International Journal Of Telemedicine And Applications[JOURNAL]
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200 papers
Quality Appraisal of Telerehabilitation Guidelines: A Systematic Review.
Salahshoori F, Jangi M, Sadeghi-Demneh E … +2 more , Fatehi F, Rahimi A
Int J Telemed Appl · 2026 · PMID 42358745 · Full text
BACKGROUND: Telerehabilitation is an expanding domain of telehealth offering remote rehabilitation services. The quality of clinical guidelines, despite significant growth, is highly inconsistent, which may affect the qu...
BACKGROUND: Telerehabilitation is an expanding domain of telehealth offering remote rehabilitation services. The quality of clinical guidelines, despite significant growth, is highly inconsistent, which may affect the quality of care and policy execution. We endeavored to systematically assess the quality of general telerehabilitation guidelines using the AGREE II instrument. METHODS: A systematic search of six databases and grey literature identified 2575 records. After screening and eligibility assessment, seven guidelines were appraised independently by two reviewers using the AGREE II tool, covering six quality domains. RESULTS: Only the American Physical Therapy Association's 2024 guideline was rated high quality across all domains. Three guidelines were rated medium quality and recommended with modifications. The remaining three were deemed low quality due to weak methodological rigor and limited stakeholder involvement. CONCLUSION: The quality of telerehabilitation guidelines differs significantly, and high-quality, evidence-based, and inclusive guidelines are essential for promoting secure, efficient, and telerehabilitation practices globally.
Application of Digital Twin Technology to Enhance Chronic Diseases Management: A Systematic Review.
Zarei A, Gholamzadeh M, Asadi F
Int J Telemed Appl · 2026 · PMID 42294133 · Full text
BACKGROUND: Given that chronic diseases account for a considerable proportion of preventable deaths globally, the adoption of innovative technologies for disease management and prevention is crucial. Digital twins (DTs),...
BACKGROUND: Given that chronic diseases account for a considerable proportion of preventable deaths globally, the adoption of innovative technologies for disease management and prevention is crucial. Digital twins (DTs), representing one of the most advanced technological solutions, enable real-time simulation and monitoring of chronic disease progression, facilitating personalized treatment strategies and early intervention. This systematic review examines current research on DT applications in chronic disease management to evaluate their potential impact. METHODS: A systematic search was conducted in four databases including PubMed, Scopus, Web of Science, and IEEE from inception to the date of the last search. The research question was formulated using PICO framework. Next, all articles were screened following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to select eligible articles based on inclusion criteria. The extracted information was analyzed to determine the main applications, domains, and employed technologies using quantitative and qualitative techniques. RESULTS: Out of 298 citations, 20 studies met our inclusion criteria after duplicate removal and screening. Most studies (45%, = 10) were published between 2023 and 2024, indicating an increasing trend in this area. Geographically, the United States contributed the most studies (25%, = 5), followed by Switzerland (15%, = 3). Our analysis revealed that primary applications of DT in chronic disease management included medical training and education (65%, = 13), personalized medicine and patient care (45%, = 9), and drug discovery and clinical trials (35%, = 7). Target groups comprised clinicians (42.11%), patients (31.58%), and medical students (15.79%). Key enabling technologies in this subject were data analytics (65%), artificial intelligence and machine learning (60%), computational physiological modeling (30%), and IoT sensors (25%). CONCLUSIONS: Our findings demonstrate that DT technology has evolved from theoretical models to integrated clinical applications, with the potential to revolutionize healthcare through personalized medicine, continuous monitoring, and AI-driven decision support.
Delivering Health Coaching in a Student-Led Telehealth Clinic: Evaluating the Impact on Health-Related Quality of Life.
Matthews K, Haines T
Int J Telemed Appl · 2026 · PMID 42272555 · Full text
Health professional student-led clinics are commonly integrated into programmes of study to provide unique learning opportunities for students and provide improved access to care for underserved populations. Participant...
Health professional student-led clinics are commonly integrated into programmes of study to provide unique learning opportunities for students and provide improved access to care for underserved populations. Participant health outcomes from student-led clinics are infrequently reported and are hard to compare with outcomes from other intervention approaches. This study aims to examine change in participant health-relate-d quality of life following engagement in a telehealth mediated health coaching focussed student-led clinic in Australia. Pre-post data using the EQ-5D-5L instrument were collected from 369 participants in the student-led telehealth clinic between August 2020 and August 2024. Participant data were converted to a utility score relevant to an Australian population. The mean change in health utility score after participating in the clinic was 0.06 (95% CI 0.03-0.08, < 0.001). Regression analyses showed that a significant positive change in mean utility score was observable in younger (18-35) participants (0.13, 95% CI 0.05-0.21, = 0.001), females (0.06, 95% CI 0.02-0.09, = 0.001) and participants with a lower baseline (< 0.6) utility score (0.14, 95% CI 0.07-0.20, < 0.001). Significant change was observed across physical health, psychological and environmental concerns. As health coaching is known to be an important feature of preventative health strategies, this research is a promising indicator of how a student-led telehealth clinic may be an effective contributor to the health care ecosystem.
AI-Based Intraoral Videography for Automated Dental Inspection and Charting in Children With Mixed Dentition.
Abu Talib M, Moufti MA, Alrachid R … +4 more , Abu Waraga O, Aldhafairi L, Alfahad S, Alhaddabi A
Int J Telemed Appl · 2026 · PMID 42220419 · Full text
Examination and documentation (charting) of teeth are indispensable yet labor-intensive processes, especially in pediatric patients, where mixed dentition, anatomical variability, and limited cooperation during imaging p...
Examination and documentation (charting) of teeth are indispensable yet labor-intensive processes, especially in pediatric patients, where mixed dentition, anatomical variability, and limited cooperation during imaging present unique challenges. Despite their distinguished potential, existing AI models lack applicability to pediatric dentistry because they are mostly designed for adult dentition and use radiographic images. To fill this gap, we developed an AI-powered model for automated pediatric dental charting using real-time intraoral videos, utilizing a YOLO-based object detection framework. The model was trained to classify 44 tooth types, including primary and permanent dentitions. The dataset is composed of 112,538 frames extracted from 89 intraoral footages of children aged 6-12 years at diverse dental development stages. Of this dataset, 80% was allocated for training and 20% for testing. The model achieved a mAP@0.5 of 0.405, with a precision of 0.495 and a recall of 0.405 across all tooth classes. Notably, the model performed substantially better in detecting primary teeth, achieving a mAP@0.5 of 0.616, compared to 0.255 for permanent teeth, due to the latter's ongoing eruption and inconsistent appearance. Despite these limitations, this study is a major advancement toward automating pediatric dental charting and will pave the way for future developments in AI applications for pediatric dentistry, facilitating early caries detection for children in schools and in large-scale public health screening programs.
Perspectives of Rehabilitation Specialists on Telerehabilitation in Jordan: Knowledge, Attitudes, and Implementation Barriers.
Al-Wardat M, Almomani AA, Yabroudi M … +1 more , Almhdawi K
Int J Telemed Appl · 2026 · PMID 42199646 · Full text
BACKGROUND: Telerehabilitation (TR) has emerged as a promising approach to improving access to rehabilitation services, particularly in low- and middle-income countries such as Jordan. However, successful implementation...
BACKGROUND: Telerehabilitation (TR) has emerged as a promising approach to improving access to rehabilitation services, particularly in low- and middle-income countries such as Jordan. However, successful implementation largely depends on rehabilitation specialists' knowledge, attitudes, and perceived barriers. AIMS: This study is aimed at exploring rehabilitation specialists' perspectives on TR in Jordan, focusing on their knowledge, attitudes, current use, and perceived implementation barriers. METHODS: A cross-sectional study was conducted among rehabilitation specialists including physical therapist, occupational therapist, and speech and language therapist practicing in Jordan. Participants completed a validated 27-item Rehabilitation Specialists' Knowledge, Attitudes, and Barriers to TR Questionnaire. Descriptive statistics were used to summarize participants' demographic characteristics and their responses related to TR knowledge, attitudes, and perceived barriers. RESULTS: A total of 300 rehabilitation specialists (mean age = 28.6 ± 6.1 years; 51% female) were included in the analysis, comprising equal numbers of physiotherapists, occupational therapists, and speech and language therapists. Overall, 81% of participants reported awareness of TR, and 57% indicated that TR was currently used in their workplace. Despite the generally favorable perceptions-59% considered TR socially somewhat acceptable and 75% believed it could save time, effort, or costs-actual engagement remained limited, with 35% reporting awareness without prior use and only 14% reporting regular use. Technological reliability and validity were endorsed by 78% and 72% of respondents, respectively. However, only 36% agreed that TR was comparable to face-to-face care. The most frequently reported barriers included limited public awareness (84%), technical issues such as poor internet connection (80%), provider willingness (74%), staff skill limitations including lack of training (71%), data privacy and security concerns (71%), location of healthcare institutions (69%), increased workload (69%), and lack of user-friendly software (61%). Early-career clinicians (< 5 years of experience), who constituted 67% of the sample, demonstrated greater openness toward TR compared with more experienced practitioners. CONCLUSION: Rehabilitation specialists in Jordan showed readiness to adopt TR. However, significant structural, educational, and cultural barriers appeared to hinder its widespread implementation.
CERV-Score: A Hybrid Machine Learning Framework for Cervical Cancer Risk Prediction Using Integrated Clinical and Genomic Data.
Alanazi AM, Dardouri S
Int J Telemed Appl · 2026 · PMID 42100295 · Full text
Cervical cancer remains a major global health burden, particularly in underserved populations where late diagnoses contribute to high mortality rates. Accurate, early risk prediction is essential for improving outcomes a...
Cervical cancer remains a major global health burden, particularly in underserved populations where late diagnoses contribute to high mortality rates. Accurate, early risk prediction is essential for improving outcomes and guiding preventive care. In this study, we introduce CERV-Score, a hybrid machine learning framework that advances prior approaches by combining structured clinical risk factors with recurrence-based genomic markers to generate continuous, probabilistic risk scores rather than traditional binary classifications. This enables nuanced patient stratification into low, moderate, and high-risk categories, providing clinicians with more actionable insights. Unlike previous models, CERV-Score integrates genomic recurrence analysis identifying genes consistently expressed across multiple RNA-seq samples to improve biological relevance and robustness. Additionally, we developed an interactive clinical-genomic decision support tool that delivers real-time, percentage-based risk predictions and includes a gene lookup function, bridging clinical practice and molecular exploration in a single platform. The hybrid CERV-Score model achieved high predictive performance (accuracy = 94.1, F1 - score = 0.91, AUC = 0.94). Bootstrap resampling (1000 iterations) applied to the test predictions produced a 95% confidence interval for accuracy of 92.8%-95.4%, confirming the stability and robustness of the model's performance. These results highlight the contribution of probabilistic scoring, recurrence-driven genomic integration, and interactive visualization to enhance both accuracy and usability. By combining methodological innovation with practical clinical utility, CERV-Score represents a meaningful step beyond existing hybrid models, laying the groundwork for more interpretable, personalized, and deployable cervical cancer risk prediction systems.
Reflecting on Themes From Telehealth Consultations Early in the Pandemic: An Opportunity to Learn From Multiprofessional Colleagues.
Meeks M, Joyce LR, Dean J … +7 more , Davies L, Ormond T, Seaton P, Sheehan D, Sutherland D, Welfare M, Basu A
Int J Telemed Appl · 2026 · PMID 42077803 · Full text
AIMS: This study is aimed at documenting the reflections of New Zealand healthcare professionals on the use of synchronous telehealth consultations. METHODS: A qualitative narrative inquiry was conducted to explore the p...
AIMS: This study is aimed at documenting the reflections of New Zealand healthcare professionals on the use of synchronous telehealth consultations. METHODS: A qualitative narrative inquiry was conducted to explore the practice of telehealth in New Zealand. Purposive sampling was used to identify clinicians from multiple professions who used telehealth during the initial phase of the COVID-19 pandemic. Fifteen semistructured interviews were conducted between October 2020 and May 2021 with clinicians from primary and secondary care, including multiple professional backgrounds. Interview transcripts were analysed thematically. RESULTS: Six themes were identified: (1) equitable access: There were concerns regarding equitable access to telehealth; (2) relationships and connections: This included connection with the whnau/family and their culture, between professions and as part of the wider health system; (3) information gathering and sharing: This included the visibility of the process as well as visibility of information regarding the client/patient; (4) adapting to change: There was significant variation between clinicians in transitioning to using telehealth; (5) professional boundaries: This included the prescribed boundaries such as the physical location of patients/clients, as well as unanticipated changes to personal, professional and organisational boundaries; (6) IT logistics: This included the potential technological drivers (enablers and disablers) within the process of incorporating telehealth. CONCLUSIONS: Telehealth was critical in healthcare provision during the COVID-19 pandemic and has continued to be used within healthcare delivery postpandemic. The themes identified provided insight into the importance of considering the provision of telehealth as a complex package and identifying contextual challenges as well as the enablers and potential benefits of using this modality.
A Real-Time, Location-Aware Remote Patient Monitoring System for Telemedicine Decision Support.
Cioca AL, Cioca M, Neamtu B
Int J Telemed Appl · 2026 · PMID 42007033 · Full text
Telemedicine has become an integral component of modern healthcare, particularly in contexts where direct patient-physician interaction is limited or unavailable. In such situations, access to objective physiological dat...
Telemedicine has become an integral component of modern healthcare, particularly in contexts where direct patient-physician interaction is limited or unavailable. In such situations, access to objective physiological data, real-time patient localization, and automated alerting can significantly improve situational awareness and support timely clinical decision-making. This paper presents a real-time, location-aware patient monitoring system developed as a low-cost, fully functional demonstration platform to support telemedicine services and risk-based alerting. The proposed system combines wearable-based physiological data acquisition with a mobile application that collects heart rate measurements and geographic coordinates, which are transmitted to a server-side platform for real-time processing, visualization, and alert generation. Patient status is displayed through an interactive map with risk-level indicators and complemented by time-series charts that facilitate the interpretation of physiological trends over time. Incoming data are continuously evaluated using a rule-based risk assessment mechanism, enabling automated email alerts when predefined critical conditions are detected. Alert notifications include relevant physiological values together with direct links to the patient's geographic location, supporting rapid response in emergency or high-risk scenarios. The system is evaluated from a functional and architectural perspective, demonstrating its ability to support remote monitoring, contextual awareness, and decision support in telemedicine settings, including telephone-based consultations. While the platform does not aim to provide clinical validation or long-term medical assessment, it illustrates the practical benefits of integrating wearable data, real-time localization, and automated alerting within a unified telemedicine-oriented framework. In addition, the proposed architecture is designed to support future extensions based on data-driven methods, including machine learning-based risk prediction and preventive health analytics. However, such approaches are not part of the current implementation and are outlined as directions for future research. The main contribution of this work lies in the design and implementation of a low-cost, location-aware telemedicine monitoring system that combines real-time data acquisition, integrated visualization, and actionable alerting within a unified and deployable architecture.
Implementation of Integrated Telemedicine Services in Resource-Limited Somalia: A Case Study of Baano Healthcare Technology.
Dirie NI, Ahmed MM, Mohamed AA
Int J Telemed Appl · 2026 · PMID 41993706 · Full text
BACKGROUND: Somalia's healthcare system faces significant challenges due to limited infrastructure and physician density (2.5 per 10,000 population). Telemedicine is a promising solution, particularly given the country's...
BACKGROUND: Somalia's healthcare system faces significant challenges due to limited infrastructure and physician density (2.5 per 10,000 population). Telemedicine is a promising solution, particularly given the country's mobile phone penetration rate of 54%. This study evaluated the implementation and impact of Baano Healthcare Technology's integrated telemedicine platform in Somalia, while also situating its utilization within the broader disparities in healthcare access, internet coverage, and socioeconomic context. METHODS: A descriptive quantitative analysis of operational data from Baano Healthcare Technology telemedicine services was conducted between July and October 2024. These services were delivered through an integrated digital platform that linked video consultations, hospital bookings, and interactive voice response self-management services within a single telemedicine system. Data were collected through three primary channels: digital consultation, hospital bookings, and IVR self-management services. Statistical analysis was performed using R programming software Version 4.4.0, and descriptive statistics and frequency distributions of service utilization patterns were calculated. Demographic data for digital users included age, sex, and residence, whereas IVR records lacked user-level metadata, which limited stratification. RESULTS: This study analyzed 610 users of video consultation and hospital booking services, along with 157,660 interactive voice response system interactions. The analysis revealed that 63.44% of users were aged 1-30 years, with a balanced sex distribution (50.82% male and 49.18% female). Hospital bookings constituted 73.61% of the services, whereas online consultations accounted for 26.39%. The Banadir region accounted for 80.49% of all users in the study. Dental services were the most requested specialty (42.98%), reflecting the scarcity of licensed dentists outside Mogadishu and the platform's role in facilitating access to rare specialties in the region. The IVR system was substantially used for chronic condition management (47%), with diabetes management being the most frequently accessed topic (23%). CONCLUSION: The implementation of integrated telemedicine services in Somalia demonstrates promising potential for expanding healthcare access, particularly in urban areas. However, its reach remains constrained by geographic and digital divides, with rural areas facing compounded barriers of poverty, provider scarcity, and low internet use. The platform's success in urban areas provides a model for expansion, although addressing infrastructure limitations and regulatory frameworks remains important.
Key Factors Associated With Nonuse of Telemedicine in Patients With Hypertension and/or Diabetes: Findings From the 2023 Indonesia Health Survey.
Alfian SD, Griselda M, Pratama MAA … +5 more , Wicaksono IA, Febriyanti RM, Insani WN, Abdulah R, Karuppannan M
Int J Telemed Appl · 2026 · PMID 41810083 · Full text
BACKGROUND: The Indonesian government has established a blueprint for health system digitalization aimed at improving health coverage. Despite the benefits of telemedicine services, its utilization remains low, and the f...
BACKGROUND: The Indonesian government has established a blueprint for health system digitalization aimed at improving health coverage. Despite the benefits of telemedicine services, its utilization remains low, and the factors associated with nonuse of telemedicine in Indonesia are not well understood. OBJECTIVE: This study aimed to assess the prevalence of telemedicine use and to identify factors contributing to its nonuse among patients with hypertension and/or diabetes, particularly considering that these patients require long-term medication management and monitoring. METHODS: This national cross-sectional study utilized data from the Indonesia Health Survey conducted in 2023, reflecting the postpandemic demographical conditions across 38 provinces in Indonesia. Telemedicine utilization and sociodemographic information were assessed based on a self-reported questionnaire. Logistic regression was performed to identify sociodemographic factors associated with nonuse of telemedicine. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. RESULTS: This study involved 63,012 patients with diabetes and/or hypertension. Most of them were women (65.1%), married (78.3%), aged 55-64 years (30.9%). Nearly all the respondents (98.0%) had not used telemedicine. Factors associated with nonuse of telemedicine included being unmarried (OR = 1.40; 95CI = 1.11-1.77), older than 34 years (OR = 3.83; 95CI = 1.90-7.73), having an educational background below the university level, farmer/fisherman and helper/laborer/driver, and living outside the islands of Java and Bali. Respondents with hypertension alone (OR = 1.67, 95CI = 1.32-2.11) were more likely to report nonuse of telemedicine compared with those with both diabetes and hypertension. CONCLUSIONS: The usage of telemedicine among patients with hypertension and/or diabetes in Indonesia is low. Personalized approaches that consider patient-specific factors and integrate telemedicine more frequently into the healthcare system are essential to enhance telemedicine adoption among patients with hypertension and/or diabetes in Indonesia.
Mobile Application for Perceived Stress and Self-Efficacy Management of Caregivers of Elderly Patients With Parkinson's Disease.
Sanaei H, Zare NV, Sadeghi T … +2 more , Sabi MS, Shoaibi A
Int J Telemed Appl · 2026 · PMID 41788295 · Full text
INTRODUCTION: Parkinson's disease (PD) places a substantial burden on caregivers, affecting their quality of life and potentially compromising patient care. Mobile health (mHealth) interventions may help reduce these cha...
INTRODUCTION: Parkinson's disease (PD) places a substantial burden on caregivers, affecting their quality of life and potentially compromising patient care. Mobile health (mHealth) interventions may help reduce these challenges. This study was aimed at evaluating the effect of a mobile application on perceived stress and self-efficacy among caregivers of older adults with PD. METHOD: This randomized controlled clinical trial was conducted with 80 caregivers recruited from the Neurology Clinic of Qaim Hospital, Iran. Participants in the intervention group received access to a PD management mobile application along with face-to-face training, while the control group received only face-to-face training at the clinic. Both groups completed the Cohen Perceived Stress Inventory and the Caregiver Self-Efficacy Scale at baseline, immediately after the intervention, and 1 month later. RESULTS: Immediately after the intervention, the intervention group demonstrated significantly lower perceived stress compared to the control group ( = 0.018). However, this difference was not sustained at the 1-month follow-up ( = 0.115). Within-group analyses showed no significant change in stress levels over time ( > 0.05). Self-efficacy scores improved in the intervention group, particularly in the domains of "gathering information about treatment" ( = 0.031) and "completing household tasks" ( = 0.041). CONCLUSION: The mobile application improved caregivers' self-efficacy and temporarily reduced perceived stress, suggesting its potential as a supportive tool for individuals caring for older adults with PD. Integrating mHealth solutions may enhance caregiver well-being and contribute to better caregiving outcomes.
Use of Mobile Application for Improving Drug Compliance and Clinical Outcomes: A Randomized Controlled Trial.
Mehta PK, Rao AR, Upadhyay N … +6 more , Mustafa S, Digra V, Wariar AS, Soni N, Chatterjee P, Chakrawarty A
Int J Telemed Appl · 2026 · PMID 41767018 · Full text
BACKGROUND: Older adults are prone to multimorbidity and polypharmacy, which often lead to adverse outcomes such as increased hospital admissions and treatment nonadherence. Smartphone and internet use among older adults...
BACKGROUND: Older adults are prone to multimorbidity and polypharmacy, which often lead to adverse outcomes such as increased hospital admissions and treatment nonadherence. Smartphone and internet use among older adults in India is rising, but its potential for addressing healthcare needs like multimorbidity management and drug adherence remains underexplored. The "Know Your Meds (KYM)" Creda Health mobile application (app) on the Google Play Store serves as a digital health assistant, offering features such as medication information, drug interaction insights, and pill reminders to improve health outcomes. This randomized controlled trial is aimed at assessing the effectiveness of the AI-based mobile app KYM in improving clinical outcomes, medication adherence, and patient satisfaction among older Indian adults. METHODOLOGY: In this randomized controlled trial, 360 participants with multimorbidity (aged > 60 years) were randomly allocated into intervention ( = 182) and control ( = 175) groups with the intervention group using the KYM app for 12 weeks, whereas the control group received standard conventional healthcare. RESULTS: Although clinical outcomes like change in blood pressure, HbA1c, and lipid levels did not show a significant difference between the two groups, there was a significant difference in medication adherence at 12-week follow-up. However, no significant change was observed in patient satisfaction. CONCLUSION: The study highlights the potential of mobile health apps in promoting adherence, though further research is required to evaluate their impact on clinical outcomes with more tailored interventions.
Efficacy of Motion Sensor Telerehabilitation for Balance and Mobility in Parkinson's Disease: A Nonrandomized Controlled Pilot Study.
Prukviwat I, Piravej K, Sangveraphunsiri V … +2 more , Jitpugdee W, Terachinda P
Int J Telemed Appl · 2026 · PMID 41756104 · Full text
PURPOSE: We developed an innovative telerehabilitation system using a 3D camera with motion sensors that provided real-time feedback. This study is aimed at evaluating its efficacy in improving balance, gait, and mobilit...
PURPOSE: We developed an innovative telerehabilitation system using a 3D camera with motion sensors that provided real-time feedback. This study is aimed at evaluating its efficacy in improving balance, gait, and mobility, as well as its feasibility in patients with idiopathic Parkinson's disease (PD). MATERIALS AND METHODS: Participants with idiopathic PD self-selected into either a telerehabilitation (tele) group or a hospital-based rehabilitation (hospital) group. The tele group received two initial sessions of hospital-based rehabilitation sessions, followed by 14 telerehabilitation sessions using the innovative system. The hospital group received 16 sessions of hospital-based rehabilitation. Outcome measures included Berg Balance Scale (BBS) score, Chula Parkinson Mobility Scale (Chula PMS) score, gait speed, and step length. The feasibility of the telerehabilitation system was also assessed. RESULTS: Forty-six participants were recruited (tele group: = 23; hospital group: = 23). Both groups showed statistically significant improvements in the BBS scores (tele: post-pre = 3.50, < 0.001; hospital: post-pre = 4.35, < 0.001), with no statistically significant difference between the groups (mean difference: -0.85, = 0.454). Chula PMS score also improved significantly in both groups (tele: post-pre = 3.45, < 0.001; hospital: post-pre = 5.70, < 0.001) without a statistically significant difference between the groups (mean difference: -2.25, = 0.086). The attendance rate exceeded 90% in both groups. CONCLUSIONS: The motion sensor telerehabilitation significantly improved balance and mobility in PD patients with no statistically significant differences between the two groups. Feasibility was high. However, the BBS improvements did not reach the minimal clinically important difference, indicating the need for further investigation. TRIAL REGISTRATION: Thai Clinical Trials Registry identifier: TCTR 20220924001.
Effectiveness of Digital and Remote Health Interventions in Pediatric Populations From Underserved or Rural Areas: A Systematic Review of Randomized Controlled Trials.
Beltrán V, Abarza L, Acuña-Mardones P … +7 more , Espinoza I, Chaple Gil A, Morales-Gómez C, Campos-Bijit V, Contador R, Díaz L, Fernández E
Int J Telemed Appl · 2026 · PMID 41705276 · Full text
BACKGROUND: Children living in underserved and rural areas experience significant barriers to healthcare access due to geographic isolation, health workforce shortages, and systemic inequities. Digital and remote health...
BACKGROUND: Children living in underserved and rural areas experience significant barriers to healthcare access due to geographic isolation, health workforce shortages, and systemic inequities. Digital and remote health interventions such as telehealth, telemental health (TMH), and mobile health (mHealth) offer promising strategies to improve pediatric health outcomes in these contexts. However, the extent of their effectiveness remains insufficiently examined through high-quality evidence. METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines and structured using the PROPS framework. Five databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Library) were searched for randomized controlled trials (RCTs) published until May 2025. Eligible studies targeted children (0-17 years) in underserved or rural settings and evaluated digital or remote interventions versus standard care. Data were extracted on study design, population, intervention modality, outcomes, and implementation characteristics. Risk of bias was assessed using the Cochrane RoB 2.0 tool. RESULTS: Eleven RCTs were included, covering interventions for obesity, asthma, ADHD, diabetes, oral health, and neonatal care. Telehealth interventions improved behavioral and biometric outcomes (e.g., BMI -score, and adherence), particularly in the United States. TMH showed high fidelity and effectiveness for ADHD management. mHealth interventions in low- and middle-income countries enhanced referral rates, service coverage, and caregiver engagement. Most studies were rated low risk of bias, though few incorporated economic or equity analyses. CONCLUSIONS: Digital health interventions are effective and feasible for improving pediatric outcomes in underserved settings. Future research should emphasize long-term impact, cost-effectiveness, and equitable access to ensure sustainable and inclusive digital healthcare delivery.
Enhancing the Diagnosis of Behçet's Disease Using Machine Learning: A Comparative Study on Clinical Data From Saudi Arabia.
Alalwany H, Alganmi N, Bawazir Y … +5 more , Mustafa M, Abusamra H, Banjar H, Alhothali A, Albaradei S
Int J Telemed Appl · 2026 · PMID 41583997 · Full text
Behçet's disease (BD) is one of the most difficult diseases to diagnose in the field of rheumatic immune diseases because it is rare, has many different symptoms, and we do not know much about how it works. Instead of tr...
Behçet's disease (BD) is one of the most difficult diseases to diagnose in the field of rheumatic immune diseases because it is rare, has many different symptoms, and we do not know much about how it works. Instead of trying to make a direct clinical diagnosis, this study was set up as an exploratory investigation to find out more about BD and figure out which clinical and laboratory features are most important. To accomplish this, clinical data were gathered from 148 patients (76 with bipolar disorder and 72 with rheumatoid arthritis) at the Rheumatology Clinic of King Abdulaziz University. We used several machine learning (ML) algorithms, such as decision tree, bagging, random forest (RF), XGBoost, and support vector machines (SVMs), to see if they could learn patterns that set BD apart from other rheumatic diseases. We used three different methods to find out how important each feature was: built-in model importance, permutation-based analysis, and Shapley additive explanation (SHAP) values. The ML models worked well, with the RF getting the best accuracy (96.7%) and an area under the curve (AUC) of 1.0. XGBoost came in second with an AUC of 0.9985. The feature analysis showed that the results were partially in line with established diagnostic criteria (Japan, ISG, and ICBD), with oral ulcers being the most important feature. Overall, this study serves as an exploratory framework to deepen understanding of BD's distinctive characteristics and underlying feature interactions, offering insights that can inform future diagnostic support systems rather than serving as a diagnostic tool itself.
Integrating Large Language Models Into UAE Community Pharmacies: Pharmacists' Perspectives on Benefits, Concerns, and Implementation Barriers.
Jarab AS, Al Meslamani AZ, Al-Qerem W … +3 more , Alyafeai H, Al Hamarneh YN, Eberhardt J
Int J Telemed Appl · 2026 · PMID 41542144 · Full text
BACKGROUND: The UAE's rapid economic growth and adoption of advanced healthcare technologies necessitate understanding pharmacists' perspectives on large language models (LLMs) to address implementation challenges and al...
BACKGROUND: The UAE's rapid economic growth and adoption of advanced healthcare technologies necessitate understanding pharmacists' perspectives on large language models (LLMs) to address implementation challenges and align with the nation's digital health initiatives. AIM: This study explored UAE pharmacists' perceived benefits, concerns, and barriers to LLM adoption, as well as factors contributing to heightened concerns in community pharmacies. METHODS: A survey-based cross-sectional study was conducted among 528 community pharmacists (51.3% female) in the UAE between October and November 2024. Pharmacists completed a validated questionnaire assessing socio-demographic information, perceived benefits, concerns, and barriers related to LLM use. Binary logistic regression was applied to identify factors associated with concerns about LLMs. RESULTS: The least-perceived benefits of LLMs included providing around-the-clock support (37.3%), designing personalized care plans (74.4%), and improving patient outcomes (77.0%). Barriers included the need for human supervision (54.7%), insufficient training (32.4%), lack of pharmacy-focused LLM programs (28.4%), and inadequate resources (28.4%). Key concerns were technical failures or downtime (97.5%), hacking vulnerabilities (97.2%) and limited capacity for empathy, cultural understanding, or ethical considerations in healthcare (95.6%). Increased age was significantly associated with greater concerns (OR = 1.124, p < 0.001). Conversely, pharmacists with master's or doctoral degrees (OR = 0.483, p = 0.008) and those likely to use LLMs in the future (OR = 0.357, < 0.001) expressed fewer concerns. CONCLUSION: The integration of LLMs into community pharmacy practice faces challenges, including hacking risks, security vulnerabilities, insufficient empathy, and technical failures. Targeted interventions such as enhanced training, robust security measures, and tailored LLM solutions are essential to address these barriers and support safe adoption in pharmacy settings.
Enhancing the Informed Consent Process in Pediatric Surgery Through an Educational Smartphone Application: Feasibility and Outcomes.
Bisanti C, Di Mitri M, Di Carlo F … +10 more , Di Carmine A, Collautti E, Cravano SM, Carta S, Gazzo G, Mauro R, Pichierri G, D'Antonio S, Gargano T, Lima M
Int J Telemed Appl · 2026 · PMID 41542143 · Full text
BACKGROUND: Informed consent (IC) is essential in medical decision-making, ensuring that patients and their families fully understand the consequences of treatment options. In pediatric surgery, however, the process is o...
BACKGROUND: Informed consent (IC) is essential in medical decision-making, ensuring that patients and their families fully understand the consequences of treatment options. In pediatric surgery, however, the process is often inadequate due to limited consultation time, high parental anxiety, and widespread misinformation. This study evaluates the effectiveness of the "ChPedBo" smartphone application in improving parental understanding and reducing preoperative anxiety. METHODS: A prospective observational study was conducted at the Department of Pediatric Surgery, IRCCS Sant'Orsola-Malpighi University Hospital of Bologna. A total of 150 questionnaires were distributed to parents of children scheduled for elective surgery; 100 completed questionnaires were included in the final analysis. Parents completed a structured 9-item questionnaire assessing knowledge, anxiety, usefulness, and satisfaction before and after using the "ChPedBo" app. Statistical analysis included the Wilcoxon signed-rank test, with a significance threshold set at < 0.05. RESULTS: Parental knowledge of their child's condition significantly improved after using the app, with mean scores increasing from 2.39 to 3.14 ( = 3.88 × 10). Similarly, comprehension of the surgical procedure improved from 2.27 to 3.20 ( = 1.71 × 10). Preoperative anxiety levels decreased from 1.64 to 1.36 ( = 0.0073). The app was rated highly useful (mean score 2.64) and received a high overall satisfaction rating (mean score 2.70). CONCLUSIONS: The "ChPedBo" app significantly enhanced parental understanding and reduced preoperative anxiety, demonstrating its potential as a valuable digital tool in the IC process for pediatric surgery. Future studies should explore its application in emergency settings and its long-term impact.
Gamification in Stomatherapy: Virtual Game for Pressure Injury Care.
Malheiros KM, Alves LG, da Costa RMEM … +6 more , David HMSL, de Paula HC, Daher DV, de Andrade CND, Werneck VMB, de Araujo Faria MG
Int J Telemed Appl · 2026 · PMID 41522084 · Full text
INTRODUCTION: Pressure injuries are injuries caused by reduced blood circulation over regular and repetitive periods when applying pressure to a specific area of the body. This incident requires daily prevention and heal...
INTRODUCTION: Pressure injuries are injuries caused by reduced blood circulation over regular and repetitive periods when applying pressure to a specific area of the body. This incident requires daily prevention and health promotion to prevent its occurrence. OBJECTIVE: To develop and evaluate a virtual board game with guidelines for pressure injury prevention for nurses specializing in stoma therapy. METHODOLOGY: This is an applied, exploratory, and descriptive technological development study. The game was developed in stages consisting of: conceptual review, definition of the game dynamics, initial design of the board and cards, creation of the cards, and definition of the components. The study stages include development with a specialist team, testing and validation of the platform with specialist nurses, and subsequently, release of the final product. RESULTS: The results showed high acceptance of the game among the 17 participants, with emphasis on high levels of engagement and learning (≥ 94% reported acquiring new knowledge), ease of use (≥ 82% strongly agreed with the intuitiveness of the interface), and intention to continue using it (94% expressed a desire to continue using and recommend the tool). The main limitations identified were related to technical difficulties during installation and the lack of interactive features for multiple users. CONCLUSION: The results of this study reinforce the potential of gamification as a complementary and innovative strategy for teaching stomatherapy. The prototype proved to be an effective and well-accepted tool for educating nurses on pressure injury prevention, with significant potential for improving knowledge and clinical practice. It is believed that gamification, combined with theoretical teaching and practical learning, can mobilize and engage participants, significantly contributing to the development of highly qualified professionals and, consequently, improving the quality of patient care.
Design and Development of an Electronic Platform for Allergen Immunotherapy in China.
Wang W, Zhu Z, Fu W … +4 more , Hu Q, Shi X, Chen R, Li J
Int J Telemed Appl · 2025 · PMID 41477578 · Full text
BACKGROUND: A variety of patient populations receive allergen immunotherapy (AIT), but clinicians still lack an effective electronic platform to manage them. METHODS: We designed a platform based on the framework of valu...
BACKGROUND: A variety of patient populations receive allergen immunotherapy (AIT), but clinicians still lack an effective electronic platform to manage them. METHODS: We designed a platform based on the framework of value set extraction standardization, integration, and structurization. Average medication scoring (AMS) and other electronic medical records were developed and stored on a MySQL database. Data storage is hosted on cloud servers, linked to a mobile application, Bluetooth lung function monitoring, and a dedicated website that acts as a front-end. RESULTS: Since 2015, 23,847 patients in 48 hospitals with AIT prescriptions were included. Of these patients, the median age was 15 (interquartile range, 10-27) years. Allergic rhinitis was the most common disorder and accounted for 9753 (40.9%) of the cases. Five hundred and thirty-three basic data elements and six independent modules were constructed for the platform to facilitate the physicians in establishing SCIT projects, symptom scores, AMS, lung function tests, and follow-up appointments. One hundred and twelve drugs including 10 dosage forms were identified from an internal list of the dataset. The unit score was calculated based on the action mechanism of the medicine. The AMS formula has six parameters: total dose, frequency, period, unit score, unit dose, and follow-up days. A lower AMS suggests a better treatment efficacy. CONCLUSION: The program presented our experience in developing, pilot testing, and evaluating an electronic AIT platform, and future research would indicate whether the template could be made more time efficient in clinical practice.
Acceptability of Telehealth-Delivered Occupational Therapy Among Individuals With Long COVID Using the Theoretical Framework of Acceptability: A Qualitative Study.
Müllenmeister C, Königs G, Heinemann S … +9 more , Schröder D, Müller F, Hummers E, Stölting A, Happle C, Dopfer-Jablonka A, Behrens G, Marotzki U, Schmachtenberg T
Int J Telemed Appl · 2025 · PMID 41477577 · Full text
BACKGROUND: Long COVID still challenges healthcare systems worldwide. Tailored treatments are scarce. In the ErgoLoCo study, we have developed and tested a telehealth-delivered occupational therapy intervention for peopl...
BACKGROUND: Long COVID still challenges healthcare systems worldwide. Tailored treatments are scarce. In the ErgoLoCo study, we have developed and tested a telehealth-delivered occupational therapy intervention for people affected by long COVID. Acceptability from both recipients and providers is a prerequisite for implementing such new interventions. AIM: This study is aimed at exploring the perceptions of people with long COVID and occupational therapists regarding the intervention's acceptability and telehealth delivery approaches. METHODS: Semistructured interviews were conducted with 13 participants who experience long COVID and received the ErgoLoCo intervention delivered as teletherapy sessions or prerecorded videos. Eight occupational therapists who guided the teletherapy sessions participated in a focus group. Materials were analyzed following qualitative descriptive methods and interpreted using the theoretical framework of acceptability (TFA). RESULTS: Occupational therapists and long COVID clients considered the occupational therapy approach a positive experience. While all participants in the teletherapy group found the occupational therapy approach helpful in coping with long COVID symptoms and regaining participation in meaningful occupations, perceptions varied in the group supplied with prerecorded videos. Some saw the intervention as helpful, but all emphasized the need for professional support from occupational therapists to use the program more effectively. The occupational therapists emphasized the need to tailor the therapy content to clients' needs to ensure effective and successful management of occupational challenges. DISCUSSION: The study highlights telehealth-delivered occupational therapy's potential benefits and challenges for individuals with long COVID. It contributes to understanding the challenges and potential of telehealth-delivered occupational therapy for long COVID rehabilitation. This study's key finding is the importance of personalized and professionally guided telehealth interventions. German Clinical Trial Registry identifier DRKS00029990.
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