONCLUSION: The identified enablers and barriers to implementing an Indigenous-focused virtual diabetes care clinic have implications for future interventions to improve rural Indigenous chronic disease care, and for governments and adjacent organisations tasked with meeting Canada's Truth and Reconciliation Commission's calls to action in healthcare. Further research examining the effectiveness of virtual diabetes care at this clinic is ongoing.
19 Apr 2026
Read appraisal →Journal of medical Internet research
Comparing Pulmonary Telerehabilitation and Center-Based Pulmonary Rehabilitation for Effectiveness and Adherence in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Pulmonary rehabilitation (PR) is a cornerstone of chronic obstructive pulmonary disease (COPD) management; however, access to traditional center-based PR (CBPR) remains limited. Digital and remote models, collectively termed pulmonary telerehabilitation (Tele-PR), have increasingly been used, but their heterogeneity in technology use, supervision, and interaction mode may influence effectiveness and sustainability. OBJECTIVE: This systematic review and meta-analysis aimed to compare the effectiveness and adherence of Tele-PR with those of CBPR in adults with COPD while systematically evaluating the impacts of supervision intensity and delivery models on key clinical outcomes. METHODS: This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) guidelines. PubMed, Embase, the Cochrane Library, and the Web of Science were searched from inception to December 10, 2025, to identify randomized controlled trials comparing Tele-PR or home-based PR (HBPR) with CBPR in adults with COPD. Random effects meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method. Between-study heterogeneity was assessed using τ², I², and 95% prediction intervals. Risk of bias was evaluated with the Cochrane Risk of Bias 2 tool, and certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS: Seventeen randomized controlled trials involving 1658 participants were included. After intervention, Tele-PR and CBPR showed comparable average effects on exercise capacity by 6-minute walk distance (k=9; n=950, 57.3%; mean difference -5.37 m, 95% CI -15.68 to 4.95; P=.26; τ²=103.97; I²=28.2%; 95% prediction intervals=-32.73 to 22.27). Although pooled effects were not statistically significant, substantial heterogeneity was observed across remote delivery models. Subgroup analyses linked digitally supported, synchronously supervised Tele-PR to less between-study variance across several outcomes, indicating greater consistency in treatment effects across different settings while revealing that low-technology HBPR yielded more variable outcomes, particularly in symptom burden. At long-term follow-up (≥6 mo), between-group differences in functional and symptom outcomes diminished, and short-term gains in exercise capacity did not consistently translate into increased daily physical activity. Certainty of evidence ranged from moderate to very low, mainly downgraded for performance bias, inconsistency across intervention models, and imprecision. CONCLUSIONS: Tele-PR may achieve short-term clinical outcomes comparable to CBPR. Distinct from prior reviews, we stratified remote programs by delivery models and supervision, identifying digitally supported Tele-PR and low-technology HBPR as 2 clinically distinct paradigms with differing consistency of effects. We further propose a structured "supervision gradient" to interpret model-dependent variability in effects across Tele-PR approaches, providing a context-sensitive framework for evidence-informed, model-specific implementation. Future remote rehabilitation should integrate real-time professional supervision and long-term behavioral maintenance to sustain benefits. Tele-PR may be particularly valuable for expanding PR access, while CBPR remains essential for patients requiring close in-person supervision or complex multidisciplinary care.
18 Apr 2026
Read appraisal →BMJ open
Remote assessment and practice implementation for disorders in ears, nose and throat: a mixed-methodology observational study in the United Kingdom
INTRODUCTION: Ear, nose and throat (ENT) conditions are highly prevalent in primary and secondary care, yet patients frequently face prolonged waits for specialist review. In England, over half of ENT patients wait beyond the NHS 18-week referral-to-treatment target. Many of these cases can be effectively managed with advice and non-surgical interventions, presenting an opportunity for remote service innovation.This study aims to evaluate the clinical effectiveness, cost-effectiveness, acceptability and environmental sustainability of a digitally enabled remote ENT clinic model compared with traditional face-to-face pathways. METHODS AND ANALYSIS: This single-centre, mixed-methods, prospective cohort study will be conducted at University Hospitals Birmingham NHS Foundation Trust. Remote clinics will use trained staff to collect diagnostic data (including endoscopic imaging and boothless hearing tests) for consultant review via secure cloud-based software. Quantitative analysis will assess patient outcomes, costs, waiting times, carbon footprint and satisfaction. Qualitative data from semi-structured interviews with patients, clinicians and managers will explore acceptability, scalability and barriers to implementation. The qualitative data will be analysed using the framework methodology, according to the non-adoption, abandonment, scale-up, spread and sustainability framework, while the strengthening the reporting of observational studies in epidemiology framework will be used to guide the reporting of quantitative data. Cost-effectiveness analyses will follow NICE guidelines, while environmental impact will be measurement will be informed by the sustainability in quality improvement framework. Recruitment will be aiming for 300 completed datasets and 30-35 interviews. ETHICS AND DISSEMINATION: Ethical approval has been granted (IRAS 350908; REC 25/SW/0116). Findings will be disseminated via conferences, peer-reviewed journals and institutional communication channels.
17 Apr 2026
Read appraisal →JMIR formative research
Development of Virtual Mental Health Stepped Care Service for a Heart Failure Remote Management Program: Qualitative Descriptive Study
BACKGROUND: Depression is highly prevalent yet undertreated among people living with heart failure, indicating barriers to mental health services. Although various digital mental health interventions have been developed to detect, treat, and manage depression in this population, these interventions have seen limited integration into clinical care and a lack of implementation research. Stepped care is a service innovation that may promote the implementation of these technologies into clinical settings, but few studies have examined how these services are designed in clinical settings. OBJECTIVE: This study aimed to identify strategies to address health system barriers to accessing mental health care from the perspective of people living with heart failure, clinicians, and researchers, and to incorporate these strategies into the design of a virtual mental health stepped care service within a heart failure remote management program. METHODS: A qualitative description study was conducted using purposive recruitment of people living with heart failure, clinicians, and researchers from a heart failure remote patient management program. As part of a service design approach, semistructured interviews explored potential strategies to address barriers to accessing mental health services. Two researchers coded the data descriptively and constructed themes to guide the development of a virtual stepped care service. RESULTS: A total of 22 participants were interviewed, comprising 13 people living with heart failure and 9 clinicians and researchers. Six themes were identified, comprising 4 requirements and 2 foundational principles. The requirements were to (1) adopt a collective approach to identify distress across methods, people, and time points; (2) maintain a referral-based approach; (3) rely on existing mental health human resources; and (4) offer patient choice among various mental health care options. These requirements were supported by two principles: (1) building on organizational strengths and (2) reducing treatment burden. Based on these findings, a virtual stepped care service was developed, incorporating a depression screening module, referral-based workflows, and, where clinically appropriate, patient choice in treatment selection. CONCLUSIONS: The stakeholder-informed design of this virtual stepped care service contributes to the limited literature on stepped care service design and demonstrates how such models can be tailored to their intended contexts. Although each component was designed to address health system barriers to mental health care for people living with heart failure, resource limitations may constrain the balance between feasibility and quality of care. Future research should evaluate the acceptability of this model among people living with heart failure and clinicians.
16 Apr 2026
Read appraisal →Sexual health
E-screening for sexually transmissible infections and blood-borne viruses in New South Wales, Australia: a cost analysis.
BACKGROUND: MyCheck is an e-testing pathway, first implemented at Sydney Sexual Health Centre, which enhances access to STI/HIV testing via telehealth and off-site sample collection; thus, reducing clinic visits. This study evaluates MyCheck's direct and indirect costs versus standard in-person screening (Xpress). METHODS: A 12-month bottom-up cost analysis from a societal perspective compared MyCheck and Xpress. Direct medical (health system), direct non-medical (patient travel) and indirect non-medical (productivity) costs were calculated using retrospective Sydney Sexual Health Centre data. Costs included pathology, staff time, overheads, consumables, patient travel and forgone productivity. Statewide scale-up costs were estimated, with sensitivity analyses adjusting for inflation, minimum wage and an increase in the proportion of MyCheck users with productivity loss. RESULTS: From January to July 2023, Sydney Sexual Health Centre conducted 2548 screening episodes (45% MyCheck, 55% Xpress), with MyCheck attracting more men who have sex with men/transgender and gender diverse patients. MyCheck's shorter appointments (median 5 min vs Xpress's 15 min) led to lower staff costs (A$5 vs A$16). MyCheck had higher overall health system cost (A$127/patient) compared with Xpress (A$91/patient), mostly due to pathology costs. However, considering patient travel cost and productivity loss for Xpress, MyCheck's societal cost (A$137) was lower than Xpress (A$146), yielding A$104,260 annual savings. Statewide scale-up provides significant societal savings (A$419,077/year). CONCLUSION: This analysis of MyCheck's direct and indirect costs compared with traditional in-person screening demonstrates significant societal savings, despite higher direct pathology costs. It underscores the importance of a broader societal perspective in cost analyses. Lowering private pathology costs could further enhance MyCheck's cost-effectiveness. MyCheck, an innovative e-screening pathway, reduces barriers for STI/blood-borne virus screening by improving patient convenience and reduced opportunity costs. Despite higher direct pathology costs, its societal cost savings support statewide scale-up for improved screening accessibility.
9 Apr 2026
Read appraisal →Physiological measurement
Towards fair and trustworthy heart rate estimation from wrist-worn photoplethysmography: a multi-wavelength dataset and uncertainty-aware deep learning approach evaluated across skin tones, sexes, and motion conditions
Objective.To improve fairness (reduced disparities across skin tones and sexes) and trust (well-calibrated uncertainty metrics that indicate unreliable predictions) in wrist-worn photoplethysmography (PPG) heart rate estimation. While PPG offers a convenient, low-cost method for continuous heart rate monitoring, accuracy is often degraded by motion artefacts and demographic variation.Approach.We collected a multi-wavelength (blue, green, red, IR) wrist-worn PPG dataset covering diverse activities, skin tones, and sexes, and developed a multi-branch PPG-accelerometer fusion convolutional neural network quantifying both aleatoric and epistemic uncertainty (the latter via Monte Carlo dropout, concrete dropout, and deep ensembles). We compared wavelength sets, quantified demographic effects, and applied uncertainty-aware post-processing to filter out high-uncertainty predictions. Evaluation used leave-one-subject-out cross validation across both the collected multi-wavelength dataset and five commonly used single-wavelength datasets.Main results.Multi-wavelength fusion improved accuracy under motion, with blue-green-red-IR achieving the lowest mean absolute error (MAE). Baseline error was higher for participants with darker skin tones and for females; uncertainty-guided rejection reduced MAE and effectively eliminated these gaps (reducing parity gaps from 1.2 BPM to 0.0 BPM for skin tone). Concrete dropout provided the best calibration-accuracy-efficiency trade-off, achieving the lowest average miscalibration area (MA=0.12) while maintaining competitive MAE.Significance.Combining calibrated uncertainty with group-aware evaluation yields a more fair and trustworthy wrist-worn PPG heart rate estimation pipeline, supporting responsible deployment in consumer and sports contexts and informing bias-aware clinical development.
9 Apr 2026
Read appraisal →Journal of medical Internet research
Supporting Access to Care Through Peripheral Devices and Patient-Generated Health Data: Qualitative Study
BACKGROUND: In 2016, the US Department of Veterans Affairs (VA) implemented a national initiative to distribute video-enabled tablets and peripheral devices, such as blood pressure monitors and weighing scales, to patients facing geographic, clinical, or socioeconomic challenges. Such patients could potentially benefit from health monitoring in conjunction with video-based care, as peripheral devices offer opportunities to enrich care received during a video visit and support tracking of health-related data collected outside of clinical care, or patient-generated health data. However, little is known about experiences with the devices and how they could support improved access to care. OBJECTIVE: We explored patients' experiences with VA-issued peripheral devices and their impact on video-based care and health monitoring outside of clinical visits. METHODS: We conducted in-depth semistructured interviews among patients who received VA-issued tablets and peripheral devices between 2023 and 2024. Purposive sampling was used to gather views based on gender, age, race or ethnicity, and rurality. Interviews were transcribed and analyzed using rapid qualitative analysis, guided by the Unified Theory of Acceptance and Use of Technology. RESULTS: Among 25 patients, most received a blood pressure monitor (21/25, 84%), a weight scale (14/25, 56%), and/or a pulse oximetry device (12/25, 48%). The majority reported using their peripheral devices (23/25, 92%) and tablets (19/25, 76%) to monitor their vital signs and attend video visits. Qualitative analysis yielded ten themes reflecting experiences and impacts of the devices, organized by the Unified Theory of Acceptance and Use of Technology constructs: "effort expectancy" consisted of (1) familiar and easy to use devices and (2) challenges of Bluetooth pairing and measurement; "performance expectancy" consisted of (3) integration with video visits, (4) health monitoring for peace of mind, (5) perceptions of improved vital signs and lifestyle behaviors, (6) removing obstacles to in-person care, and (7) desiring an overall picture of health; "social influence" consisted of (8) fostering care team connections and (9) promoting awareness of tablets and peripheral devices; and "facilitating conditions" consisted of (10) supportive help desk infrastructure. Overall, patients described using peripheral devices during virtual visits by syncing data to the tablet for real-time access by their care team. They also reported manually tracking and sharing patient-generated health data with their care team. Despite some challenges with Bluetooth pairing, patients found the devices easy to use and contributed to improved health and motivation. Devices also reduced logistical burdens of in-person visits, especially for those with limited mobility, visual impairments, mental health needs, or transportation barriers. CONCLUSIONS: Patients perceive that peripheral devices can enhance video-based care and support health care access and chronic disease management. Patients reported benefits to health, behavior, and communication with care teams. To maximize the impact, program enhancements should prioritize device interoperability, accessible training, and expanded outreach.
7 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis
AIMS: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD). METHODS AND RESULTS: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002]. CONCLUSION: Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms. REGISTRATION: PROSPERO: CRD42024521465.
5 Apr 2026
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