@Article{info:doi/10.2196/68233, author="Olimb Hillkirk, Anstein and Skavberg Roaldsen, Kirsti and Johnsen, Mari Hege", title="Physiotherapists' User Acceptance of a Lower Limb Robotic Exoskeleton in Specialized Rehabilitation: Qualitative Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="16", volume="12", pages="e68233", keywords="assistive technology", keywords="clinical implementation", keywords="deductive analysis", keywords="robot-assisted gait training therapy", keywords="RAGT", keywords="user experiences", keywords="unified theory of acceptance and use of technology", keywords="UTAUT", keywords="rehabilitation", abstract="Background: Robotic lower limb exoskeletons have emerged as promising tools in the clinical rehabilitation of patients with lower limb paralysis due to neurological disease, stroke, or spinal cord injury. Identified benefits in gait function rehabilitation include improved gait function, cardiovascular effects, enhanced training quality, patient motivation, and reduced physical and psychological workload for therapists. Despite the identified benefits, the successful adoption of this technology largely depends on therapists' user acceptance. Objective: This study aims to explore physiotherapists' perceptions of using robot-assisted lower-limb gait training in specialized neurological rehabilitation using the unified theory of acceptance and use of technology framework. Methods: A qualitative, exploratory research design with a deductive approach was used. Semistructured interviews were conducted with 7 expert physiotherapists in a Norwegian specialized rehabilitation hospital. Data collection and analysis were guided by the unified theory of acceptance and use of technology framework. Results: The physiotherapists' use of lower limb exoskeletons was greatly influenced by perceived benefits for patients or challenges, such as usability issues, the time required for adjustment to each patient, and the lack of personnel resources to facilitate their use. Thus, perceived usefulness and facilitating conditions (or lack thereof) had a great influence on the physiotherapists' intentions to use and the actual use of the exoskeleton. Conclusions: This study identified several factors influencing the physiotherapists' acceptance and integration of the lower limb exoskeleton. Available resources, such as time and personnel, were emphasized as important factors to increase the use of the exoskeleton in specialized rehabilitation. Our findings may inform service providers and engineers in specialized neurological rehabilitation settings. ", doi="10.2196/68233", url="https://rehab.jmir.org/2025/1/e68233", url="http://www.ncbi.nlm.nih.gov/pubmed/40238235" } @Article{info:doi/10.2196/63017, author="Lempe, Notger Paul and Guinemer, Camille and F{\"u}rstenau, Daniel and Dressler, Corinna and Balzer, Felix and Schaaf, Thorsten", title="Health Care Social Robots in the Age of Generative AI: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="Apr", day="14", volume="14", pages="e63017", keywords="robotics", keywords="social robots", keywords="artificial intelligence", keywords="generative AI", keywords="human-robot interaction", keywords="health care sector", keywords="PRISMA", abstract="Background: Social robots (SR), sensorimotor machines designed to interact with humans, can help to respond to the increasing demands in the health care sector. To ensure the successful use of this technology, acceptance is paramount. Generative artificial intelligence (AI) is an emerging technology with the potential to enhance the functionality of SR and promote user acceptance by further improving human-robot interaction. Objective: We present a protocol for a scoping review of the literature on the implementation of generative AI in SR in the health care sector. The aim of this scoping review is to map out the intersection of SR and generative AI in the health care sector; to explore if generative AI is applied in SR in the health care sector; to outline which models of generative AI and SR are used for these implementations; and to explore whether user acceptance is reported as an outcome following these implementations. This scoping review supports future research by providing an overview of the state of connectedness of 2 emerging technologies and by mapping out research gaps. Methods: We follow the methodological framework developed by Arksey and O'Malley and the recommendations by the Joanna Briggs Institute. Our protocol was drafted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews). We will conduct a systematic literature search of the online databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and IEEE Xplore, aiming to retrieve relevant data items via tabular data charting from references meeting specific inclusion criteria which are studies published from 2010 onwards, set in the health care sector, focusing on SR with physical bodies and implemented generative AI. There are no restrictions on study types. Results will be categorized, clustered, and summarized using tables, graphs, visual representations, and narratives. Results: After conducting a preliminary search and deduplication in the second quarter of 2024, we retrieved 3176 preliminary results. This scoping review will be supplemented with the next methodological steps, including retrieving the results in a reference management tool as well as screening titles, abstracts, and full text regarding specific inclusion criteria. The completion of these steps is scheduled for the second quarter of 2025. Limitations based on the heterogeneity of the included studies and the general breadth of a scoping review compared to a systematic review are to be expected. To reduce bias, we adopted a system of dual reviews and thorough documentation of the study selection. Conclusions: The conducted preliminary search implies that there are a sufficient number of heterogeneous references to complete this scoping review. To our knowledge, this is the first scoping review on generative AI in health care SR. International Registered Report Identifier (IRRID): PRR1-10.2196/63017 ", doi="10.2196/63017", url="https://www.researchprotocols.org/2025/1/e63017" } @Article{info:doi/10.2196/62957, author="Song, Jiafeng and Sridhar, Iytha Rishika and Rogers, Marie Darlene and Hiddleson, Cheryl and Davis, Carolyn and Holden, Lynn Tina and Ramsey-Haynes, Shanna and Reif, Lisa and Swann, Julie and Jabaley, S. Craig and Gullatte, Mary and Kamaleswaran, Rishikesan", title="Clinicians' Perceptions and Potential Applications of Robotics for Task Automation in Critical Care: Qualitative Study", journal="J Med Internet Res", year="2025", month="Mar", day="28", volume="27", pages="e62957", keywords="robotics", keywords="intensive care units", keywords="critical care", keywords="health care technology", keywords="qualitative study", abstract="Background: Interest in integrating robotics within intensive care units (ICUs) has been propelled by technological advancements, workforce challenges, and heightened clinical demands, including during the COVID-19 pandemic. The integration of robotics in ICUs could potentially enhance patient care and operational efficiency amid existing challenges faced by health care professionals, including high workload and decision-making complexities. Objective: This qualitative study aimed to explore ICU clinicians' perceptions of robotic technology and to identify the types of tasks that might benefit from robotic assistance. We focused on the degree of acceptance, perceived challenges, and potential applications for improving patient care in 5 Southeastern US hospitals between January and August 2023. Methods: A qualitative study through semistructured interviews and questionnaires was conducted with 15 ICU clinicians (7 nurses, 6 physicians, and 2 advanced practice providers) from 5 hospitals in the Southeast United States. Directed content analysis was used to categorize and interpret participants' statements, with statistical tests used to examine any role-based differences in how they viewed robotic integration. Results: Among the 15 participants, 73\% (11/15) were female, with an average of 6.4 (SD 6.3) years of ICU experience. We identified 78 distinct tasks potentially suitable for robotic assistance, of which 50 (64\%) involved direct patient care (eg, repositioning patients and assisting with simple procedures), 19 (24\%) concerned indirect patient care (eg, delivering supplies and cleaning), 6 (8\%) addressed administrative tasks (eg, answering call lights), and 3 (4\%) were classified as mixed direct and indirect (eg, sitting with a patient to keep them calm). Most participants supported the automation of routine, noncritical tasks (eg, responding to nurse calls and measuring glucose levels), viewing this strategy as a way to alleviate workload and enhance efficiency. Conversely, high-complexity tasks requiring nuanced clinical judgment (eg, ventilator settings) were deemed unsuitable for full automation. Statistical analysis revealed no significant difference in how nurses, physicians, and advanced practice providers perceived these tasks (P=.22). Conclusions: Our findings indicate a significant opportunity to use robotic systems to perform noncomplex tasks in ICUs, thereby potentially improving efficiency and reducing staff burden. Clinicians largely view robots as supportive tools rather than substitutes for human expertise. However, concerns persist regarding privacy, patient safety, and the loss of human touch, particularly for tasks requiring high-level clinical decision-making. Future research should involve broader, more diverse clinician samples and investigate the long-term impact of robotic assistance on patient outcomes while also incorporating patient perspectives to ensure ethical, patient-centered adoption of robotic technology. ", doi="10.2196/62957", url="https://www.jmir.org/2025/1/e62957" } @Article{info:doi/10.2196/48226, author="Chiu, Ching-Ju and Hua, Lin-Chun and Chiang, Jung-Hsien and Chou, Chieh-Ying", title="User-Centered Prototype Design of a Health Care Robot for Treating Type 2 Diabetes in the Community Pharmacy: Development and Usability Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="18", volume="12", pages="e48226", keywords="robot", keywords="diabetes", keywords="self-management", keywords="middle-aged adult", keywords="community pharmacy", keywords="older adult", keywords="prototype", abstract="Background: Technology can be an effective tool for providing health services and disease self-management, especially in diabetes care. Technology tools for disease self-management include health-related applications for computers and smartphones as well as the use of robots. To provide a more effective continuity of care and to better understand and facilitate disease management in middle-aged and older adult patients with diabetes, robots can be used to improve the quality of care and supplement community health resources, such as community pharmacies. Objective: The aim of this study was to develop a health care robot prototype that can be integrated into current community pharmacies. Methods: Three user-centered approaches were used: (1) review of the literature on technology use among older adults, 2) reference to the seven key diabetes self-care behaviors by the American Association of Diabetes Educators (AADE), and (3) meeting with health care providers in the community. Field investigations and interviews were conducted at community pharmacies and diabetes health education centers to determine the appearance, interface, content, and function of the robot. Results: The results show that diabetes health care prototype robots can be established through user-centered design. The following important features were revealed: (1) perceived ease of use is considered a friendly operating interface; therefore, we used less than 3 buttons in an interface; (2) minimization of the interface between blue and yellow, which is unfriendly to older adults; (3) the health education mode was the most preferred mode with sound, image, and video presentation; (4) the most predilected functions are health education resources and health records, and that patient data can be easily collected through health education games and dialogue with robots; and (5) touching the screen is the most preferred operation mode. Conclusions: An evidence-based health care robot can be developed through user-centered design, an approach in which a model that connects medical needs to people with health conditions can be built, thereby facilitating the sustainable development of technology in the diabetes care field. ", doi="10.2196/48226", url="https://humanfactors.jmir.org/2025/1/e48226" } @Article{info:doi/10.2196/59892, author="Fan, Wenqi and Zhao, Rui and Liu, Xiaoxia and Ge, Lina", title="Intelligent Robot Interventions for People With Dementia: Systematic Review and Meta-Analysis of Randomized Controlled Trials", journal="J Med Internet Res", year="2025", month="Mar", day="10", volume="27", pages="e59892", keywords="intelligent robot", keywords="artificial intelligence", keywords="dementia", keywords="agitation", keywords="anxiety", keywords="meta-analysis", abstract="Background: The application of intelligent robots in therapy is becoming more and more important for people with dementia. More extensive research is still needed to evaluate its impact on behavioral and psychological dementia symptoms, as well as quality of life in different care settings. Objective: The purpose of this research is to methodically assess how well intelligence robot interventions work for patients with dementia. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, a comprehensive search was conducted on PubMed, CINAHL, the Cochrane Library, Embase, and Web of Science from the time of their founding to February 2024, to identify relevant randomized controlled trials on the use of intelligent robots in people with dementia. Two authors (WF and RZ) independently applied the Cochrane Collaboration bias assessment tool to assess the included studies' quality. The intervention effect of intelligent robots on patients with dementia was summarized using a fixed-effect model or a random-effects model with Stata software (version 16.0; StataCorp). Subgroup analysis was performed according to the intelligent robot type and the intervention duration. Publication bias was tested using funnel plots, Egger tests, and the trim-and-fill method. Results: In total, 15 studies were finally included for systematic review, encompassing 705 participants, of which 12 studies were subjected to meta-analysis. The meta-analysis found that compared with the control group, intelligent robot intervention significantly reduced the levels of agitation (standardized mean difference --0.36, 95\% CI --0.56 to --0.17; P<.001) and anxiety (weighted mean difference --1.93, 95\% CI --3.13 to --0.72; P=.002) in patients with dementia. However, the intervention of intelligent robots had no significant effect on the following (all P>.05): cognitive function, neuropsychiatric symptoms, depression, quality of life, step count during the day, and the hours of lying down during the night of patients with dementia. Subgroup analysis revealed that the improvement of depression was related to the duration of the intervention (?12 vs 12 weeks: 0.08, 95\% CI --0.20 to 0.37 vs --0.68, 95\% CI --1.00 to --0.37; P=.26) and was independent of the type of intelligent robots (animal robots vs humanoid robots: --0.30, 95\% CI --0.75 to 0.15 vs 0.07, 95\% CI --0.21 to --0.34; P=.26). Conclusions: This study shows that intelligent robot intervention can help improve the agitation and anxiety levels of people with dementia. The intervention may be more effective the longer it is implemented. The appearance of the intelligent robot has no effect on the intervention effect. Further research is needed to help collect physiological data, such as physical activity in people with dementia; explore the impact of other intelligent robot design features on the intervention effect; and provide a reference for improving intelligent robots and intervention programs. Trial Registration: PROSPERO CRD42024523007; https://tinyurl.com/mwscn985 ", doi="10.2196/59892", url="https://www.jmir.org/2025/1/e59892" } @Article{info:doi/10.2196/63312, author="Borg, Alexander and Georg, Carina and Jobs, Benjamin and Huss, Viking and Waldenlind, Kristin and Ruiz, Mini and Edelbring, Samuel and Skantze, Gabriel and Parodis, Ioannis", title="Virtual Patient Simulations Using Social Robotics Combined With Large Language Models for Clinical Reasoning Training in Medical Education: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Mar", day="3", volume="27", pages="e63312", keywords="virtual patients", keywords="clinical reasoning", keywords="large language models", keywords="social robotics", keywords="medical education", keywords="sustainable learning", keywords="medical students", abstract="Background: Virtual patients (VPs) are computer-based simulations of clinical scenarios used in health professions education to address various learning outcomes, including clinical reasoning (CR). CR is a crucial skill for health care practitioners, and its inadequacy can compromise patient safety. Recent advancements in large language models (LLMs) and social robots have introduced new possibilities for enhancing VP interactivity and realism. However, their application in VP simulations has been limited, and no studies have investigated the effectiveness of combining LLMs with social robots for CR training. Objective: The aim of the study is to explore the potential added value of a social robotic VP platform combined with an LLM compared to a conventional computer-based VP modality for CR training of medical students. Methods: A Swedish explorative proof-of-concept study was conducted between May and July 2023, combining quantitative and qualitative methodology. In total, 15 medical students from Karolinska Institutet and an international exchange program completed a VP case in a social robotic platform and a computer-based semilinear platform. Students' self-perceived VP experience focusing on CR training was assessed using a previously developed index, and paired 2-tailed t test was used to compare mean scores (scales from 1 to 5) between the platforms. Moreover, in-depth interviews were conducted with 8 medical students. Results: The social robotic platform was perceived as more authentic (mean 4.5, SD 0.7 vs mean 3.9, SD 0.5; odds ratio [OR] 2.9, 95\% CI 0.0-1.0; P=.04) and provided a beneficial overall learning effect (mean 4.4, SD 0.6 versus mean 4.1, SD 0.6; OR 3.7, 95\% CI 0.1-0.5; P=.01) compared with the computer-based platform. Qualitative analysis revealed 4 themes, wherein students experienced the social robot as superior to the computer-based platform in training CR, communication, and emotional skills. Limitations related to technical and user-related aspects were identified, and suggestions for improvements included enhanced facial expressions and VP cases simulating multiple personalities. Conclusions: A social robotic platform enhanced by an LLM may provide an authentic and engaging learning experience for medical students in the context of VP simulations for training CR. Beyond its limitations, several aspects of potential improvement were identified for the social robotic platform, lending promise for this technology as a means toward the attainment of learning outcomes within medical education curricula. ", doi="10.2196/63312", url="https://www.jmir.org/2025/1/e63312", url="http://www.ncbi.nlm.nih.gov/pubmed/40053778" } @Article{info:doi/10.2196/64892, author="Bibbo, Daniele and Corvini, Giovanni and Schmid, Maurizio and Ranaldi, Simone and Conforto, Silvia", title="The Impact of Human-Robot Collaboration Levels on Postural Stability During Working Tasks Performed While Standing: Experimental Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="27", volume="12", pages="e64892", keywords="human-robot collaboration", keywords="cobot assistance", keywords="postural control", keywords="biomechanical risk", keywords="ergonomics", keywords="collaborative robot", abstract="Background: The integration of collaborative robots (cobots) in industrial settings has the potential to enhance worker safety and efficiency by improving postural control and reducing biomechanical risk. Understanding the specific impacts of varying levels of human-robot collaboration on these factors is crucial for optimizing cobot use. Objective: This study aims to investigate the biomechanical effects of different levels of human-robot collaboration on postural stability and control during simulated working tasks. Methods: A total of 14 participants performed simulated cashier working activities under 4 different collaboration modalities, with increasing levels of cobot assistance: full (Fu), half robot touch (HRT), half robot (HRb), and full robot (FRb). Center of pressure trajectories were extracted from 2 force plates' data to calculate 4 posturography parameters---mean distance (MDIST), mean velocity (MVELO), 95\% confidence ellipse area (AREA-CE), and sway area (AREA-SW)---which were analyzed to assess the impact of cobot intervention on postural control. Results: Nonparametric tests showed significance in the effect of the collaboration modalities on the 4 analyzed parameters. Post hoc tests revealed that FRb modality led to the greatest enhancement in postural stability, with a reduction in MDIST (4.2, SD 1.3 cm in Fu vs 1.6, SD 0.5 cm in FRb) and MVELO (16.3, SD 5.2 cm/s in Fu vs 7.9, SD 1.1 cm/s in FRb). AREA-CE and AREA-SW also decreased significantly with higher levels of cobot assistance (AREA-CE: 134, SD 91 cm{\texttwosuperior} in Fu vs 22, SD 12 cm{\texttwosuperior} in FRb; AREA-SW: 16.2, SD 8.4 cm{\texttwosuperior}/s in Fu vs 4.0, SD 1.6 cm{\texttwosuperior}/s in FRb). Complete assistance of the cobot significantly reduced interindividual variability of all center of pressure parameters. In FRb modality, as compared with all other conditions, removing the weight of the object during loading or unloading phases caused a significant decrease in all parameter values. Conclusions: Increased cobot assistance significantly enhances postural stability and reduces biomechanical load on workers during simulated tasks. Full assistance from cobots, in particular, minimizes postural displacements, indicating more consistent postural control improvements across individuals. However, high levels of cobot intervention also reduced the natural variation in how people balanced themselves. This could potentially lead to discomfort in the long run. Midlevel cobot assistance modalities can thus be considered as a good compromise in reducing biomechanical risks associated with postural stability at the same time granting a satisfactory level of user control. ", doi="10.2196/64892", url="https://humanfactors.jmir.org/2025/1/e64892" } @Article{info:doi/10.2196/65473, author="Johansson, I. Birgitta and Landahl, Jonas and Tammelin, Karin and Aerts, Erik and Lundberg, E. Christina and Adiels, Martin and Lindgren, Martin and Rosengren, Annika and Papachrysos, Nikolaos and Filipsson Nystr{\"o}m, Helena and Sj{\"o}land, Helen", title="Automated Process for Monitoring of Amiodarone Treatment: Development and Evaluation", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e65473", keywords="thyroid function", keywords="robotics", keywords="follow-up studies", keywords="disease management", keywords="decision support", keywords="automated process", keywords="monitoring", keywords="amiodarone treatment", keywords="anti-arrhythmic medication", keywords="anti-arrhythmic", keywords="development", keywords="evaluation", keywords="thyroid", keywords="liver", keywords="side effects", keywords="cardiac dysrhythmias", keywords="ventricular tachycardia", keywords="ventricular fibrillation", keywords="arrhythmia", keywords="automation", keywords="robot", keywords="algorithm", keywords="clinical decision support system", keywords="thyroid gland", keywords="heart", keywords="atrial fibrillation", abstract="Background: Amiodarone treatment requires repeated laboratory evaluations of thyroid and liver function due to potential side effects. Robotic process automation uses software robots to automate repetitive and routine tasks, and their use may be extended to clinical settings. Objective: Thus, this study aimed to develop a robot using a diagnostic classification algorithm to automate repetitive laboratory evaluations for amiodarone follow-up. Methods: We designed a robot and clinical decision support system based on expert clinical advice and current best practices in thyroid and liver disease management. The robot provided recommendations on the time interval to follow-up laboratory testing and management suggestions, while the final decision rested with a physician, acting as a human-in-the-loop. The performance of the robot was compared to the existing real-world manual follow-up routine for amiodarone treatment. Results: Following iterative technical improvements, a robot prototype was validated against physician orders (n=390 paired orders). The robot recommended a mean follow-up time interval of 4.5 (SD 2.4) months compared to the 3.1 (SD 1.4) months ordered by physicians (P<.001). For normal laboratory values, the robot recommended a 6-month follow-up in 281 (72.1\%) of cases, whereas physicians did so in only 38 (9.7\%) of cases, favoring a 3- to 4-month follow-up (n=227, 58.2\%). All patients diagnosed with new side effects (n=12) were correctly detected by the robot, whereas only 8 were by the physician. Conclusions: An automated process, using a software robot and a diagnostic classification algorithm, is a technically and medically reliable alternative for amiodarone follow-up. It may reduce manual labor, decrease the frequency of laboratory testing, and improve the detection of side effects, thereby reducing costs and enhancing patient value. ", doi="10.2196/65473", url="https://www.jmir.org/2025/1/e65473" } @Article{info:doi/10.2196/65358, author="Peramalaiah, Kanakapura Mrudula and Parmar, Tejraj Sanjay and Sepehri, Nariman and Muthukumarana, Saman and Kanitkar, Anuprita and Hin, Kit-Fong Cherry and Szturm, Joseph Tony", title="Evaluation of a Game-Based Mechatronic Device for Rehabilitation of Hand-Arm Function in Children With Cerebral Palsy: Feasibility Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2025", month="Feb", day="18", volume="12", pages="e65358", keywords="cerebral palsy", keywords="computer game--assisted rehabilitation", keywords="manual dexterity", keywords="repetitive task practice", keywords="robotic manipulandum", abstract="Background: Children with neurodevelopmental disorders, such as cerebral palsy (CP), often experience motor impairments in manual dexterity, which hinder daily tasks and social interactions. Traditional rehabilitation methods require repetitive task practice, which can be difficult for children to sustain due to low engagement. Game-based rehabilitation devices and robots offer a promising alternative by combining therapy with digital play, improving motivation and compliance. However, many systems fail to incorporate actual object manipulation, which is essential for motor learning through sensory feedback. To address this limitation, a low-cost, easy-to-use robotic manipulandum device (RMD) was developed. The RMD enables real-time object manipulation during gameplay while providing assistive force, allowing the practice of a wide range of manual dexterity skills beyond gross reaching. This system offers an engaging and effective rehabilitation approach to enhance hand function in children with CP. Objective: This study aimed to provide evidence for the feasibility and therapeutic value of the RMD game--based exercise program for children with CP. Methods: In total, 34 children with CP, aged 4 to 10 years, were randomly assigned to the experimental group (XG) or the control group (CG). The XG received a computer game--based exercise program using the RMD, focusing on object manipulation tasks, while the CG received task-specific training similar to constraint-induced movement therapy. Both groups received their respective therapy programs 3 times per week for 8 weeks. Semistructured interviews with parents and children, along with qualitative analysis, were conducted to evaluate their experiences with the exercise program. The following outcome measures were used: (1) the Peabody Developmental Motor Scale-2 (PDMS-2) grasping and visual-motor integration subtests and (2) the computer game--based upper extremity (CUE) assessment of manual dexterity. Results: No dropouts occurred during the 8-week program. Both groups showed significant improvements in the PDMS-2 subtests (P<.001) and the CUE assessment of manual dexterity, including success rates (tennis ball: P=.001; cone: P<.001; medicine ball: P=.001; and peanut ball: P<.001) and movement errors (tennis ball: P=.01; cone: P<.001; medicine ball: P=.04; and peanut ball: P<.001). The XG outperformed the CG, showing greater improvements in PDMS-2 grasping (P=.002) and visual-motor integration (P=.01). In the CUE assessment, the XG demonstrated higher success rates (medicine ball: P=.001 and peanut ball: P=.02) and fewer movement errors (cone: P<.001). Parents reported an increase in the children's independence in daily tasks. Conclusions: This study demonstrates the feasibility, acceptability, and positive outcomes of the RMD game--based exercise program for improving hand function in children with CP. The findings support further research and development of computer game--assisted rehabilitation technologies. Trial Registration: Clinical Trials Registry - India CTRI/2021/07/034903; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc4ODU ", doi="10.2196/65358", url="https://rehab.jmir.org/2025/1/e65358", url="http://www.ncbi.nlm.nih.gov/pubmed/39964707" } @Article{info:doi/10.2196/62930, author="Bevilacqua, Roberta and Maranesi, Elvira and Benadduci, Marco and Cortellessa, Gabriella and Umbrico, Alessandro and Fracasso, Francesca and Melone, Giovanni and Margaritini, Arianna and La Forgia, Angela and Di Bitonto, Pierpaolo and Potenza, Ada and Fiorini, Laura and La Viola, Carlo and Cavallo, Filippo and Leone, Alessandro and Caroppo, Andrea and Rescio, Gabriele and Marzorati, Mauro and Cesta, Amedeo and Pelliccioni, Giuseppe and Riccardi, Renato Giovanni and Rossi, Lorena", title="Exploring Dance as a Therapeutic Approach for Parkinson Disease Through the Social Robotics for Active and Healthy Ageing (SI-Robotics): Results From a Technical Feasibility Study", journal="JMIR Aging", year="2025", month="Jan", day="14", volume="8", pages="e62930", keywords="Parkinson disease", keywords="rehabilitation", keywords="Irish dancing", keywords="balance", keywords="gait", keywords="socially interacting robot", abstract="Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms. Recently, dance has started to be considered an effective intervention for people with PD. Several findings in the literature emphasize the necessity for deeper exploration into the synergistic impacts of dance therapy and exergaming for PD management. Moreover, socially engaging robotic platforms equipped with advanced interaction and perception features offer potential for monitoring patients' posture and enhancing workout routines with tailored cues. Objective: This paper presents the results of the Social Robotics for Active and Healthy Ageing (SI-Robotics) project, aimed at designing an innovative rehabilitation program targeted at seniors affected by (early-stage) PD. This study therefore aims to assess the usefulness of a dance-based rehabilitation program enriched by artificial intelligence--based exergames and contextual robotic assistance in improving motor function, balance, gait, and quality of life in patients with PD. The acceptability of the system is also investigated. Methods: The study is designed as a technical feasibility pilot to test the SI-Robotics system. For this study, 20 patients with PD were recruited. A total of 16 Irish dance--based rehabilitation sessions of 50 minutes were conducted (2 sessions per week, for 8 wks), involving 2 patients at a time. The designed rehabilitation session involves three main actors: (1) a therapist, (2) a patient, and (3) a socially interacting robot. To stimulate engagement, sessions were organized in the shape of exergames where an avatar shows patients the movements they should perform to correctly carry out a dance-based rehabilitation exercise. Results: Statistical analysis reveals a significant difference on the Performance-Oriented Mobility Assessment scale, both on balance and gait aspects, together with improvements in Short Physical Performance Battery, Unified Parkinson Disease Rating Scale--III, and Timed Up and Go test, underlying the usefulness of the rehabilitation intervention on the motor symptoms of PD. The analysis of the Unified Theory of Acceptance and Use of Technology subscales provided valuable insights into users' perceptions and interactions with the system. Conclusions: This research underscores the promise of merging dance therapy with interactive exergaming on a robotic platform as an innovative strategy to enhance motor function, balance, gait, and overall quality of life for patients grappling with PD. Trial Registration: ClinicalTrials.gov NCT05005208; https://clinicaltrials.gov/study/NCT05005208 ", doi="10.2196/62930", url="https://aging.jmir.org/2025/1/e62930" } @Article{info:doi/10.2196/63641, author="S{\o}rensen, Linda and Sagen Johannesen, Tomas Dag and Melkas, Helin{\"a} and Johnsen, Mari Hege", title="User Acceptance of a Home Robotic Assistant for Individuals With Physical Disabilities: Explorative Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="13", volume="12", pages="e63641", keywords="physical artificial intelligence", keywords="physical AI", keywords="health care robotics", keywords="assistive technology", keywords="content analysis", keywords="qualitative", keywords="health care", keywords="robotics", keywords="assistive", keywords="robot interaction", keywords="physical disabilities", keywords="readiness", keywords="amputations", abstract="Background: Health care is shifting toward 5 proactive approaches: personalized, participatory, preventive, predictive, and precision-focused services (P5 medicine). This patient-centered care leverages technologies such as artificial intelligence (AI)--powered robots, which can personalize and enhance services for users with disabilities. These advancements are crucial given the World Health Organization's projection of a global shortage of up to 10 million health care workers by 2030. Objective: This study aimed to investigate the acceptance of a humanoid assistive robot among users with physical disabilities during (1) AI-powered (using a Wizard of Oz methodology) robotic performance of predefined personalized assistance tasks and (2) operator-controlled robotic performance (simulated distant service). Methods: An explorative qualitative design was used, involving user testing in a simulated home environment and individual interviews. Directed content analysis was based on the Almere model and the model of domestic social robot acceptance. Results: Nine participants with physical disabilities aged 27 to 78 years engaged in robot interactions. They shared their perceptions across 7 acceptance concepts: hedonic attitudes, utilitarian attitudes, personal norms, social norms, control beliefs, facilitating conditions, and intention to use. Participants valued the robot's usefulness for practical services but not for personal care. They preferred automation but accepted remote control of the robot for some tasks. Privacy concerns were mixed. Conclusions: This study highlights the complex interplay of functional expectations, technological readiness, and personal and societal norms affecting the acceptance of physically assistive robots. Participants were generally positive about robotic assistance as it increases independence and lessens the need for human caregivers, although they acknowledged some current shortcomings. They were open to trying more home testing if future robots could perform most tasks autonomously. AI-powered robots offer new possibilities for creating more adaptable and personalized assistive technologies, potentially enhancing their effectiveness and viability for individuals with disabilities. ", doi="10.2196/63641", url="https://rehab.jmir.org/2025/1/e63641", url="http://www.ncbi.nlm.nih.gov/pubmed/39805579" } @Article{info:doi/10.2196/68072, author="Chen, Nai-Jung and Chang, Ching-Hao and Huang, Chiu-Mieh and Lin, Fen-He and Lu, Li-Ting and Liu, Kuan-Yi and Lai, Chih-Lin and Lin, Chin-Yao and Hou, Yi-Chou and Guo, Jong-Long", title="Assessing the Effectiveness of Interactive Robot-Assisted Virtual Health Coaching for Health Literacy and Disease Knowledge of Patients with Chronic Kidney Disease: Quasiexperimental Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e68072", keywords="chronic kidney disease", keywords="disease knowledge", keywords="eHealth", keywords="health coaching", keywords="health education", keywords="health literacy", keywords="interactive robot", abstract="Background: Chronic kidney disease (CKD) imposes a significant global health and economic burden, impacting millions globally. Despite its high prevalence, public awareness and understanding of CKD remain limited, leading to delayed diagnosis and suboptimal management. Traditional patient education methods, such as 1-on-1 verbal instruction or printed brochures, are often insufficient, especially considering the shortage of nursing staff. Technology-assisted education presents a promising and standardized solution, emphasizing the need for innovative and scalable approaches to improve CKD-specific knowledge and health literacy. Objective: This study aimed to develop and evaluate the effectiveness of an innovative 12-unit virtual health coaching program delivered through interactive robots that is intended to enhance disease knowledge and health literacy among patients with CKD. Methods: A quasiexperimental design was used, and 60 participants were evenly assigned to experimental and comparison groups. However, due to attrition, 14 participants in the experimental group and 16 participants in the comparison group completed the study. The intervention involved a 12-unit program, with each unit lasting approximately 20 minutes to 30 minutes and delivered across 3 to 4 learning sessions, and participants completed 3 to 4 units per session. The program addressed key aspects of CKD-specific health literacy including functional, communicative, and critical literacy and CKD-specific knowledge including basic knowledge, prevention, lifestyle, dietary intake, and medication. Data were collected through validated pre and postintervention questionnaires. All 30 participants completed the program and subsequent evaluations, with outcome measures assessing changes in CKD-specific knowledge and health literacy. Results: Postintervention analysis using generalized estimating equations, adjusted for age, revealed that the experimental group (n=14) had significantly greater improvements in health literacy (coefficient=2.51, Wald $\chi${\texttwosuperior}1=5.89; P=.02) and disease knowledge (coefficient=1.66, Wald $\chi${\texttwosuperior}1=11.75; P=.001) than the comparison group (n=16). Postintervention t tests revealed significant improvements in CKD-specific health literacy and disease knowledge (P<.001) between the experimental and comparison groups. Additional analyses identified significant group {\texttimes} time interactions, indicating improvements in communicative literacy (P=.01) and critical literacy (P=.02), while no significant changes were observed in functional literacy. Regarding disease knowledge, the experimental group demonstrated a significant improvement in medication (P<.001), whereas changes in basic knowledge, prevention, lifestyle, and dietary intake were not significant. Conclusions: This study demonstrated that interactive robot-assisted eHealth coaching effectively enhanced CKD-specific disease knowledge and health literacy. Despite the challenges posed by the COVID-19 pandemic, which constrained sample sizes, the findings indicate that this program is a promising patient education tool in clinical nephrology. Future research should involve larger sample sizes to enhance generalizability and examine additional factors influencing effectiveness. ", doi="10.2196/68072", url="https://www.jmir.org/2025/1/e68072" } @Article{info:doi/10.2196/60374, author="Pearce, Nettleton Louise Michelle and Pryor, Julie and Redhead, Jason and Sherrington, Catherine and Hassett, Leanne", title="Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e60374", keywords="rehabilitation", keywords="technology", keywords="digital health", keywords="virtual reality", keywords="robotics", keywords="exoskeleton device", keywords="implementation science", keywords="physiotherapy", keywords="physical therapy", keywords="occupational therapy", keywords="mobile phone", abstract="Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65\%), occupational therapists (1396/4208, 33\%), and allied health assistants (96/4208, 2\%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70\%). Devices were typically used to target impairment and activity limitation--related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94\%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47\%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51\%, vs outpatient services, 963/2335, 41\%) ($\chi$21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51\%, vs all other conditions, between 24\%-31\%; $\chi$25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use. ", doi="10.2196/60374", url="https://www.jmir.org/2024/1/e60374" } @Article{info:doi/10.2196/59442, author="Kang, Aimei and Wu, XiuLi", title="Assessing Visitor Expectations of AI Nursing Robots in Hospital Settings: Cross-Sectional Study Using the Kano Model", journal="JMIR Nursing", year="2024", month="Nov", day="27", volume="7", pages="e59442", keywords="nursing robot", keywords="artificial intelligence", keywords="Kano model", keywords="demand survey", keywords="nursing", keywords="care robots", keywords="nursing management", abstract="Background: Globally, the rates at which the aging population and the prevalence of chronic diseases are increasing are substantial. With declining birth rates and a growing percentage of older individuals, the demand for nursing staff is steadily rising. However, the shortage of nursing personnel has been a long-standing issue. In recent years, numerous researchers have advocated for the implementation of nursing robots as a substitute for traditional human labor. Objective: This study analyzes hospital visitors' attitudes and priorities regarding the functional areas of artificial intelligence (AI) nursing robots based on the Kano model. Building on this analysis, recommendations are provided for the functional optimization of AI nursing robots, aiming to facilitate their adoption in the nursing field. Methods: Using a random sampling method, 457 hospital visitors were surveyed between December 2023 and March 2024 to compare the differences in demand for AI nursing robot functionalities among the visitors. Results: A comparative analysis of the Kano attribute quadrant diagrams showed that visitors seeking hospitalization prioritized functional aspects that enhance medical activities. In contrast, visitors attending outpatient examinations focused more on functional points that assist in medical treatment. Additionally, visitors whose purpose was companionship and care emphasized functional aspects that offer psychological and life support to patients. Conclusions: AI nursing robots serve various functional areas and cater to diverse audience groups. In the future, it is essential to thoroughly consider users' functional needs and implement targeted functional developments to maximize the effectiveness of AI nursing robots. ", doi="10.2196/59442", url="https://nursing.jmir.org/2024/1/e59442" } @Article{info:doi/10.2196/64406, author="Chow, L. James C. and Li, Kay", title="Ethical Considerations in Human-Centered AI: Advancing Oncology Chatbots Through Large Language Models", journal="JMIR Bioinform Biotech", year="2024", month="Nov", day="6", volume="5", pages="e64406", keywords="artificial intelligence", keywords="humanistic AI", keywords="ethical AI", keywords="human-centered AI", keywords="machine learning", keywords="large language models", keywords="natural language processing", keywords="oncology chatbot", keywords="transformer-based model", keywords="ChatGPT", keywords="health care", doi="10.2196/64406", url="https://bioinform.jmir.org/2024/1/e64406", url="http://www.ncbi.nlm.nih.gov/pubmed/39321336" } @Article{info:doi/10.2196/55761, author="Nyamathi, Adeline and Dutt, Nikil and Lee, Jung-Ah and Rahmani, M. Amir and Rasouli, Mahkameh and Krogh, Donna and Krogh, Erik and Sultzer, David and Rashid, Humayun and Liaqat, Hamza and Jawad, Riyam and Azhar, Farhan and Ahmad, Ali and Qamar, Bilal and Bhatti, Yasin Taha and Khay, Chet and Ludlow, Jocelyn and Gibbs, Lisa and Rousseau, Julie and Abbasian, Mahyar and Song, Yutong and Jeong, Cheonkam and Brunswicker, Sabine", title="Establishing the Foundations of Emotional Intelligence in Care Companion Robots to Mitigate Agitation Among High-Risk Patients With Dementia: Protocol for an Empathetic Patient-Robot Interaction Study", journal="JMIR Res Protoc", year="2024", month="Oct", day="4", volume="13", pages="e55761", keywords="persons with dementia", keywords="empathy-based care companion robot", keywords="agitation", keywords="fall risk", keywords="artificial intelligence", keywords="AI", abstract="Background: An estimated 6.7 million persons are living with dementia in the United States, a number expected to double by 2060. Persons experiencing moderate to severe dementia are 4 to 5 times more likely to fall than those without dementia, due to agitation and unsteady gait. Socially assistive robots fail to address the changing emotional states associated with agitation, and it is unclear how emotional states change, how they impact agitation and gait over time, and how social robots can best respond by showing empathy. Objective: This study aims to design and validate a foundational model of emotional intelligence for empathetic patient-robot interaction that mitigates agitation among those at the highest risk: persons experiencing moderate to severe dementia. Methods: A design science approach will be adopted to (1) collect and store granular, personal, and chronological data using Personicle (an open-source software platform developed to automatically collect data from phones and other devices), incorporating real-time visual, audio, and physiological sensing technologies in a simulation laboratory and at board and care facilities; (2) develop statistical models to understand and forecast the emotional state, agitation level, and gait pattern of persons experiencing moderate to severe dementia in real time using machine learning and artificial intelligence and Personicle; (3) design and test an empathy-focused conversation model, focused on storytelling; and (4) test and evaluate this model for a care companion robot (CCR) in the community. Results: The study was funded in October 2023. For aim 1, architecture development for Personicle data collection began with a search for existing open-source data in January 2024. A community advisory board was formed and met in December 2023 to provide feedback on the use of CCRs and provide personal stories. Full institutional review board approval was received in March 2024 to place cameras and CCRs at the sites. In March 2024, atomic marker development was begun. For aim 2, after a review of open-source data on patients with dementia, the development of an emotional classifier was begun. Data labeling was started in April 2024 and completed in June 2024 with ongoing validation. Moreover, the team established a baseline multimodal model trained and validated on healthy-person data sets, using transformer architecture in a semisupervised manner, and later retrained on the labeled data set of patients experiencing moderate to severe dementia. In April 2024, empathy alignment of large language models was initiated using prompt engineering and reinforcement learning. Conclusions: This innovative caregiving approach is designed to recognize the signs of agitation and, upon recognition, intervene with empathetic verbal communication. This proposal has the potential to have a significant impact on an emerging field of computational dementia science by reducing unnecessary agitation and falls of persons experiencing moderate to severe dementia, while reducing caregiver burden. International Registered Report Identifier (IRRID): PRR1-10.2196/55761 ", doi="10.2196/55761", url="https://www.researchprotocols.org/2024/1/e55761", url="http://www.ncbi.nlm.nih.gov/pubmed/39365656" } @Article{info:doi/10.2196/58629, author="Trainum, Katie and Liu, Jiaying and Hauser, Elliott and Xie, Bo", title="Nursing Staff's Perspectives of Care Robots for Assisted Living Facilities: Systematic Literature Review", journal="JMIR Aging", year="2024", month="Sep", day="16", volume="7", pages="e58629", keywords="robots", keywords="nursing staff", keywords="nursing home", keywords="senior living", keywords="systematic review", keywords="aging", keywords="older adults", keywords="gerontology", keywords="participatory design", keywords="user needs", keywords="nurses", keywords="nursing", keywords="retirement", keywords="long-term care", keywords="geriatrics", keywords="elderly", keywords="older people", keywords="syntheses", keywords="review methods", keywords="review methodology", keywords="searches", keywords="searching", keywords="systematic", keywords="experiences", keywords="attitudes", keywords="opinions", keywords="perceptions", keywords="perspectives", keywords="preferences", keywords="needs", keywords="preference", abstract="Background: Care robots have been proposed in response to nursing shortages in assisted living facilities (ALFs) and the growing population of older adults. While the use of care robots may improve the general health and well-being of older adults, their introduction changes the work of nursing staff fundamentally, and it has implications for the entire health care system. In developing such technology, it is important to include end users, but so far, the nursing staff's perspectives have largely been ignored. Objective: This study aims to examine the literature on nursing staff's attitudes, needs, and preferences related to the use of care robots in ALFs, in order to discover gaps in the literature and guide future research. Methods: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 protocol. On May 12, 2023, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, the IEEE Xplore Digital Library, and the ACM Digital Library using predetermined search terms. Included publications, written in English, focused on the predevelopment phase, in which information was gathered on nursing staff's attitudes, needs, and preferences regarding care robots for ALFs. Publications were excluded if they did not provide peer-reviewed empirical data. The studies' findings were summarized, coded, and analyzed into major themes using thematic analysis and narrative synthesis. Their quality was assessed using McGill University's Mixed Methods Appraisal Tool and the Joanna Briggs Institute's critical appraisal tools. Results: The final sample included 15 studies. Most of the studies (n=11, 73\%) were rated as good quality; however, there was a general lack of reporting on important methodological decisions and sample characteristics. Nursing staff desired care robots that could assist with physically demanding tasks and reduce their workload but had mixed feelings on whether robots could or should assist with social tasks. In addition, nursing staff are concerned about the ethics of care robots, as well as about their safety, accessibility, and operability. The nursing staff's culture, qualification, and role in the facility may influence their perspectives of care robots. The studies lacked theory-driven designs and large sample sizes. Eight (53\%) studies mentioned using a participatory design approach, but a lack of established criteria for what constitutes participatory design leads to varying degrees of methodological quality. Conclusions: There was consensus among nursing staff that care robots should serve as nursing assistants to reduce workload. Whether robots could or should assist with social tasks remains a question. Further research is needed to mitigate nursing staff's concerns and understand the socioecological factors that influence their perspectives of care robots and their adoption in ALFs. In addition, theory-driven and large sample size study designs are necessary, as well as work to develop clear criteria for related participatory design research. ", doi="10.2196/58629", url="https://aging.jmir.org/2024/1/e58629" } @Article{info:doi/10.2196/58046, author="M{\"u}ller, Pascal and Jahn, Patrick", title="Cocreative Development of Robotic Interaction Systems for Health Care: Scoping Review", journal="JMIR Hum Factors", year="2024", month="Sep", day="12", volume="11", pages="e58046", keywords="human-robot interaction", keywords="cocreation", keywords="robotics", keywords="user-centered design", keywords="health care", abstract="Background: Robotic technologies present challenges to health care professionals and are therefore rarely used. Barriers such as lack of controllability and adaptability and complex control functions affect the human-robot relationship. In addition to educational opportunities, the possibility of individual adaptation can improve the usability and practical implementation of robotics. Previous work has focused on developments from a technology-centered perspective and has included user interests too late in the process. Objective: This study addresses the following research question: What cocreative research approaches are used in the field of nursing robotics to improve the usability, intended use, and goal-directed application of robotic developments for nurses and to support the nursing process? Methods: This scoping review provides an overview of the topic and the research activities taking place within it. Five databases and the reference lists of the identified publications were searched for studies without further restrictions. Studies were included if they developed and evaluated interaction and control platforms for robotic systems in health care in a cocreative way with end users. Results: The search resulted in 419 hits, of which 3 publications were included. All publications were feasibility or user studies that were mainly carried out in the European Union. The 3 interaction and control platforms presented were all prototypes and not commercially available. In addition to those in need of care, all studies also included family carers and health care professionals. Conclusions: Robotic interaction and control platforms in health care are rarely, if ever, developed and evaluated with feasibility or user studies that include prototypes and end users. While the involvement of end users is crucial, this review emphasizes that all stakeholders, including health care professionals, should participate in the development process to ensure a holistic understanding of application needs and a focus on user experiences and practical health care needs. It is emphasized that the active involvement of end users in the development process is critical to effectively meeting the needs of the target group. Trial Registration: Deutsches Register Klinischer Studien DRKS00034195; https://drks.de/search/de/trial/DRKS00034195 ", doi="10.2196/58046", url="https://humanfactors.jmir.org/2024/1/e58046" } @Article{info:doi/10.2196/55257, author="Wong, Yi Karen Lok and Hung, Lillian and Wong, Joey and Park, Juyoung and Alfares, Hadil and Zhao, Yong and Mousavinejad, Abdolhossein and Soni, Albin and Zhao, Hui", title="Adoption of Artificial Intelligence--Enabled Robots in Long-Term Care Homes by Health Care Providers: Scoping Review", journal="JMIR Aging", year="2024", month="Aug", day="27", volume="7", pages="e55257", keywords="artificial intelligence", keywords="robot", keywords="long-term care home", keywords="health care provider", keywords="scoping review", keywords="person-centered care", abstract="Background: Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)--enabled robots may solve such challenges and support person-centered care. There is a dearth of literature exploring the perspectives of health care providers, which are crucial to implementing AI-enabled robots. Objective: This scoping review aims to explore this scant body of literature to answer two questions: (1) what barriers do health care providers perceive in adopting AI-enabled robots in LTC homes? (2) What strategies can be taken to overcome these barriers to the adoption of AI-enabled robots in LTC homes? Methods: We are a team consisting of 3 researchers, 2 health care providers, 2 research trainees, and 1 older adult partner with diverse disciplines in nursing, social work, engineering, and medicine. Referring to the Joanna Briggs Institute methodology, our team searched databases (CINAHL, MEDLINE, PsycINFO, Web of Science, ProQuest, and Google Scholar) for peer-reviewed and gray literature, screened the literature, and extracted the data. We analyzed the data as a team. We compared our findings with the Person-Centered Practice Framework and Consolidated Framework for Implementation Research to further our understanding of the findings. Results: This review includes 33 articles that met the inclusion criteria. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Strategies to mitigate these barriers were also explored: (1) accommodate the various needs of residents and health care providers, (2) increase the understanding of the benefits of using robots, (3) review and overcome the safety issues, and (4) boost interest in the use of robots and provide training. Conclusions: Previous literature suggested using AI-enabled robots to resolve the challenges of increasing care needs and staff shortages in LTC. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots. International Registered Report Identifier (IRRID): RR2-doi:10.1136/bmjopen-2023-075278 ", doi="10.2196/55257", url="https://aging.jmir.org/2024/1/e55257", url="http://www.ncbi.nlm.nih.gov/pubmed/39190455" } @Article{info:doi/10.2196/56669, author="Tan, Kian Cheng and Lou, Q. Vivian W. and Cheng, Man Clio Yuen and He, Chu Phoebe and Khoo, Joo Veronica Eng", title="Improving the Social Well-Being of Single Older Adults Using the LOVOT Social Robot: Qualitative Phenomenological Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="23", volume="11", pages="e56669", keywords="companionship", keywords="older adults", keywords="social well-being", keywords="pets", keywords="social robots", keywords="elderly", keywords="wellbeing", keywords="qualitative research", keywords="robot", keywords="companion", keywords="body temperature", keywords="development", keywords="research design", keywords="design", keywords="interviews", keywords="psychosocial support", keywords="support", keywords="psychosocial", keywords="temperature regulation", keywords="social", keywords="care home", keywords="aging", keywords="ageing", keywords="robotics", keywords="well-being", keywords="loneliness", keywords="technology", keywords="mobile phone", abstract="Background: This study examined the social well-being of single older adults through the companionship of a social robot, LOVOT (Love+Robot; Groove X). It is designed as a companion for older adults, providing love and affection through verbal and physical interaction. We investigated older adults' perceptions of the technology and how they benefitted from interacting with LOVOT, to guide the future development of social robots. Objective: This study aimed to use a phenomenological research design to understand the participants' experiences of companionship provided by the social robot. Our research focused on (1) examining the social well-being of single older adults through the companionship of social robots and (2) understanding the perceptions of single older adults when interacting with social robots. Given the prevalence of technology use to support aging, understanding single older adults' social well-being and their perceptions of social robots is essential to guide future research on and design of social robots. Methods: A total of 5 single women, aged 60 to 75 years, participated in the study. The participants interacted independently with the robot for a week in their own homes and then participated in a poststudy interview to share their experiences. Results: In total, 4 main themes emerged from the participants' interactions with LOVOT, such as caring for a social robot, comforting presence of the social robot, meaningful connections with the social robot, and preference for LOVOT over pets. Conclusions: The results indicate that single older adults can obtain psychosocial support by interacting with LOVOT. LOVOT is easily accepted as a companion and makes single older adults feel like they have a greater sense of purpose and someone to connect with. This study suggests that social robots can provide companionship to older adults who live alone. Social robots can help alleviate loneliness by allowing single older adults to form social connections with robots as companions. These findings are particularly important given the rapid aging of the population and the increasing number of single-person households in Singapore. ", doi="10.2196/56669", url="https://humanfactors.jmir.org/2024/1/e56669" } @Article{info:doi/10.2196/52676, author="Reicherzer, Leah and Scheermesser, Mandy and Kl{\"a}y, Adrian and Duarte, E. Jaime and Graf, S. Eveline", title="Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists", journal="JMIR Rehabil Assist Technol", year="2024", month="Aug", day="9", volume="11", pages="e52676", keywords="assistive device", keywords="barriers", keywords="facilitators", keywords="mobility", keywords="older adults", keywords="wearable robots", abstract="Background: Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. Objective: The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Methods: Six older adults (aged 72?88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Results: Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. Conclusions: A light wearable robot---the Myosuit---was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need. ", doi="10.2196/52676", url="https://rehab.jmir.org/2024/1/e52676" } @Article{info:doi/10.2196/48126, author="Palmier, C{\'e}cilia and Rigaud, Anne-Sophie and Ogawa, Toshimi and Wieching, Rainer and Dacunha, S{\'e}bastien and Barbarossa, Federico and Stara, Vera and Bevilacqua, Roberta and Pino, Maribel", title="Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review", journal="J Med Internet Res", year="2024", month="Jun", day="18", volume="26", pages="e48126", keywords="robotic coaching solutions", keywords="ethical issues", keywords="ethical recommendations", keywords="older adults", keywords="geriatrics", keywords="guidelines", abstract="Background: Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent. Objective: The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults. Methods: We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation. Results: In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users' personal data. Conclusions: Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals' quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects. ", doi="10.2196/48126", url="https://www.jmir.org/2024/1/e48126", url="http://www.ncbi.nlm.nih.gov/pubmed/38888953" } @Article{info:doi/10.2196/55597, author="Vagnetti, Roberto and Camp, Nicola and Story, Matthew and Ait-Belaid, Khaoula and Mitra, Suvobrata and Zecca, Massimiliano and Di Nuovo, Alessandro and Magistro, Daniele", title="Instruments for Measuring Psychological Dimensions in Human-Robot Interaction: Systematic Review of Psychometric Properties", journal="J Med Internet Res", year="2024", month="Jun", day="5", volume="26", pages="e55597", keywords="psychometric", keywords="human-robot interaction", keywords="psychological dimensions", keywords="robot", keywords="assessment", keywords="systematic review", abstract="Background: Numerous user-related psychological dimensions can significantly influence the dynamics between humans and robots. For developers and researchers, it is crucial to have a comprehensive understanding of the psychometric properties of the available instruments used to assess these dimensions as they indicate the reliability and validity of the assessment. Objective: This study aims to provide a systematic review of the instruments available for assessing the psychological aspects of the relationship between people and social and domestic robots, offering a summary of their psychometric properties and the quality of the evidence. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across different databases: Scopus, PubMed, and IEEE Xplore. The search strategy encompassed studies meeting the following inclusion criteria: (1) the instrument could assess psychological dimensions related to social and domestic robots, including attitudes, beliefs, opinions, feelings, and perceptions; (2) the study focused on validating the instrument; (3) the study evaluated the psychometric properties of the instrument; (4) the study underwent peer review; and (5) the study was in English. Studies focusing on industrial robots, rescue robots, or robotic arms or those primarily concerned with technology validation or measuring anthropomorphism were excluded. Independent reviewers extracted instrument properties and the methodological quality of their evidence following the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Results: From 3828 identified records, the search strategy yielded 34 (0.89\%) articles that validated and examined the psychometric properties of 27 instruments designed to assess individuals' psychological dimensions in relation to social and domestic robots. These instruments encompass a broad spectrum of psychological dimensions. While most studies predominantly focused on structural validity (24/27, 89\%) and internal consistency (26/27, 96\%), consideration of other psychometric properties was frequently inconsistent or absent. No instrument evaluated measurement error and responsiveness despite their significance in the clinical context. Most of the instruments (17/27, 63\%) were targeted at both adults and older adults (aged ?18 years). There was a limited number of instruments specifically designed for children, older adults, and health care contexts. Conclusions: Given the strong interest in assessing psychological dimensions in the human-robot relationship, there is a need to develop new instruments using more rigorous methodologies and consider a broader range of psychometric properties. This is essential to ensure the creation of reliable and valid measures for assessing people's psychological dimensions regarding social and domestic robots. Among its limitations, this review included instruments applicable to both social and domestic robots while excluding those for other specific types of robots (eg, industrial robots). ", doi="10.2196/55597", url="https://www.jmir.org/2024/1/e55597", url="http://www.ncbi.nlm.nih.gov/pubmed/38682783" } @Article{info:doi/10.2196/54095, author="Li, Yun and Wang, Min and Wang, Lu and Cao, Yuan and Liu, Yuyan and Zhao, Yan and Yuan, Rui and Yang, Mengmeng and Lu, Siqian and Sun, Zhichao and Zhou, Feihu and Qian, Zhirong and Kang, Hongjun", title="Advances in the Application of AI Robots in Critical Care: Scoping Review", journal="J Med Internet Res", year="2024", month="May", day="27", volume="26", pages="e54095", keywords="critical care medicine", keywords="artificial intelligence", keywords="AI", keywords="robotics", keywords="intensive care unit", keywords="ICU", abstract="Background: In recent epochs, the field of critical medicine has experienced significant advancements due to the integration of artificial intelligence (AI). Specifically, AI robots have evolved from theoretical concepts to being actively implemented in clinical trials and applications. The intensive care unit (ICU), known for its reliance on a vast amount of medical information, presents a promising avenue for the deployment of robotic AI, anticipated to bring substantial improvements to patient care. Objective: This review aims to comprehensively summarize the current state of AI robots in the field of critical care by searching for previous studies, developments, and applications of AI robots related to ICU wards. In addition, it seeks to address the ethical challenges arising from their use, including concerns related to safety, patient privacy, responsibility delineation, and cost-benefit analysis. Methods: Following the scoping review framework proposed by Arksey and O'Malley and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a scoping review to delineate the breadth of research in this field of AI robots in ICU and reported the findings. The literature search was carried out on May 1, 2023, across 3 databases: PubMed, Embase, and the IEEE Xplore Digital Library. Eligible publications were initially screened based on their titles and abstracts. Publications that passed the preliminary screening underwent a comprehensive review. Various research characteristics were extracted, summarized, and analyzed from the final publications. Results: Of the 5908 publications screened, 77 (1.3\%) underwent a full review. These studies collectively spanned 21 ICU robotics projects, encompassing their system development and testing, clinical trials, and approval processes. Upon an expert-reviewed classification framework, these were categorized into 5 main types: therapeutic assistance robots, nursing assistance robots, rehabilitation assistance robots, telepresence robots, and logistics and disinfection robots. Most of these are already widely deployed and commercialized in ICUs, although a select few remain under testing. All robotic systems and tools are engineered to deliver more personalized, convenient, and intelligent medical services to patients in the ICU, concurrently aiming to reduce the substantial workload on ICU medical staff and promote therapeutic and care procedures. This review further explored the prevailing challenges, particularly focusing on ethical and safety concerns, proposing viable solutions or methodologies, and illustrating the prospective capabilities and potential of AI-driven robotic technologies in the ICU environment. Ultimately, we foresee a pivotal role for robots in a future scenario of a fully automated continuum from admission to discharge within the ICU. Conclusions: This review highlights the potential of AI robots to transform ICU care by improving patient treatment, support, and rehabilitation processes. However, it also recognizes the ethical complexities and operational challenges that come with their implementation, offering possible solutions for future development and optimization. ", doi="10.2196/54095", url="https://www.jmir.org/2024/1/e54095", url="http://www.ncbi.nlm.nih.gov/pubmed/38801765" } @Article{info:doi/10.2196/51389, author="Kr{\"o}plin, Juliane and Maier, Leonie and Lenz, Jan-Hendrik and Romeike, Bernd", title="Knowledge Transfer and Networking Upon Implementation of a Transdisciplinary Digital Health Curriculum in a Unique Digital Health Training Culture: Prospective Analysis", journal="JMIR Med Educ", year="2024", month="Apr", day="15", volume="10", pages="e51389", keywords="big data", keywords="digital didactics", keywords="digital health applications", keywords="digital leadership", keywords="digital literacy", keywords="generative artificial intelligence", keywords="mobile working", keywords="robotics", keywords="telemedicine", keywords="wearables", abstract="Background: Digital health has been taught at medical faculties for a few years. However, in general, the teaching of digital competencies in medical education and training is still underrepresented. Objective: This study aims to analyze the objective acquisition of digital competencies through the implementation of a transdisciplinary digital health curriculum as a compulsory elective subject at a German university. The main subject areas of digital leadership and management, digital learning and didactics, digital communication, robotics, and generative artificial intelligence were developed and taught in a transdisciplinary manner over a period of 1 semester. Methods: The participants evaluated the relevant content of the curriculum regarding the competencies already taught in advance during the study, using a Likert scale. The participants' increase in digital competencies were examined with a pre-post test consisting of 12 questions. Statistical analysis was performed using an unpaired 2-tailed Student t test. A P value of <.05 was considered statistically significant. Furthermore, an analysis of the acceptance of the transdisciplinary approach as well as the application of an alternative examination method (term paper instead of a test with closed and open questions) was carried out. Results: In the first year after the introduction of the compulsory elective subject, students of human medicine (n=15), dentistry (n=3), and medical biotechnology (n=2) participated in the curriculum. In total, 13 participants were women (7 men), and 61.1\% (n=11) of the participants in human medicine and dentistry were in the preclinical study stage (clinical: n=7, 38.9\%). All the aforementioned learning objectives were largely absent in all study sections (preclinical: mean 4.2; clinical: mean 4.4; P=.02). The pre-post test comparison revealed a significant increase of 106\% in knowledge (P<.001) among the participants. Conclusions: The transdisciplinary teaching of a digital health curriculum, including digital teaching methods, considers perspectives and skills from different disciplines. Our new curriculum facilitates an objective increase in knowledge regarding the complex challenges of the digital transformation of our health care system. Of the 16 student term papers arising from the course, robotics and artificial intelligence attracted the most interest, accounting for 9 of the submissions. ", doi="10.2196/51389", url="https://mededu.jmir.org/2024/1/e51389" } @Article{info:doi/10.2196/52443, author="Otaka, Eri and Osawa, Aiko and Kato, Kenji and Obayashi, Yota and Uehara, Shintaro and Kamiya, Masaki and Mizuno, Katsuhiro and Hashide, Shusei and Kondo, Izumi", title="Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study", journal="JMIR Aging", year="2024", month="Apr", day="11", volume="7", pages="e52443", keywords="dementia care", keywords="robotics", keywords="emotion", keywords="facial expression", keywords="expression intensity", keywords="long-term care", keywords="sensory modality", keywords="gerontology", keywords="gerontechnology", abstract="Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for ``happy,'' ``sad,'' ``angry,'' ``surprised,'' ``scared,'' and ``disgusted'' were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for ``happy'' was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for ``happy'' was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care. Trial Registration: UMIN Clinical Trials Registry UMIN000046256; https://tinyurl.com/yw37auan ", doi="10.2196/52443", url="https://aging.jmir.org/2024/1/e52443" } @Article{info:doi/10.2196/54425, author="Choi, Hyeonkyeong and Kim, Seunghee and Jang, Wonseuk", title="User Experience Evaluation of a Spinal Surgery Robot: Workload, Usability, and Satisfaction Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="1", volume="11", pages="e54425", keywords="robot spine surgery", keywords="usability", keywords="satisfaction", keywords="System Usability Scale", keywords="surgical navigation systems", keywords="robotics", keywords="surgery", keywords="neurosurgery", abstract="Background: Robotic spine surgery has continued to evolve since its US Food and Drug Administration approval in 2004, with products now including real-time video guidance and navigation during surgery. As the market for robotic surgical devices evolves, it is important to consider usability factors. Objective: The primary objective of this study was to determine the user experience of a surgical-assistive robotic device. The secondary objective was to evaluate workload, usability, the After-Scenario Questionnaire (ASQ), and the System Usability Scale (SUS). In addition, this study compares the workload, usability, and satisfaction survey of the device among different occupational groups using the device. Methods: Doctors (n=15) and nurses (n=15), the intended users of the surgical assistant robot, participated in the usability evaluation. Participants performed essential scenarios for the surgical assistant robot and provided scenario-specific satisfaction (ASQ), workload (NASA Task Load Index), and usability (SUS) scores. Results: Both doctors and nurses had task success rates of 85\% or higher for each scenario. ASQ results showed that both doctors and nurses were least satisfied with ease of completing the task of registration (group 1: mean 4.73, SD 1.57 and group 2: mean 4.47, SD 1.8), amount of time it took (group 1: mean 4.47, SD 1.63 and group 2: mean 4.40, SD 2.09), and support information satisfaction (group 1: mean 5.13, SD 1.50 and group 2: mean 5.13, SD 1.89). All participants had low workloads, and the overall Task Load Index score had a P value of .77, which is greater than .05. The SUS results showed that the overall usability mean for doctors was 64.17 (SD 16.52) and the mean for nurses was 61.67 (SD 19.18), with a P value of .84, which is greater than .05, indicating no difference between the 2 groups. Conclusions: In this study, doctors and nurses evaluated the interaction of the device in a simulated environment, the operating room. By evaluating the use experience and usability of the device with real intended users, we can develop a more effective and convenient user interface. ", doi="10.2196/54425", url="https://humanfactors.jmir.org/2024/1/e54425", url="http://www.ncbi.nlm.nih.gov/pubmed/38432688" } @Article{info:doi/10.2196/45494, author="Fiorini, Laura and D'Onofrio, Grazia and Sorrentino, Alessandra and Cornacchia Loizzo, Gabriella Federica and Russo, Sergio and Ciccone, Filomena and Giuliani, Francesco and Sancarlo, Daniele and Cavallo, Filippo", title="The Role of Coherent Robot Behavior and Embodiment in Emotion Perception and Recognition During Human-Robot Interaction: Experimental Study", journal="JMIR Hum Factors", year="2024", month="Jan", day="26", volume="11", pages="e45494", keywords="social robot", keywords="emotion recognition", keywords="human emotion perception", keywords="human-robot interaction", keywords="robot cospeech gestures evaluation", abstract="Background: Social robots are becoming increasingly important as companions in our daily lives. Consequently, humans expect to interact with them using the same mental models applied to human-human interactions, including the use of cospeech gestures. Research efforts have been devoted to understanding users' needs and developing robot's behavioral models that can perceive the user state and properly plan a reaction. Despite the efforts made, some challenges regarding the effect of robot embodiment and behavior in the perception of emotions remain open. Objective: The aim of this study is dual. First, it aims to assess the role of the robot's cospeech gestures and embodiment in the user's perceived emotions in terms of valence (stimulus pleasantness), arousal (intensity of evoked emotion), and dominance (degree of control exerted by the stimulus). Second, it aims to evaluate the robot's accuracy in identifying positive, negative, and neutral emotions displayed by interacting humans using 3 supervised machine learning algorithms: support vector machine, random forest, and K-nearest neighbor. Methods: Pepper robot was used to elicit the 3 emotions in humans using a set of 60 images retrieved from a standardized database. In particular, 2 experimental conditions for emotion elicitation were performed with Pepper robot: with a static behavior or with a robot that expresses coherent (COH) cospeech behavior. Furthermore, to evaluate the role of the robot embodiment, the third elicitation was performed by asking the participant to interact with a PC, where a graphical interface showed the same images. Each participant was requested to undergo only 1 of the 3 experimental conditions. Results: A total of 60 participants were recruited for this study, 20 for each experimental condition for a total of 3600 interactions. The results showed significant differences (P<.05) in valence, arousal, and dominance when stimulated with the Pepper robot behaving COH with respect to the PC condition, thus underlying the importance of the robot's nonverbal communication and embodiment. A higher valence score was obtained for the elicitation of the robot (COH and robot with static behavior) with respect to the PC. For emotion recognition, the K-nearest neighbor classifiers achieved the best accuracy results. In particular, the COH modality achieved the highest level of accuracy (0.97) when compared with the static behavior and PC elicitations (0.88 and 0.94, respectively). Conclusions: The results suggest that the use of multimodal communication channels, such as cospeech and visual channels, as in the COH modality, may improve the recognition accuracy of the user's emotional state and can reinforce the perceived emotion. Future studies should investigate the effect of age, culture, and cognitive profile on the emotion perception and recognition going beyond the limitation of this work. ", doi="10.2196/45494", url="https://humanfactors.jmir.org/2024/1/e45494", url="http://www.ncbi.nlm.nih.gov/pubmed/38277201" } @Article{info:doi/10.2196/50626, author="Darko, Mirekuwaa Elizabeth and Kleib, Manal and Lemermeyer, Gillian and Tavakoli, Mahdi", title="Robotics in Nursing: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Nov", day="13", volume="12", pages="e50626", keywords="automation", keywords="robots", keywords="nursing", keywords="nursing robots", keywords="nursing robotic technologies", abstract="Background: Globally, health care systems are challenged with the shortage of health care professionals, particularly nurses. The decline in the nursing workforce is primarily attributed to an aging population, increased demand for health care services, and a shortage of qualified nurses. Stressful working conditions have also increased the physical and emotional demands and perceptions of burnout, leading to attrition among nurses. Robotics has the potential to alleviate some of the workforce challenges by augmenting and supporting nurses in their roles; however, the impact of robotics on nurses is an understudied topic, and limited literature exists. Objective: We aim to understand the extent and type of evidence in relation to robotics integration in nursing practice. Methods: The Joanna Briggs Institute methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist will guide the scoping review. The MEDLINE (Ovid), Embase (Ovid), CINAHL Plus with Full Text (EBSCOhost), Scopus, Cochrane Library, and IEEE Xplore electronic bibliographic databases will be searched to retrieve papers. In addition, gray literature sources, including Google Scholar, dissertations, theses, registries, blogs, and relevant organizational websites will be searched. Furthermore, the reference lists of included studies retrieved from the databases and the gray literature will be hand-searched to ensure relevant papers are not missed. In total, 2 reviewers will independently screen retrieve papers at each stage of the screening process and independently extract data from the included studies. A third reviewer will be consulted to help decision-making if conflicts arise. Data analysis will be completed using both descriptive statistics and content analysis. The results will be presented using tabular and narrative formats. Results: The review is expected to describe the current evidence on the integration and impact of robots and robotics into nursing clinical practice, provide insights into the current state and knowledge gaps, identify a direction for future research, and inform policy and practice. The authors expect to begin the data searches in late January 2024. Conclusions: The robotics industry is evolving rapidly, providing different solutions that promise to revamp health care delivery with possible improvements to nursing practice. This review protocol outlines the steps proposed to systematically investigate this topic and provides an opportunity for more insights from scholars and researchers working in the field. International Registered Report Identifier (IRRID): PRR1-10.2196/50626 ", doi="10.2196/50626", url="https://www.researchprotocols.org/2023/1/e50626", url="http://www.ncbi.nlm.nih.gov/pubmed/37955956" } @Article{info:doi/10.2196/46826, author="Williams, Jess A. and Freed, Maureen and Theofanopoulou, Nikki and Daud{\'e}n Roquet, Claudia and Klasnja, Predrag and Gross, James and Schleider, Jessica and Slovak, Petr", title="Feasibility, Perceived Impact, and Acceptability of a Socially Assistive Robot to Support Emotion Regulation With Highly Anxious University Students: Mixed Methods Open Trial", journal="JMIR Ment Health", year="2023", month="Oct", day="31", volume="10", pages="e46826", keywords="emotion regulation", keywords="students", keywords="anxiety", keywords="digital intervention", keywords="mixed-methods", abstract="Background: Mental health difficulties among university students have been rising rapidly over the last decade, and the demand for university mental health services commonly far exceeds available resources. Digital interventions are seen as one potential solution to these challenges. However, as in other mental health contexts, digital programs often face low engagement and uptake, and the field lacks usable, engaging, evidence-supported mental health interventions that may be used flexibly when students need them most. Objective: The aim of this study is to investigate the feasibility and acceptability of a new, in situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in situ support for emotion regulation (ER)---a well-known transdiagnostic construct---directly in the moments when individuals are facing emotionally challenging situations. A secondary aim is to consider the perceived impact of Purrble on youth mental health, as reported by students over a 7-week deployment. Methods: A mixed methods open trial was conducted with 78 under- and postgraduate students at Oxford University. Participants were recruited based on moderate to high levels of anxiety measured by Generalized Anxiety Disorder-7 at baseline (mean 16.09, SD 3.03). All participants had access to Purrble for 7 weeks during the spring term with data on their perceived anxiety, emotion dysregulation, ER self-efficacy, and engagement with the intervention collected at baseline (pre), week 4 (mid), and week 8 (postintervention). Qualitative responses were also collected at the mid- and postintervention points. Results: The findings demonstrated a sustained engagement with Purrble over the 7-week period, with the acceptability further supported by the qualitative data indicating that students accepted Purrble and that Purrble was well-integrated into their daily routines. Exploratory quantitative data analysis indicated that Purrble was associated with reductions in student anxiety (dz=0.96, 95\% CI 0.62-1.29) and emotion dysregulation (dz=0.69, 95\% CI 0.38-0.99), and with an increase in ER self-efficacy (dz=--0.56, 95\% CI --0.86 to --0.26). Conclusions: This is the first trial of a simple physical intervention that aims to provide ongoing ER support to university students. Both quantitative and qualitative data suggest that Purrble is an acceptable and feasible intervention among students, the engagement with which can be sustained at a stable level across a 7-week period while retaining a perceived benefit for those who use it (n=32, 61\% of our sample). The consistency of use is particularly promising given that there was no clinician engagement or further support provided beyond Purrble being delivered to the students. These results show promise for an innovative intervention model, which could be complementary to the existing interventions. ", doi="10.2196/46826", url="https://mental.jmir.org/2023/1/e46826", url="http://www.ncbi.nlm.nih.gov/pubmed/37906230" } @Article{info:doi/10.2196/48618, author="Tan, Kelvin Cheng Kian and Lou, Q. Vivian W. and Cheng, Man Clio Yuen and He, Chu Phoebe and Mor, Ying Yan", title="Technology Acceptance of a Social Robot (LOVOT) Among Single Older Adults in Hong Kong and Singapore: Protocol for a Multimethod Study", journal="JMIR Res Protoc", year="2023", month="Aug", day="17", volume="12", pages="e48618", keywords="gerontechnology", keywords="older people", keywords="senior technology acceptance", keywords="single people", keywords="social robot", abstract="Background: Given the rapidly aging nature of our global population, policy makers around the world are now emphatically promoting active aging. To address the psychosocial needs of older persons and support active aging, researchers are exploring the use of assistive technologies, specifically social robots as companions. However, there is limited evidence on the efficacy of social robots in promoting active aging for older people in the Hong Kong and Singapore contexts. Objective: This study presents the protocol of a study that investigates the acceptance and quality of interaction between a Japanese social robot, LOVOT, and single older adults in Hong Kong and Singapore. Methods: We used a baseline assessment to measure the primary outcome, participants' acceptance of technology, and a sense of loneliness, namely, the participants' differences in responses to LOVOT before and following their interaction with the social robot in this multimethod study design. The baseline assessment consisted of the Qualtrics survey, which measures senior technology acceptance, loneliness, older people's quality of life, subjective happiness, cultural values, willingness to pay, and demographic characteristics, along with the LOVOT's sociability and system usability. In the study, participants interacted with LOVOT in 3 sessions before being surveyed to measure the older people's acceptance and attitudes toward LOVOT. A pre--social robot intervention also occurred in the first session. The study was conducted in both Hong Kong and Singapore. A total of 15 single older adults (ie, individuals who live alone) from Hong Kong and another 15 from Singapore were recruited. Participants were 60-75 years of age, lived by themselves, and had no known cognitive or mental issues. Results: The study began recruiting in March 2022, and recruitment was completed at the end of October 2022. Data collection and data set construction were completed at the end of January 2023. Analysis of the data is currently being conducted, and we plan to publish the results by mid-2023. Conclusions: At an individual level, the study will clarify if LOVOT influences single older adults' psychosocial well-being by reducing their loneliness. At a community level, the study's findings will illustrate whether LOVOT can provide increased social connectedness while decreasing individual loneliness. Last, this study's conclusions can inform policy makers to provide social robots to older people to improve their quality of life. Findings can also inform gerontechnology developers on which aspects and cultural considerations to take into account for future inventions. International Registered Report Identifier (IRRID): DERR1-10.2196/48618 ", doi="10.2196/48618", url="https://www.researchprotocols.org/2023/1/e48618", url="http://www.ncbi.nlm.nih.gov/pubmed/37590084" } @Article{info:doi/10.2196/46617, author="Tobis, Slawomir and Piasek-Skupna, Joanna and Neumann-Podczaska, Agnieszka and Suwalska, Aleksandra and Wieczorowska-Tobis, Katarzyna", title="The Effects of Stakeholder Perceptions on the Use of Humanoid Robots in Care for Older Adults: Postinteraction Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Aug", day="4", volume="25", pages="e46617", keywords="older adult", keywords="care robot", keywords="stakeholder", keywords="perception", keywords="needs and requirements", keywords="user need", keywords="patient need", keywords="elder", keywords="gerontology", keywords="geriatric", keywords="caregiver", keywords="attitude", keywords="opinion", keywords="home care", keywords="caregiving", keywords="robot", abstract="Background: Efficient use of humanoid social robots in the care for older adults requires precise knowledge of expectations in this area. There is little research in this field that includes the interaction of stakeholders with the robot. Even fewer studies have compared the perceptions of older people (as care recipients) and professional caregivers (representing those taking care of older adults in teams with robots). Objective: The aim of this study was to analyze whether specific aspects of the perceptions about humanoid robots influence attitudes after interacting with the robot and to compare the opinions of different stakeholders (older people and their professional caregivers) on this topic. We analyzed the potential impact of the differences in perception of the robot between stakeholder groups with respect to how the robot should be designed and tailored to fit the specific needs of future users. We also attempted to define areas where targeted educational activities could bring the attitudes of the two groups of stakeholders closer to each other. Methods: The studied group was a conveniently available sample of individuals who took part in the presentation of and interaction with a humanoid social robot. Among them, there were 48 community-dwelling older adults (aged ?60 years), who were participants of day care units (which may signal the presence of self-care needs), and 53 professional caregivers. The participants were asked to express their views after an interaction with a humanoid social robot (TIAGo) using the Users' Needs, Requirements and Abilities Questionnaire (UNRAQ) and the Godspeed Questionnaire Series (GQS). Results: Compared to the caregivers, older adults not only assessed the robot more positively with respect to its roles as a companion and assistant (P=.009 and P=.003, respectively) but also had higher scores on their need to increase their knowledge about the robot (P=.049). Regarding the robot's functions, the greatest differences between groups were observed for the social aspects on the UNRAQ, including decreasing the sense of loneliness (P=.003) and accompanying the user in everyday activities (P=.005). As for the GQS, the mean scores of the Animacy, Likeability, and Perceived Intelligence scales were significantly higher for older participants than for caregivers (P=.04, P<.001, and P<.001, respectively). The only parameter for which the caregivers' scores were higher than those of the older adults was the Artificial-Lifelike item from the Anthropomorphism scale of the GQS (P=.03). Conclusions: The acceptance of the social functions of a humanoid robot is related to its perception in all analyzed aspects, whereas the expected usefulness of a care robot is not linked to aspects of anthropomorphism. Successful implementation of robots in the care for older people thus depends on considering not only the fears, needs, and requirements of various stakeholders but also on the perceptions of the robot. Given the differences between the stakeholders, targeted and properly structured educational and training activities for caregivers and prospective users may enable a seamless integration of robotic technologies in care provision. ", doi="10.2196/46617", url="https://www.jmir.org/2023/1/e46617", url="http://www.ncbi.nlm.nih.gov/pubmed/37540548" } @Article{info:doi/10.2196/44125, author="Mahmoudi Asl, Aysan and Kouters, Suzanne and Castro-Gonz{\'a}lez, {\'A}lvaro and Van der Roest, Henri{\"e}tte and Franco Martin, Manuel and Dr{\"o}es, Rose-Marie", title="Potential Facilitators of and Barriers to Implementing the MINI Robot in Community-Based Meeting Centers for People With Dementia and Their Carers in the Netherlands and Spain: Explorative Qualitative Study", journal="J Med Internet Res", year="2023", month="Aug", day="2", volume="25", pages="e44125", keywords="dementia", keywords="meeting centers", keywords="mild cognitive impairment", keywords="social robots", abstract="Background: Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation. Objective: The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain. Methods: Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described. Results: Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies. Conclusions: The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD's preferences and demands and MC policies, which will contribute to the MINI robot's effective adoption and deployment. ", doi="10.2196/44125", url="https://www.jmir.org/2023/1/e44125", url="http://www.ncbi.nlm.nih.gov/pubmed/37531190" } @Article{info:doi/10.2196/42870, author="Wang, Ruohan and Lv, Honghao and Lu, Zhangli and Huang, Xiaoyan and Wu, Haiteng and Xiong, Junjie and Yang, Geng", title="A Medical Assistive Robot for Telehealth Care During the COVID-19 Pandemic: Development and Usability Study in an Isolation Ward", journal="JMIR Hum Factors", year="2023", month="Apr", day="20", volume="10", pages="e42870", keywords="COVID-19", keywords="MAR", keywords="telehealth care", keywords="video chat system", keywords="mental health care", abstract="Background: The COVID-19 pandemic is affecting the mental and emotional well-being of patients, family members, and health care workers. Patients in the isolation ward may have psychological problems due to long-term hospitalization, the development of the epidemic, and the inability to see their families. A medical assistive robot (MAR), acting as an intermediary of communication, can be deployed to address these mental pressures. Objective: CareDo, a MAR with telepresence and teleoperation functions, was developed in this work for remote health care. The aim of this study was to investigate its practical performance in the isolation ward during the pandemic. Methods: Two systems were integrated into the CareDo robot. For the telepresence system, a web real-time communications solution is used for the multiuser chat system and a convolutional neural network is used for expression recognition. For the teleoperation system, an incremental motion mapping method is used for operating the robot remotely. A clinical trial of this system was conducted at First Affiliated Hospital, Zhejiang University. Results: During the clinical trials, tasks such as video chatting, emotion detection, and medical supplies delivery were performed via the CareDo robot. Seven voice commands were set for performing system wakeup, video chatting, and system exiting. Durations from 1 to 3 seconds of common commands were set to improve voice command detection. The facial expression was recorded 152 times for a patient in 1 day for the psychological intervention. The recognition accuracy reached 95\% and 92.8\% for happy and neutral expressions, respectively. Conclusions: Patients and health care workers can use this MAR in the isolation ward for telehealth care during the COVID-19 pandemic. This can be a useful approach to break the chains of virus transmission and can also be an effective way to conduct remote psychological intervention. ", doi="10.2196/42870", url="https://humanfactors.jmir.org/2023/1/e42870", url="http://www.ncbi.nlm.nih.gov/pubmed/36634269" } @Article{info:doi/10.2196/42704, author="Jenkinson, P. George and Houghton, Natasha and van Zalk, Nejra and Waller, Jo and Bello, Fernando and Tzemanaki, Antonia", title="Acceptability of Automated Robotic Clinical Breast Examination: Survey Study", journal="J Particip Med", year="2023", month="Apr", day="3", volume="15", pages="e42704", keywords="breast cancer detection", keywords="automated diagnosis", keywords="breast examination", keywords="health care robotics", keywords="patient and public involvement", keywords="participatory design", keywords="user acceptability", keywords="mammography", keywords="breast cancer", abstract="Background: In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10\% of invasive breast cancers occur in women aged ?45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)---using soft robotic technology and machine learning for fully automated clinical breast examination---is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology. Objective: This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design. Methods: This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks' mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients. Results: Most respondents (143/155, 92.3\%) indicated that they would definitely or probably use R-CBE, with 82.6\% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users' perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key. Conclusions: There is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential. ", doi="10.2196/42704", url="https://jopm.jmir.org/2023/1/e42704", url="http://www.ncbi.nlm.nih.gov/pubmed/37010907" } @Article{info:doi/10.2196/42652, author="Trainum, Katie and Tunis, Rachel and Xie, Bo and Hauser, Elliott", title="Robots in Assisted Living Facilities: Scoping Review", journal="JMIR Aging", year="2023", month="Mar", day="6", volume="6", pages="e42652", keywords="robotics", keywords="long-term care", keywords="nursing home", keywords="residential care", keywords="scoping review", keywords="review method", keywords="robot", keywords="aging", keywords="elder", keywords="older adult", keywords="gerontology", keywords="geriatric", keywords="senior living", abstract="Background: Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain. Objective: This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research. Methods: On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework. Results: The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26\%) considered the context of care: most studies (48/69, 70\%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors' disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics. Conclusions: The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards. ", doi="10.2196/42652", url="https://aging.jmir.org/2023/1/e42652", url="http://www.ncbi.nlm.nih.gov/pubmed/36877560" } @Article{info:doi/10.2196/39786, author="Huang, Rong and Li, Hongxiu and Suomi, Reima and Li, Chenglong and Peltoniemi, Teijo", title="Intelligent Physical Robots in Health Care: Systematic Literature Review", journal="J Med Internet Res", year="2023", month="Jan", day="18", volume="25", pages="e39786", keywords="intelligent physical robot", keywords="artificial intelligence", keywords="health care", keywords="literature review", abstract="Background: Intelligent physical robots based on artificial intelligence have been argued to bring about dramatic changes in health care services. Previous research has examined the use of intelligent physical robots in the health care context from different perspectives; however, an overview of the antecedents and consequences of intelligent physical robot use in health care is lacking in the literature. Objective: In this paper, we aimed to provide an overview of the antecedents and consequences of intelligent physical robot use in health care and to propose potential agendas for future research through a systematic literature review. Methods: We conducted a systematic literature review on intelligent physical robots in the health care field following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Literature searches were conducted in 5 databases (PubMed, Scopus, PsycINFO, Embase, and CINAHL) in May 2021, focusing on studies using intelligent physical robots for health care purposes. Subsequently, the quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We performed an exploratory content analysis and synthesized the findings extracted from the included articles. Results: A total of 94 research articles were included in the review. Intelligent physical robots, including mechanoid, humanoid, android, and animalistic robots, have been used in hospitals, nursing homes, mental health care centers, laboratories, and patients' homes by both end customers and health care professionals. The antecedents for intelligent physical robot use are categorized into individual-, organization-, and robot-related factors. Intelligent physical robot use in the health care context leads to both non--health-related consequences (emotional outcomes, attitude and evaluation outcomes, and behavioral outcomes) and consequences for (physical, mental, and social) health promotion for individual users. Accordingly, an integrative framework was proposed to obtain an overview of the antecedents and consequences of intelligent physical robot use in the health care context. Conclusions: This study contributes to the literature by summarizing current knowledge in the field of intelligent physical robot use in health care, by identifying the antecedents and the consequences of intelligent physical robot use, and by proposing potential future research agendas in the specific area based on the research findings in the literature and the identified knowledge gaps. ", doi="10.2196/39786", url="https://www.jmir.org/2023/1/e39786", url="http://www.ncbi.nlm.nih.gov/pubmed/36652280" } @Article{info:doi/10.2196/42792, author="Yoshii, Kenta and Kimura, Daiki and Kosugi, Akihiro and Shinkawa, Kaoru and Takase, Toshiro and Kobayashi, Masatomo and Yamada, Yasunori and Nemoto, Miyuki and Watanabe, Ryohei and Ota, Miho and Higashi, Shinji and Nemoto, Kiyotaka and Arai, Tetsuaki and Nishimura, Masafumi", title="Screening of Mild Cognitive Impairment Through Conversations With Humanoid Robots: Exploratory Pilot Study", journal="JMIR Form Res", year="2023", month="Jan", day="13", volume="7", pages="e42792", keywords="mild cognitive impairment", keywords="Alzheimer disease", keywords="neuropsychiatric symptoms", keywords="neuropsychological assessment", keywords="simple screening", keywords="humanoid robot", keywords="robot", keywords="symptoms", keywords="neuropsychological", keywords="monitoring", abstract="Background: The rising number of patients with dementia has become a serious social problem worldwide. To help detect dementia at an early stage, many studies have been conducted to detect signs of cognitive decline by prosodic and acoustic features. However, many of these methods are not suitable for everyday use as they focus on cognitive function or conversational speech during the examinations. In contrast, conversational humanoid robots are expected to be used in the care of older people to help reduce the work of care and monitoring through interaction. Objective: This study focuses on early detection of mild cognitive impairment (MCI) through conversations between patients and humanoid robots without a specific examination, such as neuropsychological examination. Methods: This was an exploratory study involving patients with MCI and cognitively normal (CN) older people. We collected the conversation data during neuropsychological examination (Mini-Mental State Examination [MMSE]) and everyday conversation between a humanoid robot and 94 participants (n=47, 50\%, patients with MCI and n=47, 50\%, CN older people). We extracted 17 types of prosodic and acoustic features, such as the duration of response time and jitter, from these conversations. We conducted a statistical significance test for each feature to clarify the speech features that are useful when classifying people into CN people and patients with MCI. Furthermore, we conducted an automatic classification experiment using a support vector machine (SVM) to verify whether it is possible to automatically classify these 2 groups by the features identified in the statistical significance test. Results: We obtained significant differences in 5 (29\%) of 17 types of features obtained from the MMSE conversational speech. The duration of response time, the duration of silent periods, and the proportion of silent periods showed a significant difference (P<.001) and met the reference value r=0.1 (small) of the effect size. Additionally, filler periods (P<.01) and the proportion of fillers (P=.02) showed a significant difference; however, these did not meet the reference value of the effect size. In contrast, we obtained significant differences in 16 (94\%) of 17 types of features obtained from the everyday conversations with the humanoid robot. The duration of response time, the duration of speech periods, jitter (local, relative average perturbation [rap], 5-point period perturbation quotient [ppq5], difference of difference of periods [ddp]), shimmer (local, amplitude perturbation quotient [apq]3, apq5, apq11, average absolute differences between the amplitudes of consecutive periods [dda]), and F0cov (coefficient of variation of the fundamental frequency) showed a significant difference (P<.001). In addition, the duration of response time, the duration of silent periods, the filler period, and the proportion of fillers showed significant differences (P<.05). However, only jitter (local) met the reference value r=0.1 (small) of the effect size. In the automatic classification experiment for the classification of participants into CN and MCI groups, the results showed 66.0\% accuracy in the MMSE conversational speech and 68.1\% accuracy in everyday conversations with the humanoid robot. Conclusions: This study shows the possibility of early and simple screening for patients with MCI using prosodic and acoustic features from everyday conversations with a humanoid robot with the same level of accuracy as the MMSE. ", doi="10.2196/42792", url="https://formative.jmir.org/2023/1/e42792", url="http://www.ncbi.nlm.nih.gov/pubmed/36637896" } @Article{info:doi/10.2196/37731, author="Liao, Gen-Yih and Huang, Tzu-Ling and Wong, May-Kuen and Shyu, Lotus Yea-Ing and Ho, Lun-Hui and Wang, Chi and Cheng, E. T. C. and Teng, Ching-I", title="Enhancing Nurse--Robot Engagement: Two-Wave Survey Study", journal="J Med Internet Res", year="2023", month="Jan", day="9", volume="25", pages="e37731", keywords="healthcare", keywords="health care", keywords="eHealth", keywords="digital heath", keywords="health technology", keywords="personal innovativeness", keywords="robot", keywords="structural equation modeling", keywords="survey", keywords="intelligent technology", keywords="smart technology", keywords="robotics", keywords="nurse", keywords="nursing", keywords="attitude", keywords="engagement", keywords="healthcare professional", keywords="benefit", keywords="Taiwan", keywords="Asia", abstract="Background: Robots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse--robot engagement. Objective: This study aimed to examine how the benefits and maintenance of robots and nurses' personal innovativeness impact nurses' attitudes to robots and nurse--robot engagement. Methods: Our study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave. Results: Robot benefits are positively related to nurse--robot engagement ($\beta$=.13, P<.05), while robot maintenance requirements are negatively related to nurse--robot engagement ($\beta$=--.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075). Conclusions: Our study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses' engagement with them. We found that the impact of robot benefits on nurse--robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context. ", doi="10.2196/37731", url="https://www.jmir.org/2023/1/e37731", url="http://www.ncbi.nlm.nih.gov/pubmed/36622738" } @Article{info:doi/10.2196/41313, author="van Dam, Kirstin and Gielissen, Marieke and Reijnders, Rachelle and van der Poel, Agnes and Boon, Brigitte", title="Experiences of Persons With Executive Dysfunction in Disability Care Using a Social Robot to Execute Daily Tasks and Increase the Feeling of Independence: Multiple-Case Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="3", volume="9", number="4", pages="e41313", keywords="executive dysfunction", keywords="disability care", keywords="social robots", keywords="assistive technology", keywords="independence", keywords="daily tasks", keywords="executive function", keywords="rehabilitation", keywords="disability support", keywords="daily care", keywords="implementation", abstract="Background: Executive functions are essential for independently navigating nearly all of our daily activities. Executive dysfunction often occurs as a result of a neurodevelopmental disorder. Persons with executive dysfunction experience challenges regarding independent execution of daily tasks. Social robots might support persons with executive dysfunction to execute daily tasks and promote their feeling of independence. Objective: This study aimed to study the impact of interacting with social robot Tessa on goal attainment in the execution of daily tasks and perceived independence of persons with executive dysfunction. Methods: In this multiple-case study, 18 participant--caregiver couples were followed up while using Tessa in the home environment for 3 months. Goal attainment on independently performing a self-determined goal was measured by the Goal Attainment Scale, and participant--caregiver couples were interviewed about their experience with their interaction with Tessa and how they perceived Tessa's impact on their independence. Results: In total, 11 (61\%) participants reached their goal after 6 weeks and maintained their goal after 3 months. During the study period, 2 participant--caregiver couples withdrew because of mismatch with Tessa. Participants set goals in the following domains: execution of household tasks; intake of food, water, or medication; being ready in time for an appointment; going to bed or getting out of bed on time; personal care; and exercise. Participants perceived that Tessa increased the feeling of independence by generating more structure, stimulation, and self-direction. Participant--caregiver couples reported that the auditive information provided by Tessa was more effective in coping with executive dysfunction compared to their initial approaches using visual information, and the use of Tessa had a positive impact on their relationship. Conclusions: This study paid ample time and attention to the implementation of a social robot in daily care practice. The encouraging findings support the use of social robot Tessa for the execution of daily tasks and increasing independence of persons with executive dysfunction in disability care. ", doi="10.2196/41313", url="https://rehab.jmir.org/2022/4/e41313", url="http://www.ncbi.nlm.nih.gov/pubmed/36326800" } @Article{info:doi/10.2196/40528, author="Isabet, Baptiste and Rigaud, Anne-Sophie and Li, Wanji and Pino, Maribel", title="Telepresence Robot Intervention to Reduce Loneliness and Social Isolation in Older Adults Living at Home (Project DOMIROB): Protocol for a Clinical Nonrandomized Study", journal="JMIR Res Protoc", year="2022", month="Oct", day="31", volume="11", number="10", pages="e40528", keywords="older adults", keywords="telepresence robot", keywords="feeling of loneliness", keywords="social isolation", keywords="home", keywords="acceptability", keywords="usability", abstract="Background: There is a growing prevalence of loneliness and social isolation among older adults (OAs). These problems are often associated with depressive states, cognitive decline, sleep disorders, addictions, and increased mortality. To limit loneliness and social isolation in OAs, some authors recommend the use of new communication technologies to maintain a social link with family members as well as with health and social care professionals. Among these communication tools, telepresence robots (TRs) seem to be a promising solution. These robots offer users the possibility of making video calls with their relatives, social workers, and health care professionals, to maintain social contact and access to support services while living at home. Nevertheless, TRs have been relatively unstudied in real-life environments. Objective: The main objective of this study is to measure the impact of a 12-week intervention using a TR on the feeling of loneliness and on social isolation of OAs living at home. Its secondary objective is to establish recommendations for the implementation of TRs in the studied context. Methods: A nonrandomized study will be conducted among 60 OAs living at home who will participate in the study for 24 weeks. During this period, they will host a TR for 12 weeks to use it in their home. After the end of the intervention a 12-week follow-up ensues. In total, 4 evaluations will be performed over the entire experimental phase for each participant at weeks 0, 6, 12, and 24. A multidimensional assessment of the impact of the robot will be performed using a multimethod approach including standardized scales and a semistructured interview. This assessment will also help to identify the ergonomic aspects that influence the robot's usability and acceptability among OAs. Results: Data collection started in September 2020 and is expected to be completed in early 2023. In August 2022, 56 participants were recruited for the study. Data analysis will take place between August 2022 and is expected to be completed in early 2023. Conclusions: The DOMIROB study will provide new knowledge on the impact of social TRs in OAs living at home. The results will make it possible to suggest technological, ethical, and organizational recommendations for the use and implementation of TRs for OAs in real-life settings. Trial Registration: ClinicalTrials.gov NCT04767100; https://clinicaltrials.gov/ct2/show/NCT04767100 International Registered Report Identifier (IRRID): DERR1-10.2196/40528 ", doi="10.2196/40528", url="https://www.researchprotocols.org/2022/10/e40528", url="http://www.ncbi.nlm.nih.gov/pubmed/36315231" } @Article{info:doi/10.2196/38864, author="Bradwell, Hannah and Edwards, J. Katie and Winnington, Rhona and Thill, Serge and Allgar, Victoria and Jones, B. Ray", title="Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study", journal="JMIR Aging", year="2022", month="Aug", day="24", volume="5", number="3", pages="e38864", keywords="social robots", keywords="companion robots", keywords="well-being", keywords="older adults", keywords="dementia", keywords="robot pets", keywords="COVID-19", abstract="Background: Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). Objective: We aimed to address the limited effectiveness research on JfA devices. Methods: We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. Results: There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85\%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. Conclusions: Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. Trial Registration: ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463 ", doi="10.2196/38864", url="https://aging.jmir.org/2022/3/e38864", url="http://www.ncbi.nlm.nih.gov/pubmed/35830959" } @Article{info:doi/10.2196/35304, author="Klebbe, Robert and Scherzinger, Stefan and Eicher, Cornelia", title="Assistive Robots for Patients With Amyotrophic Lateral Sclerosis: Exploratory Task-Based Evaluation Study With an Early-Stage Demonstrator", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="23", volume="9", number="3", pages="e35304", keywords="amyotrophic lateral sclerosis", keywords="disability", keywords="disabled", keywords="disabilities", keywords="assistive robotics", keywords="human robot interaction", keywords="robotic manipulator", keywords="semi-autonomous control", keywords="motor independence", keywords="activity of daily living", keywords="daily need", keywords="everyday activities", keywords="activities of daily living", keywords="development", keywords="usability", keywords="user design", keywords="motor impairment", keywords="physical disability", keywords="robot", keywords="assistive technology", keywords="assistive device", keywords="Europe", abstract="Background: Although robotic manipulators have great potential in promoting motor independence of people with motor impairments, only few systems are currently commercially available. In addition to technical, economic, and normative barriers, a key challenge for their distribution is the current lack of evidence regarding their usefulness, acceptance, and user-specific requirements. Objective: Against this background, a semiautonomous robot system was developed in the research and development project, robot-assisted services for individual and resource-oriented intensive and palliative care of people with amyotrophic lateral sclerosis (ROBINA), to support people with amyotrophic lateral sclerosis (ALS) in various everyday activities. Methods: The developed early-stage demonstrator was evaluated in a task-based laboratory study of 11 patients with ALS. On the basis of a multimethod design consisting of standardized questionnaires, open-ended questions, and observation protocols, participants were asked about its relevance to everyday life, usability, and design requirements. Results: Most participants considered the system to provide relevant support within the test scenarios and for their everyday life. On the basis of the System Usability Scale, the overall usability of the robot-assisted services for individual and resource-oriented intensive and palliative care of people with ALS system was rated as excellent, with a median of 90 (IQR 75-95) points. Moreover, 3 central areas of requirements for the development of semiautonomous robotic manipulators were identified and discussed: requirements for semiautonomous human-robot collaboration, requirements for user interfaces, and requirements for the adaptation of robotic capabilities regarding everyday life. Conclusions: Robotic manipulators can contribute to increase the autonomy of people with ALS. A key issue for future studies is how the existing ability level and the required robotic capabilities can be balanced to ensure both high user satisfaction and effective and efficient task performance. ", doi="10.2196/35304", url="https://rehab.jmir.org/2022/3/e35304", url="http://www.ncbi.nlm.nih.gov/pubmed/35998031" } @Article{info:doi/10.2196/37434, author="Mahmoudi Asl, Aysan and Molinari Ulate, Mauricio and Franco Martin, Manuel and van der Roest, Henri{\"e}tte", title="Methodologies Used to Study the Feasibility, Usability, Efficacy, and Effectiveness of Social Robots For Elderly Adults: Scoping Review", journal="J Med Internet Res", year="2022", month="Aug", day="1", volume="24", number="8", pages="e37434", keywords="aged", keywords="dementia", keywords="social robots", keywords="pet-bots", keywords="community settings", keywords="long-term care", keywords="methods", keywords="scoping review", abstract="Background: New research fields to design social robots for older people are emerging. By providing support with communication and social interaction, these robots aim to increase quality of life. Because of the decline in functioning due to cognitive impairment in older people, social robots are regarded as promising, especially for people with dementia. Although study outcomes are hopeful, the quality of studies on the effectiveness of social robots for the elderly is still low due to many methodological limitations. Objective: We aimed to review the methodologies used thus far in studies evaluating the feasibility, usability, efficacy, and effectiveness of social robots in clinical and social settings for elderly people, including persons with dementia. Methods: Dedicated search strings were developed. Searches in MEDLINE (PubMed), Web of Science, PsycInfo, and CINAHL were performed on August 13, 2020. Results: In the 33 included papers, 23 different social robots were investigated for their feasibility, usability, efficacy, and effectiveness. A total of 8 (24.2\%) studies included elderly persons in the community, 9 (27.3\%) included long-term care facility residents, and 16 (48.5\%) included people with dementia. Most of the studies had a single aim, of which 7 (21.2\%) focused on efficacy and 7 (21.2\%) focused on effectiveness. Moreover, forms of randomized controlled trials were the most applied designs. Feasibility and usability were often studied together in mixed methods or experimental designs and were most often studied in individual interventions. Feasibility was often assessed with the Unified Theory of the Acceptance and Use of Technology model. Efficacy and effectiveness studies used a range of psychosocial and cognitive outcome measures. However, the included studies failed to find significant improvements in quality of life, depression, and cognition. Conclusions: This study identified several shortcomings in methodologies used to evaluate social robots, resulting in ambivalent study findings. To improve the quality of these types of studies, efficacy/effectiveness studies will benefit from appropriate randomized controlled trial designs with large sample sizes and individual intervention sessions. Experimental designs might work best for feasibility and usability studies. For each of the 3 goals (efficacy/effectiveness, feasibility, and usability) we also recommend a mixed method of data collection. Multiple interaction sessions running for at least 1 month might aid researchers in drawing significant results and prove the real long-term impact of social robots. ", doi="10.2196/37434", url="https://www.jmir.org/2022/8/e37434", url="http://www.ncbi.nlm.nih.gov/pubmed/35916695" } @Article{info:doi/10.2196/36505, author="Dinesen, Birthe and Hansen, Kidde Helle and Gr{\o}nborg, Bruun Gry and Dyrvig, Anne-Kirstine and Leisted, Dalskov Sofie and Stenstrup, Henrik and Skov Schacksen, Cathrine and Oestergaard, Claus", title="Use of a Social Robot (LOVOT) for Persons With Dementia: Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="1", volume="9", number="3", pages="e36505", keywords="dementia", keywords="social robots", keywords="artificial intelligence", keywords="health care professionals", keywords="health care", keywords="persons with dementia", abstract="Background: Approximately 50 million people worldwide are living with dementia. Social robots have been developed and tested to determine whether they improve the quality of life for persons with dementia. A new mobile social robot called LOVOT has artificial intelligence and sensor technologies built in. LOVOT, which is manufactured in Japan, has not yet been tested for use by persons with dementia. Objective: This study aimed to explore how the social robot LOVOT interacts with persons with dementia and how health care professionals experience working with LOVOT in their interaction with persons with dementia. Methods: The study was carried out at 3 nursing homes in Denmark, all with specialized units for persons with dementia. The interaction between the persons with dementia and LOVOT was tested in both individual sessions for 4 weeks and group sessions for 12 weeks. A total of 42 persons were included in the study, of which 12 were allocated to the individual sessions. A triangulation of data collection techniques was used: the World Health Organization-5 questionnaire, face scale, participant observation, and semistructured focus group interviews with health care professionals (n=3). Results: There were no clinically significant changes in the well-being of the persons with dementia followed in the individual or group interaction sessions over time. The results from the face scale showed that in both the individual and group sessions, persons with dementia tended to express more positive facial expressions after the sessions. Findings on how persons with dementia experienced their interaction with LOVOT can be stated in terms of the following themes: LOVOT opens up communication and interaction; provides entertainment; creates a breathing space; is accepted and creates joy; induces feelings of care; can create an overstimulation of feelings; is not accepted; is perceived as an animal; is perceived as being nondemanding; and prevents touch deprivation. Findings regarding the health care professionals' experiences using LOVOT were as follows: the artificial behavior seems natural; and it is a communication tool that can stimulate, create feelings of security, and open up communication. Our findings indicate that the social robot is a tool that can be used in interactions with persons with dementia. Conclusions: The LOVOT robot is the next generation of social robots with advanced artificial intelligence. The vast majority of persons with dementia accepted the social robot LOVOT. LOVOT had positive effects, opened up communication, and facilitated interpersonal interaction. Although LOVOT did not create noticeable effects on social well-being, it gave individual persons a respite from everyday life. Some residents were overstimulated by emotions after interacting with LOVOT. Health care professionals accepted the social robot and view LOVOT as a new tool in the work with persons with dementia. ", doi="10.2196/36505", url="https://rehab.jmir.org/2022/3/e36505", url="http://www.ncbi.nlm.nih.gov/pubmed/35916689" } @Article{info:doi/10.2196/36734, author="Shahria, Tanzil Md and Sunny, Haque Md Samiul and Zarif, Islam Md Ishrak and Khan, Rahaman Md Mahafuzur and Modi, Parag Preet and Ahamed, Iqbal Sheikh and Rahman, H. Mohammad", title="A Novel Framework for Mixed Reality--Based Control of Collaborative Robot: Development Study", journal="JMIR Biomed Eng", year="2022", month="May", day="17", volume="7", number="1", pages="e36734", keywords="robot framework", keywords="mixed reality", keywords="collaborative robot", keywords="Unity", keywords="Windows Mixed Reality", keywords="Azure mixed reality services", keywords="HoloLens 2", abstract="Background: Applications of robotics in daily life are becoming essential by creating new possibilities in different fields, especially in the collaborative environment. The potentials of collaborative robots are tremendous as they can work in the same workspace as humans. A framework employing a top-notch technology for collaborative robots will surely be worthwhile for further research. Objective: This study aims to present the development of a novel framework for the collaborative robot using mixed reality. Methods: The framework uses Unity and Unity Hub as a cross-platform gaming engine and project management tool to design the mixed reality interface and digital twin. It also uses the Windows Mixed Reality platform to show digital materials on holographic display and the Azure mixed reality services to capture and expose digital information. Eventually, it uses a holographic device (HoloLens 2) to execute the mixed reality--based collaborative system. Results: A thorough experiment was conducted to validate the novel framework for mixed reality--based control of a collaborative robot. This framework was successfully applied to implement a collaborative system using a 5--degree of freedom robot (xArm-5) in a mixed reality environment. The framework was stable and worked smoothly throughout the collaborative session. Due to the distributed nature of cloud applications, there is a negligible latency between giving a command and the execution of the physical collaborative robot. Conclusions: Opportunities for collaborative robots in telerehabilitation and teleoperation are vital as in any other field. The proposed framework was successfully applied in a collaborative session, and it can also be applied in other similar potential applications for robust and more promising performance. ", doi="10.2196/36734", url="https://biomedeng.jmir.org/2022/1/e36734" } @Article{info:doi/10.2196/33380, author="Teng, Rachel and Ding, Yichen and See, Choong Kay", title="Use of Robots in Critical Care: Systematic Review", journal="J Med Internet Res", year="2022", month="May", day="16", volume="24", number="5", pages="e33380", keywords="COVID-19", keywords="intensive care", keywords="high dependency", keywords="telepresence", keywords="intubation", abstract="Background: The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective: Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods: This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results: A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions: Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=234162 ", doi="10.2196/33380", url="https://www.jmir.org/2022/5/e33380", url="http://www.ncbi.nlm.nih.gov/pubmed/35576567" } @Article{info:doi/10.2196/33714, author="Camp, Nicola and Johnston, Julie and Lewis, C. Martin G. and Zecca, Massimiliano and Di Nuovo, Alessandro and Hunter, Kirsty and Magistro, Daniele", title="Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults", journal="JMIR Aging", year="2022", month="May", day="5", volume="5", number="2", pages="e33714", keywords="aging", keywords="wearable sensors", keywords="environmental sensors", keywords="social robots", keywords="activities of daily living", keywords="older adults", keywords="elderly", keywords="robots", keywords="wearables", abstract="Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults' perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (?70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. ", doi="10.2196/33714", url="https://aging.jmir.org/2022/2/e33714", url="http://www.ncbi.nlm.nih.gov/pubmed/35511248" } @Article{info:doi/10.2196/32322, author="Shin, H. Marlena and McLaren, Jaye and Ramsey, Alvin and Sullivan, L. Jennifer and Moo, Lauren", title="Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With Stakeholders", journal="JMIR Aging", year="2022", month="May", day="3", volume="5", number="2", pages="e32322", keywords="mild cognitive impairment", keywords="socially assistive robot", keywords="robot technology", keywords="caregiver support", keywords="gerontology", keywords="aging in place", keywords="qualitative research", keywords="mobile phone", abstract="Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input. Objective: The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders' overall opinions about the robot. Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique. Results: Overall, most stakeholders across groups felt positively about the robot's ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor's office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home--related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot's mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security. Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots. ", doi="10.2196/32322", url="https://aging.jmir.org/2022/2/e32322", url="http://www.ncbi.nlm.nih.gov/pubmed/35503518" } @Article{info:doi/10.2196/36094, author="Guemghar, Imane and Pires de Oliveira Padilha, Paula and Abdel-Baki, Amal and Jutras-Aswad, Didier and Paquette, Jesseca and Pomey, Marie-Pascale", title="Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review", journal="JMIR Ment Health", year="2022", month="Apr", day="19", volume="9", number="4", pages="e36094", keywords="social robots", keywords="socially assistive robots", keywords="SARs", keywords="mental health", keywords="mental health services", keywords="dementia", keywords="autism spectrum disorder", keywords="schizophrenia", keywords="depression", keywords="scoping review", abstract="Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O'Malley's framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. ", doi="10.2196/36094", url="https://mental.jmir.org/2022/4/e36094", url="http://www.ncbi.nlm.nih.gov/pubmed/35438639" } @Article{info:doi/10.2196/26990, author="Burdea, Grigore and Kim, Nam and Polistico, Kevin and Kadaru, Ashwin and Grampurohit, Namrata and Hundal, Jasdeep and Pollack, Simcha", title="Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports", journal="JMIR Rehabil Assist Technol", year="2022", month="Apr", day="13", volume="9", number="2", pages="e26990", keywords="subacute stroke", keywords="virtual reality", keywords="gamification", keywords="therapeutic game controller", keywords="integrative rehabilitation", keywords="BrightArm Duo", keywords="BrightArm Compact", keywords="upper extremity", keywords="cognition", keywords="depression", abstract="Background: BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. Objective: The aim of this study is to design and test a robotic rehabilitation table--based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. Methods: A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. Results: The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225\% and 100\% increase), grasp strength (27\% and 16\% increase), and pinch strength (31\% and 15\% increase). The shoulder flexion range increased by 17\% and 18\% and elbow supination range by 75\% and 58\%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). Conclusions: The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. Trial Registration: ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170 ", doi="10.2196/26990", url="https://rehab.jmir.org/2022/2/e26990", url="http://www.ncbi.nlm.nih.gov/pubmed/35416787" } @Article{info:doi/10.2196/31162, author="Waycott, Jenny and Zhao, Wei and Kelly, M. Ryan and Robertson, Elena", title="Technology-Mediated Enrichment in Aged Care: Survey and Interview Study", journal="JMIR Aging", year="2022", month="Apr", day="12", volume="5", number="2", pages="e31162", keywords="aged care", keywords="older adults", keywords="technology", keywords="social enrichment", keywords="virtual reality", keywords="robots", keywords="videoconferencing", keywords="care providers", abstract="Background: Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings. Objective: This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care. Methods: A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment. ", doi="10.2196/31162", url="https://aging.jmir.org/2022/2/e31162", url="http://www.ncbi.nlm.nih.gov/pubmed/34975014" } @Article{info:doi/10.2196/34200, author="Kottink, Roza Anke Ida and Nikamp, DM Corien and Bos, P. Foskea and van der Sluis, K. Corry and van den Broek, Marieke and Onneweer, Bram and Stolwijk-Sw{\"u}ste, M. Janneke and Brink, M. Sander and Voet, BM Nicoline and Buurke, B. Jacob and Rietman, S. Johannes and Prange-Lasonder, B. Gerdienke", title="Therapeutic Effect of a Soft Robotic Glove for Activities of Daily Living In People With Impaired Hand Strength: Protocol for a Multicenter Clinical Trial (iHand)", journal="JMIR Res Protoc", year="2022", month="Apr", day="5", volume="11", number="4", pages="e34200", keywords="upper extremity", keywords="hand function", keywords="hand strength", keywords="robotics", keywords="rehabilitation", keywords="assistive technology", keywords="activities of daily living", keywords="wearable devices", keywords="soft-robotic glove", keywords="wearable", keywords="hand", keywords="robot", keywords="assist", keywords="protocol", keywords="therapy", keywords="support", keywords="intervention", keywords="function", abstract="Background: Decline of hand function, especially reduced hand strength, is a common problem that can be caused by many disorders and results in difficulties performing activities of daily living. A wearable soft robotic glove may be a solution, enabling use of the affected arm and hand repeatedly during functional daily activities and providing intensive and task-specific training simultaneously with assistance of hand function. Objective: We aim to investigate the therapeutic effect of an assistive soft robotic glove (Carbonhand). Methods: This multicenter uncontrolled intervention study consists of 3 preassessments (T0, T1, and T2), a postassessment (T3), and a follow-up assessment (T4). Participants are patients who experience hand function limitations. For the intervention, participants will use the glove during activities of daily living at home for 6 weeks, with a recommended use of at least 180 minutes per week. The primary outcome measure is handgrip strength, and secondary outcome measures are related to functional arm and hand abilities, amount of glove use, and quality of life. Results: The first participant was included on June 25, 2019. Currently, the study has been extended due to the COVID-19 pandemic; data collection and analysis are expected to be completed in 2022. Conclusions: The Carbonhand system is a wearable assistive device, allowing performance of functional activities to be enhanced directly during functional daily activities. At the same time, active movement of the user is encouraged as much as possible, which has potential to provide highly intensive and task-specific training. As such, it is one of the first assistive devices to incorporate assist-as-needed principles. This is the first powered clinical trial that investigates the unique application of an assistive grip-supporting soft robotic glove outside of clinical settings with the aim to have a therapeutic effect. Trial Registration: Netherlands Trial Register NTR NL7561; https://www.trialregister.nl/trial/7561 International Registered Report Identifier (IRRID): DERR1-10.2196/34200 ", doi="10.2196/34200", url="https://www.researchprotocols.org/2022/4/e34200", url="http://www.ncbi.nlm.nih.gov/pubmed/35380115" } @Article{info:doi/10.2196/29224, author="Koh, Qi Wei and Whelan, Sally and Heins, Pascale and Casey, Dympna and Toomey, Elaine and Dr{\"o}es, Rose-Marie", title="The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites", journal="JMIR Aging", year="2022", month="Feb", day="22", volume="5", number="1", pages="e29224", keywords="social robot", keywords="pet robots", keywords="low-cost robot", keywords="dementia", keywords="older adults", keywords="qualitative research", keywords="qualitative content analysis", abstract="Background: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to ``older adults,'' ``dementia,'' and ``institutional care'' and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets. ", doi="10.2196/29224", url="https://aging.jmir.org/2022/1/e29224", url="http://www.ncbi.nlm.nih.gov/pubmed/35191844" } @Article{info:doi/10.2196/29656, author="Rossi, Silvia and Santini, Junior Silvano and Di Genova, Daniela and Maggi, Gianpaolo and Verrotti, Alberto and Farello, Giovanni and Romualdi, Roberta and Alisi, Anna and Tozzi, Eugenio Alberto and Balsano, Clara", title="Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial", journal="J Med Internet Res", year="2022", month="Jan", day="13", volume="24", number="1", pages="e29656", keywords="children", keywords="emotional health", keywords="emergency department", keywords="social robots", keywords="anxiety", keywords="stress", abstract="Background: Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. Objective: This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. Methods: This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r). Results: A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2\%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57). Conclusions: SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. Trial Registration: ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909 ", doi="10.2196/29656", url="https://www.jmir.org/2022/1/e29656", url="http://www.ncbi.nlm.nih.gov/pubmed/34854814" } @Article{info:doi/10.2196/28022, author="Latikka, Rita and Rubio-Hern{\'a}ndez, Rosana and Lohan, Simona Elena and Rantala, Juho and Nieto Fern{\'a}ndez, Fernando and Laitinen, Arto and Oksanen, Atte", title="Older Adults' Loneliness, Social Isolation, and Physical Information and Communication Technology in the Era of Ambient Assisted Living: A Systematic Literature Review", journal="J Med Internet Res", year="2021", month="Dec", day="30", volume="23", number="12", pages="e28022", keywords="loneliness", keywords="social isolation", keywords="older adults", keywords="physical information and communication technology", keywords="systematic literature review", abstract="Background: Loneliness and social isolation can have severe effects on human health and well-being. Partial solutions to combat these circumstances in demographically aging societies have been sought from the field of information and communication technology (ICT). Objective: This systematic literature review investigates the research conducted on older adults' loneliness and social isolation, and physical ICTs, namely robots, wearables, and smart homes, in the era of ambient assisted living (AAL). The aim is to gain insight into how technology can help overcome loneliness and social isolation other than by fostering social communication with people and what the main open-ended challenges according to the reviewed studies are. Methods: The data were collected from 7 bibliographic databases. A preliminary search resulted in 1271 entries that were screened based on predefined inclusion criteria. The characteristics of the selected studies were coded, and the results were summarized to answer our research questions. Results: The final data set consisted of 23 empirical studies. We found out that ICT solutions such as smart homes can help detect and predict loneliness and social isolation, and technologies such as robotic pets and some other social robots can help alleviate loneliness to some extent. The main open-ended challenges across studies relate to the need for more robust study samples and study designs. Further, the reviewed studies report technology- and topic-specific open-ended challenges. Conclusions: Technology can help assess older adults' loneliness and social isolation, and alleviate loneliness without direct interaction with other people. The results are highly relevant in the COVID-19 era, where various social restrictions have been introduced all over the world, and the amount of research literature in this regard has increased recently. ", doi="10.2196/28022", url="https://www.jmir.org/2021/12/e28022", url="http://www.ncbi.nlm.nih.gov/pubmed/34967760" } @Article{info:doi/10.2196/18972, author="Maier, Andr{\'e} and Eicher, Cornelia and Kiselev, Joern and Klebbe, Robert and Greu{\`e}l, Marius and Kettemann, Dagmar and Gaudlitz, Marcel and Walter, Bertram and Oleimeulen, Ursula and M{\"u}nch, Christoph and Meyer, Thomas and Spittel, Susanne", title="Acceptance of Enhanced Robotic Assistance Systems in People With Amyotrophic Lateral Sclerosis--Associated Motor Impairment: Observational Online Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Dec", day="6", volume="8", number="4", pages="e18972", keywords="amyotrophic lateral sclerosis", keywords="assistive robotics", keywords="technology commitment", keywords="robotic arm assistance", abstract="Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive paresis of the extremities and the loss of manual functioning. Due to the severe functional impairment that the disease entails, ALS requires the provision of comprehensive nursing care and a complex set of assistive technology devices. To relieve caregivers and promote autonomy of people with ALS, robotic assistance systems are being developed. This trial aims to evaluate the acceptance of technology, in general, and of robotic arm assistance among people with ALS in order to lay the groundwork for the development of a semiautomatic robotic arm that can be controlled by humans via a multimodal user interface and that will allow users to handle objects and attend to their own bodies. Objective: The aim of this study was to perform a systematic analysis of technology commitment and acceptance of robotic assistance systems from the perspective of physically limited people living with ALS. Methods: The investigation was conducted as a study of a prospective cohort. Participants were only included if they had received a medical diagnosis of ALS. Data collection took place via an online questionnaire on the Ambulanzpartner Soziotechnologie internet platform. Technological commitment was measured using the Neyer short scale. Furthermore, a multidimensional questionnaire was specially developed to analyze participant acceptance of robotic arm assistance: the Acceptance Measure of Robotic Arm Assistance (AMRAA). This questionnaire was accompanied by a video introducing the robot arm. ALS severity was ascertained using the ALS Functional Rating Scale--Extended (ALSFRS-EX). Results: A total of 268 people with ALS participated in the survey. Two-thirds of the participants were male. The overall mean ALS severity score was 42.9 (SD 11.7) points out of 60 on the ALSFRS-EX, with the most relevant restrictions on arms and legs (<60\% of normal functioning). Technological commitment ranked high, with the top third scoring 47.2 points out of 60. Younger participants and males showed significantly higher values. The AMRAA score was, again, significantly higher among younger participants. However, the gender difference within the overall cohort was not significant. The more limited the arm functioning of participants according to the ALSFRS-EX subscale, the higher the acceptance rate of robotic assistance. This relationship proved significant. Conclusions: People with ALS display high technological commitment and feel positive about using technological assistance systems. In our study, younger participants were more open to technology use, in general, and robotic assistance, in particular. Self-appraisal of technology acceptance, competence, and control conviction were generally higher among men. However, any presumed gender difference vanished when users were asked to rate the anticipated usefulness of the technology, in particular the robotic arm. The acceptance was also reflected in users' increased willingness to use a robotic arm as the functionality of their own arms decreased. From the perspective of people with ALS, robotic assistance systems are critical to promoting individual autonomy. Another key consideration in the development of future assistive technologies should be the reduction of caregiver burden. Trial Registration: German Clinical Trials Register DRKS00012803; https://tinyurl.com/w9yzduhd ", doi="10.2196/18972", url="https://rehab.jmir.org/2021/4/e18972", url="http://www.ncbi.nlm.nih.gov/pubmed/34874891" } @Article{info:doi/10.2196/20046, author="Busse, Sophie Theresa and Kernebeck, Sven and Nef, Larissa and Rebacz, Patrick and Kickbusch, Ilona and Ehlers, Peter Jan", title="Views on Using Social Robots in Professional Caregiving: Content Analysis of a Scenario Method Workshop", journal="J Med Internet Res", year="2021", month="Nov", day="10", volume="23", number="11", pages="e20046", keywords="social robots", keywords="robotics", keywords="health care sector", keywords="health personnel", keywords="ethics", keywords="forecasting", keywords="trends", keywords="technology", keywords="digital transformation", keywords="professional caregiving", abstract="Background: Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. Objective: In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. Methods: In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. Results: The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. Conclusions: The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future. ", doi="10.2196/20046", url="https://www.jmir.org/2021/11/e20046", url="http://www.ncbi.nlm.nih.gov/pubmed/34757318" } @Article{info:doi/10.2196/28914, author="Slovak, Petr and Ford, Q. Brett and Widen, Sherri and Daud{\'e}n Roquet, Claudia and Theofanopoulou, Nikki and Gross, J. James and Hankin, Benjamin and Klasnja, Predrag", title="An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="9", volume="10", number="11", pages="e28914", keywords="randomized controlled trial", keywords="children", keywords="emotion regulation", keywords="in situ intervention", keywords="intervention", keywords="emotion", keywords="protocol", keywords="exploratory", keywords="efficacy", keywords="model", keywords="prevention", keywords="treatment", keywords="risk factor", abstract="Background: Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot---in the form of an interactive plush toy---that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children's emotion regulation routines, there is no quantitative evidence of the intervention's impact on child outcomes. Objective: The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation---Purrble---that can be deployed across prevention and treatment contexts. Methods: Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents' rating of child dysregulation will be ?10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child's emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30\% of the sample) will be interviewed after deployment as part of the process analysis. Results: The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (\#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022. Conclusions: This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization. Trial Registration: ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455 International Registered Report Identifier (IRRID): PRR1-10.2196/28914 ", doi="10.2196/28914", url="https://www.researchprotocols.org/2021/11/e28914", url="http://www.ncbi.nlm.nih.gov/pubmed/34751666" } @Article{info:doi/10.2196/25745, author="Kaelin, C. Vera and Valizadeh, Mina and Salgado, Zurisadai and Parde, Natalie and Khetani, A. Mary", title="Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review", journal="J Med Internet Res", year="2021", month="Nov", day="4", volume="23", number="11", pages="e25745", keywords="health care", keywords="pediatric rehabilitation", keywords="technology", keywords="young persons", keywords="robotics", keywords="human-machine interaction", keywords="personalization", keywords="customization", keywords="goal-setting", keywords="natural language processing", keywords="machine learning", abstract="Background: In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. Objective: The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. Methods: We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. Results: The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77\%) and human-machine interaction (51/94, 54\%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89\%), and only 11\% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99\%). Only 1\% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1\%) described individual goal-setting as part of their therapy process or intervention planning. Conclusions: There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families. ", doi="10.2196/25745", url="https://www.jmir.org/2021/11/e25745", url="http://www.ncbi.nlm.nih.gov/pubmed/34734833" } @Article{info:doi/10.2196/30337, author="Bradwell, Louise Hannah and Edwards, Katie and Shenton, Deborah and Winnington, Rhona and Thill, Serge and Jones, B. Ray", title="User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="1", volume="8", number="4", pages="e30337", keywords="companion robots", keywords="social robots", keywords="Paro", keywords="older adults", keywords="dementia", keywords="care homes", keywords="engagement", keywords="acceptability", keywords="gerontology", keywords="Joy for All", keywords="social care", keywords="user-centered design", abstract="Background: Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective: In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods: We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results: Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions: This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations. ", doi="10.2196/30337", url="https://rehab.jmir.org/2021/4/e30337", url="http://www.ncbi.nlm.nih.gov/pubmed/34723825" } @Article{info:doi/10.2196/28381, author="Momattin, Hisham and Arafa, Shokry and Momattin, Shahad and Rahal, Rayan and Waterson, James", title="Robotic Pharmacy Implementation and Outcomes in Saudi Arabia: A 21-Month Usability Study", journal="JMIR Hum Factors", year="2021", month="Sep", day="1", volume="8", number="3", pages="e28381", keywords="patient satisfaction", keywords="automation", keywords="integration", keywords="medication error", keywords="outpatient", keywords="medication management", keywords="usability", keywords="medication dispensing", keywords="robotics", keywords="pharmacy", keywords="medication records", keywords="error", keywords="record", keywords="implementation", keywords="outcome", abstract="Background: We describe the introduction, use, and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was specifically undertaken to increase throughput, reduce medication dispensing error rates, improve patient satisfaction, and free up pharmacists' time to allow for increased face-to-face consultations with patients. Objective: We forecasted growth of our outpatient service at 25\% per annum over 5- and 10-year horizons and set out to prepare our outpatient pharmacy service to meet this demand. Initial project goals were set as a 50\% reduction in the average patient wait time, a 15\% increase in patient satisfaction regarding pharmacy wait time and pharmacy services, a 25\% increase in pharmacist productivity, and zero dispensing errors. This was expected to be achieved within 10 months of go-live. Realignment of pharmacist activity toward counseling and medication review with patients was a secondary goal, along with the rapid development of a reputation in the served community for patient-centered care. Methods: Preimplementation data for patient wait time for dispensing of prescribed medications as a specific measure of patient satisfaction was gathered as part of wider ongoing data collection in this field. Pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1000 prescriptions were also aggregated. All preimplementation data was gathered over an 11-month period. Results: From go-live, data were gathered on the above metrics in 1-month increments. At the 10-month point, there had been a 53\% reduction in the average wait time, a 20\% increase in patient satisfaction regarding pharmacy wait time, with a 22\% increase in overall patient satisfaction regarding pharmacy services, and a 33\% increase in pharmacist productivity. A zero dispensing error rate was reported. Conclusions: The robotic pharmacy solution studied was highly effective, but a robust upstream supply chain is vital to ensure stock levels, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility's software systems for appointments, medication records, and prescription generation in order to garner its full benefits. Overall patient satisfaction with pharmacy services is strongly influenced by wait time and follow-up studies are required to identify how to use this positive effect and make optimal use of freed-up pharmacist time. The extra time spent by pharmacists with patients and the opportunity for complete overview of the patient's medication history, which full integration provides, may allow us to address challenging issues such as medication nonadherence. Reduced wait times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing patients to have increased contact time with pharmacists. ", doi="10.2196/28381", url="https://humanfactors.jmir.org/2021/3/e28381", url="http://www.ncbi.nlm.nih.gov/pubmed/34304149" } @Article{info:doi/10.2196/25849, author="Lam, Kyle and Purkayastha, Sanjay and Kinross, M. James", title="The Ethical Digital Surgeon", journal="J Med Internet Res", year="2021", month="Jul", day="5", volume="23", number="7", pages="e25849", keywords="digital surgery", keywords="ethics", keywords="data governance", keywords="robotics", keywords="digital surgeons", keywords="surgery", keywords="digital health care", keywords="smartphone app", doi="10.2196/25849", url="https://www.jmir.org/2021/7/e25849", url="http://www.ncbi.nlm.nih.gov/pubmed/34453502" } @Article{info:doi/10.2196/23471, author="Chiu, Ching-Ju and Hsieh, Shiuan and Li, Chia-Wei", title="Needs and Preferences of Middle-Aged and Older Adults in Taiwan for Companion Robots and Pets: Survey Study", journal="J Med Internet Res", year="2021", month="Jun", day="11", volume="23", number="6", pages="e23471", keywords="middle-aged adults", keywords="older adults", keywords="companionship demand", keywords="robot", keywords="pet", keywords="acceptance", abstract="Background: In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also, animal-assisted therapy has been used to provide assistance, companionship, and interaction among the elderly and has been shown to have a positive impact on their emotional and psychological well-being. Both pets and robots can provide dynamic communication and positive interaction patterns. However, preferences for middle-aged and older adults in this regard are not clear. Objective: This study explored the degree of acceptance of robots and pets as partners in later life and to determine the needs and preferences of elderly individuals related to companion robots. Methods: A total of 273 middle-aged and older adults aged ?45 years and living in the community were invited to answer a structured questionnaire after watching a companion robot video. Sociodemographic data, physical health status and activities, experience with technology, eHealth literacy, and acceptance and attitude toward robots and pets were recorded and analyzed using multinomial logistic regression analysis. Results: Age, level of education, type of dwelling, occupation, retirement status, number of comorbidities, experience with pets, experience using apps, and eHealth literacy were significantly associated with acceptance of robots and pets. Middle-aged and older women preferred robots with an animal-like appearance, while men preferred robots that resembled a human adult. In terms of robot functions, participants preferred a companion robot with dancing, singing, storytelling, or news-reporting functions. Participants' marital status and whether or not they lived alone affected their preference of functions in the companion robot. Conclusions: Findings from this study inform the development of social robots with regard to their appearance and functions to address loneliness in later life in fast-aging societies. ", doi="10.2196/23471", url="https://www.jmir.org/2021/6/e23471/", url="http://www.ncbi.nlm.nih.gov/pubmed/34347621" } @Article{info:doi/10.2196/25340, author="Koh, Qi Wei and Ang, Hui Faith Xin and Casey, Dympna", title="Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Feb", day="12", volume="8", number="1", pages="e25340", keywords="social robot", keywords="assistive technology", keywords="robotic animals", keywords="pet robots", keywords="older adults", keywords="dementia", keywords="low-cost robot", keywords="psychosocial intervention", keywords="intervention", keywords="robot", keywords="review", abstract="Background: Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost and familiarly and realistically designed pet robots. Objective: The aim of this review is to synthesize evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia. Methods: The Arksey and O'Malley framework was used to guide this review. First, the research question was identified. Second, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorized, and presented narratively. Results: A total of 9 studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost. Conclusions: Overall, the findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets. ", doi="10.2196/25340", url="http://rehab.jmir.org/2021/1/e25340/", url="http://www.ncbi.nlm.nih.gov/pubmed/33497349" } @Article{info:doi/10.2196/25284, author="Alfred, C. Myrtede and Cohen, N. Tara and Cohen, A. Kate and Kanji, F. Falisha and Choi, Eunice and Del Gaizo, John and Nemeth, S. Lynne and Alekseyenko, V. Alexander and Shouhed, Daniel and Savage, J. Stephen and Anger, T. Jennifer and Catchpole, Ken", title="Using Flow Disruptions to Examine System Safety in Robotic-Assisted Surgery: Protocol for a Stepped Wedge Crossover Design", journal="JMIR Res Protoc", year="2021", month="Feb", day="9", volume="10", number="2", pages="e25284", keywords="robotic surgical procedures", keywords="patient safety", keywords="ergonomics", keywords="crossover design", abstract="Background: The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. Objective: This study aims to understand and measure current robotic-assisted surgery processes in a systematic, quantitative, and replicable manner to identify latent systemic threats and opportunities for improvement based on our observations and to implement and evaluate interventions. This 5-year study will follow a human factors engineering approach to improve the safety and efficiency of robotic-assisted surgery across 4 US hospitals. Methods: The study uses a stepped wedge crossover design with 3 interventions, introduced in different sequences at each of the hospitals over four 8-month phases. Robotic-assisted surgery procedures will be observed in the following specialties: urogynecology, gynecology, urology, bariatrics, general, and colorectal. We will use the data collected from observations, surveys, and interviews to inform interventions focused on teamwork, task design, and workplace design. We intend to evaluate attitudes toward each intervention, safety culture, subjective workload for each case, effectiveness of each intervention (including through direct observation of a sample of surgeries in each observational phase), operating room duration, length of stay, and patient safety incident reports. Analytic methods will include statistical data analysis, point process analysis, and thematic content analysis. Results: The study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 (CSMC and MDRH: Pro00056245; VCMC: STUDY 270; MUSC: Pro00088741). After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of the 4 sites. Conclusions: This will be the largest direct observational study of surgery ever conducted with data collected on 680 robotic surgery procedures at 4 different institutions. The proposed interventions will be evaluated using individual-level (workload and attitude), process-level (perioperative duration and flow disruption), and organizational-level (safety culture and complications) measures. An implementation science framework is also used to investigate the causes of success or failure of each intervention at each site and understand the potential spread of the interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/25284 ", doi="10.2196/25284", url="https://www.researchprotocols.org/2021/2/e25284", url="http://www.ncbi.nlm.nih.gov/pubmed/33560239" } @Article{info:doi/10.2196/23939, author="Buchanan, Christine and Howitt, Lyndsay M. and Wilson, Rita and Booth, G. Richard and Risling, Tracie and Bamford, Megan", title="Predicted Influences of Artificial Intelligence on the Domains of Nursing: Scoping Review", journal="JMIR Nursing", year="2020", month="Dec", day="17", volume="3", number="1", pages="e23939", keywords="nursing", keywords="artificial intelligence", keywords="machine learning", keywords="robotics", keywords="patient-centered care", keywords="review", abstract="Background: Artificial intelligence (AI) is set to transform the health system, yet little research to date has explored its influence on nurses---the largest group of health professionals. Furthermore, there has been little discussion on how AI will influence the experience of person-centered compassionate care for patients, families, and caregivers. Objective: This review aims to summarize the extant literature on the emerging trends in health technologies powered by AI and their implications on the following domains of nursing: administration, clinical practice, policy, and research. This review summarizes the findings from 3 research questions, examining how these emerging trends might influence the roles and functions of nurses and compassionate nursing care over the next 10 years and beyond. Methods: Using an established scoping review methodology, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Center, Scopus, Web of Science, and ProQuest databases were searched. In addition to the electronic database searches, a targeted website search was performed to access relevant gray literature. Abstracts and full-text studies were independently screened by 2 reviewers using prespecified inclusion and exclusion criteria. Included articles focused on nursing and digital health technologies that incorporate AI. Data were charted using structured forms and narratively summarized. Results: A total of 131 articles were retrieved from the scoping review for the 3 research questions that were the focus of this manuscript (118 from database sources and 13 from targeted websites). Emerging AI technologies discussed in the review included predictive analytics, smart homes, virtual health care assistants, and robots. The results indicated that AI has already begun to influence nursing roles, workflows, and the nurse-patient relationship. In general, robots are not viewed as replacements for nurses. There is a consensus that health technologies powered by AI may have the potential to enhance nursing practice. Consequently, nurses must proactively define how person-centered compassionate care will be preserved in the age of AI. Conclusions: Nurses have a shared responsibility to influence decisions related to the integration of AI into the health system and to ensure that this change is introduced in a way that is ethical and aligns with core nursing values such as compassionate care. Furthermore, nurses must advocate for patient and nursing involvement in all aspects of the design, implementation, and evaluation of these technologies. International Registered Report Identifier (IRRID): RR2-10.2196/17490 ", doi="10.2196/23939", url="https://nursing.jmir.org/2020/1/e23939/", url="http://www.ncbi.nlm.nih.gov/pubmed/34406963" } @Article{info:doi/10.2196/23496, author="Beran, Tanya and Pearson, Reynolds Jacqueline and Lashewicz, Bonnie and Baggott, Sandy", title="Perspectives of Child Life Specialists After Many Years of Working With a Humanoid Robot in a Pediatric Hospital: Narrative Design", journal="J Med Internet Res", year="2020", month="Nov", day="19", volume="22", number="11", pages="e23496", keywords="child life", keywords="support", keywords="pediatric", keywords="distraction", keywords="robotics", keywords="human-robot interaction", abstract="Background: Child life specialists (CLSs) play an important role in supporting patients and their families during their visits to a children's hospital. Although CLSs are equipped with considerable expertise to support families during some of the most difficult moments of their lives, we introduced an additional resource to them in the form of a humanoid robot named MEDi. Objective: The aim of this study is to explore the experiences of CLSs using a robot to support children. Methods: We interviewed 7 CLSs who had worked with this robot for several years. The transcribed interviews were analyzed using open and axial coding. Results: The first main theme that emerged was the process of navigating from fear to friendship in learning to use a humanoid robot for therapeutic support. The second major theme was MEDi as a source of connection and support to children. CLSs' perceptions of MEDi as an adaptable resource and working with the limits of MEDi constituted the last 2 themes. Conclusions: These descriptions show how CLSs can incorporate a robot into their practice. ", doi="10.2196/23496", url="http://www.jmir.org/2020/11/e23496/", url="http://www.ncbi.nlm.nih.gov/pubmed/33211014" } @Article{info:doi/10.2196/17509, author="Saadatzi, Nasser Mohammad and Logsdon, Cynthia M. and Abubakar, Shamsudeen and Das, Sumit and Jankoski, Penelope and Mitchell, Heather and Chlebowy, Diane and Popa, O. Dan", title="Acceptability of Using a Robotic Nursing Assistant in Health Care Environments: Experimental Pilot Study", journal="J Med Internet Res", year="2020", month="Nov", day="12", volume="22", number="11", pages="e17509", keywords="robot-assisted healthcare", keywords="robotic nurse assistant", keywords="technology acceptance model", keywords="user acceptability", keywords="patient walking", abstract="Background: According to the US Bureau of Labor Statistics, nurses will be the largest labor pool in the United States by 2022, and more than 1.1 million nursing positions have to be filled by then in order to avoid a nursing shortage. In addition, the incidence rate of musculoskeletal disorders in nurses is above average in comparison with other occupations. Robot-assisted health care has the potential to alleviate the nursing shortage by automating mundane and routine nursing tasks. Furthermore, robots in health care environments may assist with safe patient mobility and handling and may thereby reduce the likelihood of musculoskeletal disorders. Objective: This pilot study investigates the perceived ease of use and perceived usefulness (acceptability) of a customized service robot as determined by nursing students (as proxies for nursing staff in health care environments). This service robot, referred to as the Adaptive Robotic Nurse Assistant (ARNA), was developed to enhance the productivity of nurses through cooperation during physical tasks (eg, patient walking, item fetching, object delivery) as well as nonphysical tasks (eg, patient observation and feedback). This pilot study evaluated the acceptability of ARNA to provide ambulatory assistance to patients. Methods: We conducted a trial with 24 participants to collect data and address the following research question: Is the use of ARNA as an ambulatory assistive device for patients acceptable to nurses? The experiments were conducted in a simulated hospital environment. Nursing students (as proxies for nursing staff) were grouped in dyads, with one participant serving as a nurse and the other acting as a patient. Two questionnaires were developed and administrated to the participants based on the Technology Acceptance Model with respect to the two subscales of perceived usefulness and perceived ease of use metrics. In order to evaluate the internal consistency/reliability of the questionnaires, we calculated Cronbach alpha coefficients. Furthermore, statistical analyses were conducted to evaluate the relation of each variable in the questionnaires with the overall perceived usefulness and perceived ease of use metrics. Results: Both Cronbach alpha values were acceptably high (.93 and .82 for perceived usefulness and perceived ease of use questionnaires, respectively), indicating high internal consistency of the questionnaires. The correlation between the variables and the overall perceived usefulness and perceived ease of use metrics was moderate. The average perceived usefulness and perceived ease of use metrics among the participants were 4.13 and 5.42, respectively, out of possible score of 7, indicating a higher-than-average acceptability of this service robot. Conclusions: The results served to identify factors that could affect nurses' acceptance of ARNA and aspects needing improvement (eg, flexibility, ease of operation, and autonomy level). ", doi="10.2196/17509", url="http://www.jmir.org/2020/11/e17509/", url="http://www.ncbi.nlm.nih.gov/pubmed/33180024" } @Article{info:doi/10.2196/19251, author="Bass, Alec and Aubertin-Leheudre, Myl{\`e}ne and Vincent, Claude and Karelis, D. Antony and Morin, N. Suzanne and McKerral, Michelle and Duclos, Cyril and Gagnon, H. Dany", title="Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study", journal="JMIR Res Protoc", year="2020", month="Sep", day="24", volume="9", number="9", pages="e19251", keywords="assistive technology", keywords="locomotion", keywords="spinal cord injury", keywords="rehabilitation", keywords="robotics", keywords="osteoporosis", abstract="Background: In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity---typically linked to this mode of mobility---contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. Objective: This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton--assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. Methods: A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton--assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. Results: This study is currently underway with active recruitment in Montr{\'e}al, Qu{\'e}bec, Canada. Results are expected in the spring of 2021. Conclusions: The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton--assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. Trial Registration: ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID): DERR1-10.2196/19251 ", doi="10.2196/19251", url="http://www.researchprotocols.org/2020/9/e19251/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663160" } @Article{info:doi/10.2196/18787, author="Boumans, Roel and van Meulen, Fokke and van Aalst, William and Albers, Joyce and Janssen, Mar{\`e}se and Peters-Kop, Marieke and Huisman - de Waal, Getty and van de Poll, Alexandra and Hindriks, Koen and Neerincx, Mark and Olde Rikkert, Marcel", title="Quality of Care Perceived by Older Patients and Caregivers in Integrated Care Pathways With Interviewing Assistance From a Social Robot: Noninferiority Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Sep", day="9", volume="22", number="9", pages="e18787", keywords="integrated care pathway", keywords="social robot", keywords="quality of care", keywords="noninferiority randomized controlled trial", abstract="Background: Society is facing a global shortage of 17 million health care workers, along with increasing health care demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem. Objective: Our objective is to evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measure (PROM) interviews versus the currently used professional interviews. Methods: A multicenter, two-parallel-group, nonblinded, randomized controlled trial was used to test for noninferiority of the quality of care delivered through robot-assisted care. The randomization was performed using a computer-generated table. The setting consisted of two outpatient clinics, and the study took place from July to December 2019. Of 419 patients who visited the participating outpatient clinics, 110 older patients met the criteria for recruitment. Inclusion criteria were the ability to speak and read Dutch and being assisted by a participating health care professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, and paranoia or similar psychiatric problems. The intervention consisted of a social robot conducting a 36-item PROM. As the main outcome measure, the customized Consumer Quality Index (CQI) was used, as reported by patients and caregivers for the outpatient pathway of care. Results: In total, 75 intermediately frail older patients were included in the study, randomly assigned to the intervention and control groups, and processed: 36 female (48\%) and 39 male (52\%); mean age 77.4 years (SD 7.3), range 60-91 years. There was no significant difference in the total patient CQI scores between the patients included in the robot-assisted care pathway (mean 9.27, SD 0.65, n=37) and those in the control group (mean 9.00, SD 0.70, n=38): P=.08, 95\% CI --0.04 to 0.58. There was no significant difference in the total CQI scores between caregivers in the intervention group (mean 9.21, SD 0.76, n=30) and those in the control group (mean 9.09, SD 0.60, n=35): P=.47, 95\% CI --0.21 to 0.46. No harm or unintended effects occurred. Conclusions: Geriatric patients and their informal caregivers valued robot-assisted and nonrobot-assisted care pathways equally. Trial Registration: ClinicalTrials.gov NCT03857789; https://clinicaltrials.gov/ct2/show/NCT03857789 ", doi="10.2196/18787", url="http://www.jmir.org/2020/9/e18787/", url="http://www.ncbi.nlm.nih.gov/pubmed/32902387" } @Article{info:doi/10.2196/20169, author="Cresswell, Kathrin and Ramalingam, Sandeep and Sheikh, Aziz", title="Can Robots Improve Testing Capacity for SARS-CoV-2?", journal="J Med Internet Res", year="2020", month="Aug", day="12", volume="22", number="8", pages="e20169", keywords="robotics", keywords="testing", keywords="SARS-CoV-2", keywords="COVID-19", keywords="pandemic", keywords="virus", keywords="infectious disease", doi="10.2196/20169", url="http://www.jmir.org/2020/8/e20169/", url="http://www.ncbi.nlm.nih.gov/pubmed/32735547" } @Article{info:doi/10.2196/18003, author="?ukasik, Sylwia and Tobis, S?awomir and Kropi?ska, Sylwia and Suwalska, Aleksandra", title="Role of Assistive Robots in the Care of Older People: Survey Study Among Medical and Nursing Students", journal="J Med Internet Res", year="2020", month="Aug", day="12", volume="22", number="8", pages="e18003", keywords="assistive robots", keywords="older adults", keywords="acceptance", keywords="medical students", keywords="nursing students", abstract="Background: Populations are aging at an alarming rate in many countries around the world. There has been not only a decrease in the number of births and an increase in the percentage of older people, but also an increase in the number of people living alone. There is growing demand for specialist medical care and daily care with the number of people who can act as caregivers reducing. The use of assistive robots can, at least partially, solve these problems. Objective: The purpose of this study was to examine the opinions of future health care professionals (medical and nursing students) regarding the use of assistive robots in the care of older people. Methods: The study was conducted with a group of 178 students from Poznan University of Medical Sciences, Pozna?, Poland (110 nursing students and 68 medical students), using the Users' Needs, Requirements, and Abilities Questionnaire. Results: The participants of this study believed that assistive robots should, first of all, remind older people to take medication regularly, ensure their safety, monitor their health status and environment, provide cognitive training, and encourage them to maintain physical activity. In the students' opinion, the robot should not be an older person's companion but only act as an assistant. Nursing students had significantly higher scores than medical students in several statements concerning everyday use of robots, including reminding about meals (P=.03), monitoring the environment (P=.001), providing advice about a healthy diet (P=.04), monitoring the intake of food and fluids (P=.02), and automatic ``switch on'' function (P=.02). Nursing students were more focused on the social functions of robots, including encouraging contact with friends (P=.003) and reducing the sense of loneliness and improving mood (P=.008). Medical students were more aware of privacy issues in the statement concerning the possibility of switching off the robot in specific situations (P=.01). Conclusions: Our study revealed a generally positive attitude of future doctors and nurses toward assistive robots, which can have an impact on their acceptance by older adults. In the future, medical professionals could help their patients to choose the right robots (and necessary functions) that are best suited to their needs. However, this would require expanding the curriculum to include the issues of gerontechnology. ", doi="10.2196/18003", url="https://www.jmir.org/2020/8/e18003", url="http://www.ncbi.nlm.nih.gov/pubmed/32784187" } @Article{info:doi/10.2196/17286, author="Abdi, Sarah and de Witte, Luc and Hawley, Mark", title="Emerging Technologies With Potential Care and Support Applications for Older People: Review of Gray Literature", journal="JMIR Aging", year="2020", month="Aug", day="11", volume="3", number="2", pages="e17286", keywords="artificial intelligence", keywords="internet of things", keywords="mobile phone", keywords="robotics", keywords="emerging technologies", keywords="older people", keywords="care and support", abstract="Background: The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care systems. Emerging technological developments have the potential to address some of the care and support challenges of older people. However, limited work has been done to identify emerging technological developments with the potential to meet the care and support needs of the aging population. Objective: This review aimed to gain an overview of emerging technologies with potential care and support applications for older people, particularly for those living at home. Methods: A scoping gray literature review was carried out by using the databases of 13 key organizations, hand searching reference lists of included documents, using funding data, and consulting technology experts. A narrative synthesis approach was used to analyze and summarize the findings of the literature review. Results: A total of 39 documents were included in the final analysis. From the analysis, 8 emerging technologies were identified that could potentially be used to meet older people's needs in various care and support domains. These emerging technologies were (1) assistive autonomous robots; (2) self-driving vehicles; (3) artificial intelligence--enabled health smart apps and wearables; (4) new drug release mechanisms; (5) portable diagnostics; (6) voice-activated devices; (7) virtual, augmented, and mixed reality; and (8) intelligent homes. These emerging technologies were at different levels of development, with some being trialed for care applications, whereas others being in the early phases of development. However, only a few documents mentioned including older people during the process of designing and developing these technologies. Conclusions: This review has identified key emerging technologies with the potential to contribute to the support and care needs of older people. However, to increase the adoption of these technologies by older people, there is a need to involve them and other stakeholders, such as formal and informal carers, in the process of designing and developing these technologies. ", doi="10.2196/17286", url="http://aging.jmir.org/2020/2/e17286/", url="http://www.ncbi.nlm.nih.gov/pubmed/32780020" } @Article{info:doi/10.2196/18839, author="Chattopadhyay, Debaleena and Ma, Tengteng and Sharifi, Hasti and Martyn-Nemeth, Pamela", title="Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2020", month="Jul", day="30", volume="22", number="7", pages="e18839", keywords="virtual humans", keywords="avatars", keywords="patient-facing systems", keywords="meta-analysis", keywords="conversational agents", keywords="chatbot", keywords="digital interlocutors", abstract="Background: Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. Objective: The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. Methods: Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. Results: Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged --- simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95\% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3\%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). Conclusions: We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness. ", doi="10.2196/18839", url="http://www.jmir.org/2020/7/e18839/", url="http://www.ncbi.nlm.nih.gov/pubmed/32729837" } @Article{info:doi/10.2196/18551, author="D{\"o}ring, Nicola and Mohseni, Rohangis M. and Walter, Roberto", title="Design, Use, and Effects of Sex Dolls and Sex Robots: Scoping Review", journal="J Med Internet Res", year="2020", month="Jul", day="30", volume="22", number="7", pages="e18551", keywords="sex toys", keywords="sexual objectification", keywords="anthropomorphization", keywords="embodied sexual fantasies", keywords="parasocial interactions and relationships, mobile phone", abstract="Background: Although sex toys representing human body parts are widely accepted and normalized, human-like full-body sex dolls and sex robots have elicited highly controversial debates. Objective: This systematic scoping review of the academic literature on sex dolls and sex robots, the first of its kind, aimed to examine the extent and type of existing academic knowledge and to identify research gaps against this backdrop. Methods: A comprehensive multidisciplinary, multidatabase search strategy was used. All steps of literature search and selection, data charting, and synthesis followed the leading methodological guideline, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A total of 29 (17 peer reviewed) and 98 publications (32 peer reviewed) for sex dolls and sex robots, respectively, from 1993 to 2019 were included. Results: According to the topics and methodologies, the sex doll and sex robot publications were divided into 5 and 6 groups, respectively. The majority of publications were theoretical papers. Thus far, no observational or experimental research exists that uses actual sex dolls or sex robots as stimulus material. Conclusions: There is a need to improve the theoretical elaboration and the scope and depth of empirical research examining the sexual uses of human-like full-body material artifacts, particularly concerning not only risks but also opportunities for sexual and social well-being. ", doi="10.2196/18551", url="https://www.jmir.org/2020/7/e18551", url="http://www.ncbi.nlm.nih.gov/pubmed/32729841" } @Article{info:doi/10.2196/14927, author="Sch{\"u}ssler, Sandra and Zuschnegg, Julia and Paletta, Lucas and Fellner, Maria and Lodron, Gerald and Steiner, Josef and Pansy-Resch, Sandra and Lammer, Lara and Prodromou, Dimitrios and Brunsch, Sebastian and Holter, Magdalena and Carnevale, Lorenzo and Russegger, Silvia", title="The Effects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2020", month="Feb", day="5", volume="9", number="2", pages="e14927", keywords="dementia", keywords="socially assistive robot", keywords="home care", keywords="caregiver", keywords="dementia trainers", keywords="motivation", keywords="physical training", keywords="cognitive training", keywords="care burden", keywords="humanoid robot", abstract="Background: New technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages. Objective: This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC--based dementia training program (Coach Pepper) versus an exclusively tablet PC--based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia. Methods: A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC--based dementia training program), and the control group will receive exclusively tablet PC--based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation. Results: To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020. Conclusions: The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home. International Registered Report Identifier (IRRID): DERR1-10.2196/14927 ", doi="10.2196/14927", url="https://www.researchprotocols.org/2020/2/e14927" } @Article{info:doi/10.2196/15429, author="Sapci, Hasan A. and Sapci, Aylin H.", title="Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review", journal="JMIR Aging", year="2019", month="Nov", day="29", volume="2", number="2", pages="e15429", keywords="innovative assisted living tools for aging society", keywords="artificially intelligent home monitoring", keywords="older adults", keywords="robotic technologies", keywords="smart home", abstract="Background: The increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults' daily activities and health-related issues might prevent medical emergencies. Objective: The primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems. Methods: A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people's care, independent living, and novel assistive technologies were included in the study. Results: A total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal. Conclusions: The use of ubiquitous in-home monitoring and smart technologies for aged people's care will increase their independence and the health care services available to them as well as improve frail elderly people's health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults. ", doi="10.2196/15429", url="http://aging.jmir.org/2019/2/e15429/", url="http://www.ncbi.nlm.nih.gov/pubmed/31782740" } @Article{info:doi/10.2196/16194, author="Musk, Elon and ", title="An Integrated Brain-Machine Interface Platform With Thousands of Channels", journal="J Med Internet Res", year="2019", month="Oct", day="31", volume="21", number="10", pages="e16194", keywords="brain-machine interface", keywords="sensory function", keywords="motor function", keywords="neurology", doi="10.2196/16194", url="http://www.jmir.org/2019/10/e16194/", url="http://www.ncbi.nlm.nih.gov/pubmed/31642810" } @Article{info:doi/10.2196/13667, author="Johanson, L. Deborah and Ahn, Seok Ho and MacDonald, A. Bruce and Ahn, Kyu Byeong and Lim, JongYoon and Hwang, Euijun and Sutherland, J. Craig and Broadbent, Elizabeth", title="The Effect of Robot Attentional Behaviors on User Perceptions and Behaviors in a Simulated Health Care Interaction: Randomized Controlled Trial", journal="J Med Internet Res", year="2019", month="Oct", day="4", volume="21", number="10", pages="e13667", keywords="robotics", keywords="health care robotics", keywords="social interaction", keywords="engagement", keywords="social intelligence", abstract="Background: For robots to be effectively used in health applications, they need to display appropriate social behaviors. A fundamental requirement in all social interactions is the ability to engage, maintain, and demonstrate attention. Attentional behaviors include leaning forward, self-disclosure, and changes in voice pitch. Objective: This study aimed to examine the effect of robot attentional behaviors on user perceptions and behaviors in a simulated health care interaction. Methods: A parallel randomized controlled trial with a 1:1:1:1 allocation ratio was conducted. We randomized participants to 1 of 4 experimental conditions before engaging in a scripted face-to-face interaction with a fully automated medical receptionist robot. Experimental conditions included a self-disclosure condition, voice pitch change condition, forward lean condition, and neutral condition. Participants completed paper-based postinteraction measures relating to engagement, perceived robot attention, and perceived robot empathy. We video recorded interactions and coded for participant attentional behaviors. Results: A total of 181 participants were recruited from the University of Auckland. Participants who interacted with the robot in the forward lean and self-disclosure conditions found the robot to be significantly more stimulating than those who interacted with the robot in the voice pitch or neutral conditions (P=.03). Participants in the forward lean, self-disclosure, and neutral conditions found the robot to be significantly more interesting than those in the voice pitch condition (P<.001). Participants in the forward lean and self-disclosure conditions spent significantly more time looking at the robot than participants in the neutral condition (P<.001). Significantly, more participants in the self-disclosure condition laughed during the interaction (P=.01), whereas significantly more participants in the forward lean condition leant toward the robot during the interaction (P<.001). Conclusions: The use of self-disclosure and forward lean by a health care robot can increase human engagement and attentional behaviors. Voice pitch changes did not increase attention or engagement. The small effects with regard to participant perceptions are potentially because of the limitations in self-report measures or a lack of comparison for most participants who had never interacted with a robot before. Further research could explore the use of self-disclosure and forward lean using a within-subjects design and in real health care settings. ", doi="10.2196/13667", url="https://www.jmir.org/2019/10/e13667", url="http://www.ncbi.nlm.nih.gov/pubmed/31588904" } @Article{info:doi/10.2196/12010, author="Mubin, Omar and Alnajjar, Fady and Jishtu, Nalini and Alsinglawi, Belal and Al Mahmud, Abdullah", title="Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients' Rehabilitation: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2019", month="Sep", day="8", volume="6", number="2", pages="e12010", keywords="stroke", keywords="robot", keywords="exoskeleton", keywords="virtual reality", keywords="augmented reality", keywords="gamification", keywords="rehabilitation", abstract="Background: Robot-assisted therapy has become a promising technology in the field of rehabilitation for poststroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for most stroke survivors. With current advancements in technology there has been the introduction of virtual reality (VR), augmented reality (AR), customizable games, or a combination thereof, that aid robotic therapy in retaining, or increasing the interests of, patients so they keep performing their exercises. However, there are gaps in the evidence regarding the transition from clinical rehabilitation to home-based therapy which calls for an updated synthesis of the literature that showcases this trend. The present review proposes a categorization of these studies according to technologies used, and details research in both upper limb and lower limb applications. Objective: The goal of this work was to review the practices and technologies implemented in the rehabilitation of poststroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies (VR, AR, or gamification) in improving activity and participation in poststroke survivors. Methods: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies of interest (VR, AR, or gamification) was performed in the following databases: MEDLINE, EMBASE, Science Direct \& The Cochrane Library. Exoskeleton-based studies that did not include any VR, AR or gamification elements were excluded, but publications from the years 2010 to 2017 were included. Results in the form of improvements in the patients' condition were also recorded and taken into consideration in determining the effectiveness of any of the therapies on the patients. Results: Thirty studies were identified based on the inclusion criteria, and this included randomized controlled trials as well as exploratory research pieces. There were a total of about 385 participants across the various studies. The use of technologies such as VR-, AR-, or gamification-based exoskeletons could fill the transition from the clinic to a home-based setting. Our analysis showed that there were general improvements in the motor function of patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps with understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation. Conclusions: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the individual therapies. ", doi="10.2196/12010", url="https://rehab.jmir.org/2019/2/e12010", url="http://www.ncbi.nlm.nih.gov/pubmed/31586360" } @Article{info:doi/10.2196/13853, author="Eichenberg, Christiane and Khamis, Marwa and H{\"u}bner, Lisa", title="The Attitudes of Therapists and Physicians on the Use of Sex Robots in Sexual Therapy: Online Survey and Interview Study", journal="J Med Internet Res", year="2019", month="Aug", day="20", volume="21", number="8", pages="e13853", keywords="robotics", keywords="sexual health", keywords="therapy", abstract="Background: Various types of robots have already been successfully used in medical care, and the use of new technologies is also playing an increasing role in the area of sexuality. Sex robots are marketed as advanced sex toys and sex dolls with artificial intelligence. Only a few considerations about the therapeutic use of sex robots in sexual therapy are debated in expert discussions. Objective: The aim of this study was to conduct a first exploratory survey on the attitudes of sex therapists and physicians toward the therapeutic benefits of sex robots. Methods: This study comprised a quantitative online survey and a qualitative interview study. A self-constructed questionnaire was used to survey the general attitudes of sex therapists and physicians regarding the benefits of sex robots in therapy. The qualitative study was designed to gain in-depth insight into the participants' beliefs and attitudes. Therefore, semistructured interviews were conducted. The quantitative data were evaluated by statistical analysis, and the interviews were transcribed and analyzed by using a grounded theory approach. Results: A total of 72 sex therapists and physicians completed our self-constructed questionnaire (response rate 15\%, 72/480). Only a few respondents (11\%, 8/72) said that the use of sex robots was not conceivable for them, and almost half of all therapists and physicians could imagine recommending sex robots in therapy (45\%, 33/72). The attitude toward sex robots as a therapeutic tool was very heterogeneous, with gender (P=.006), age (P=.03), and occupational differences (P=.05); female therapists, older therapists, and psychologists (in contrast to physicians) were more critical toward the therapeutic use of sex robots. The analysis of the 5 interviews identified 3 high-level core themes that were representative of the participants' responses: (1) the importance of the personal definition of sex robots for the assessment of their therapeutic benefits, (2) therapeutic benefits and dangers of sex robots, and (3) considerations on the quality of human-robot sexuality. Initial insights into the possible therapeutic use of sex robots in different disorders (eg, sexual dysfunction or pedophilia) and situations were gained from the perspective of sex therapists. Conclusions: The results of this study provide a first overview of the potential therapeutic use of sex robots. Moral, ethical, and treatment-related issues in this context are still unresolved and need to be further researched. We suggest integrating the topic into the training of sex therapists to form opinions beyond media images and to show therapy possibilities. Scientists engaged in sexual research should be involved in the development of sex robots to design robots with positive effects on sexual education, sexual therapy, sexual counseling, and sexual well-being for interested groups. ", doi="10.2196/13853", url="https://www.jmir.org/2019/8/e13853/", url="http://www.ncbi.nlm.nih.gov/pubmed/31432784" } @Article{info:doi/10.2196/13228, author="Daniele, Katia and Marcucci, Maura and Cattaneo, Cesarina and Borghese, Alberto Nunzio and Zannini, Lucia", title="How Prefrail Older People Living Alone Perceive Information and Communications Technology and What They Would Ask a Robot for: Qualitative Study", journal="J Med Internet Res", year="2019", month="Aug", day="06", volume="21", number="8", pages="e13228", keywords="frail elders", keywords="independent living", keywords="attitude", keywords="technology", keywords="information technology", keywords="robotics", keywords="qualitative research", keywords="interview", abstract="Background: In the last decade, the family system has changed significantly. Although in the past, older people used to live with their children, nowadays, they cannot always depend on assistance of their relatives. Many older people wish to remain as independent as possible while remaining in their homes, even when living alone. To do so, there are many tasks that they must perform to maintain their independence in everyday life, and above all, their well-being. Information and communications technology (ICT), particularly robotics and domotics, could play a pivotal role in aging, especially in contemporary society, where relatives are not always able to accurately and constantly assist the older person. Objective: The aim of this study was to understand the needs, preferences, and views on ICT of some prefrail older people who live alone. In particular, we wanted to explore their attitude toward a hypothetical caregiver robot and the functions they would ask for. Methods: We designed a qualitative study based on an interpretative phenomenological approach. A total of 50 potential participants were purposively recruited in a big town in Northern Italy and were administered the Fried scale (to assess the participants' frailty) and the Mini-Mental State Examination (to evaluate the older person's capacity to comprehend the interview questions). In total, 25 prefrail older people who lived alone participated in an individual semistructured interview, lasting approximately 45 min each. Overall, 3 researchers independently analyzed the interviews transcripts, identifying meaning units, which were later grouped in clustering of themes, and finally in emergent themes. Constant triangulation among researchers and their reflective attitude assured trustiness. Results: From this study, it emerged that a number of interviewees who were currently using ICT (ie, smartphones) did not own a computer in the past, or did not receive higher education, or were not all young older people (aged 65-74 years). Furthermore, we found that among the older people who described their relationship with ICT as negative, many used it in everyday life. Referring to robotics, the interviewees appeared quite open-minded. In particular, robots were considered suitable for housekeeping, for monitoring older people's health and accidental falls, and for entertainment. Conclusions: Older people's use and attitudes toward ICT does not always seem to be related to previous experiences with technological devices, higher education, or lower age. Furthermore, many participants in this study were able to use ICT, even if they did not always acknowledge it. Moreover, many interviewees appeared to be open-minded toward technological devices, even toward robots. Therefore, proposing new advanced technology to a group of prefrail people, who are self-sufficient and can live alone at home, seems to be feasible. ", doi="10.2196/13228", url="https://www.jmir.org/2019/8/e13228/", url="http://www.ncbi.nlm.nih.gov/pubmed/31389341" } @Article{info:doi/10.2196/12549, author="Barwise, K. Amelia and Patten, A. Christi and Bock, J. Martha and Hughes, A. Christine and Brockman, A. Tabetha and Valdez Soto, A. Miguel and Wi, Chung-Il and Juhn, J. Young and Witt, R. Daniel and Sinicrope, Stephen and Kreps, R. Samantha and Saling, D. Henry and Levine, A. James and Balls-Berry, E. Joyce", title="Acceptability of Robotic-Assisted Exercise Coaching Among Diverse Youth: Pilot Study", journal="JMIR Pediatr Parent", year="2019", month="Jul", day="31", volume="2", number="2", pages="e12549", keywords="robotics", keywords="adolescents", keywords="exercise", keywords="coaching", keywords="physical activity", keywords="technology", abstract="Background: Almost 80\% of adolescents do not achieve 60 minutes or more of physical activity each day as recommended by current US national guidelines. There is a need to develop and promote interventions that increase physical activity among adolescents. With increased interest in digital technologies among adolescents, robotic-assisted platforms are a novel and engaging strategy to deliver physical activity interventions. Objective: This study sought to assess the potential acceptability of robotic-assisted exercise coaching among diverse youth and to explore demographic factors associated with acceptance. Methods: This pilot study used a cross-sectional survey design. We recruited adolescents aged 12-17 years at three community-based sites in Rochester, MN. Written informed consent was obtained from participants' parents or guardians and participants gave consent. Participants watched a brief demonstration of the robotic system-human interface (ie, robotic human trainer). The exercise coaching was delivered in real time via an iPad tablet placed atop a mobile robotic wheel base and controlled remotely by the coach using an iOS device or computer. Following the demonstration, participants completed a 28-item survey that assessed sociodemographic information, smoking and depression history, weight, and exercise habits; the survey also included the eight-item Technology Acceptance Scale (TAS), a validated instrument used to assess perceived usefulness and ease of use of new technologies. Results: A total of 190 adolescents participated in this study. Of the participants, 54.5\% were (103/189) male, 42.6\% (81/190) were racial minorities, 5.8\% (11/190) were Hispanic, and 28.4\% (54/190) lived in a lower-income community. Their mean age was 15.0 years (SD 2.0). A total of 24.7\% (47/190) of participants met national recommendations for physical activity. Their mean body mass index (BMI) was 21.8 kg/m2 (SD 4.0). Of note, 18.4\% (35/190) experienced depression now or in the past. The mean TAS total score was 32.8 (SD 7.8) out of a possible score of 40, indicating high potential receptivity to the technology. No significant associations were detected between TAS score and gender, age, racial minority status, participant neighborhood, BMI, meeting national recommendations for physical activity levels, or depression history (P>.05 for all). Of interest, 67.8\% (129/190) of participants agreed that they and their friends were likely to use the robot to help them exercise. Conclusions: This preliminary study found that among a racially and socioeconomically diverse group of adolescents, robotic-assisted exercise coaching is likely acceptable. The finding that all demographic groups represented had similarly high receptivity to the robotic human exercise trainer is encouraging for ultimate considerations of intervention scalability and reach among diverse adolescent populations. Next steps will be to evaluate consumer preferences for robotic-assisted exercise coaching (eg, location, duration, supervised or structured, choice of exercise, and/or lifestyle activity focus), develop the treatment protocol, and evaluate feasibility and consumer uptake of the intervention among diverse youth. ", doi="10.2196/12549", url="https://pediatrics.jmir.org/2019/2/e12549/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518333" } @Article{info:doi/10.2196/13322, author="Scoglio, AJ Arielle and Reilly, D. Erin and Gorman, A. Jay and Drebing, E. Charles", title="Use of Social Robots in Mental Health and Well-Being Research: Systematic Review", journal="J Med Internet Res", year="2019", month="Jul", day="24", volume="21", number="7", pages="e13322", keywords="social robotics", keywords="socially assistive robots", keywords="mental health", keywords="interventions", abstract="Background: Technology-assisted clinical interventions are increasingly common in the health care field, often with the proposed aim to improve access to and cost-effectiveness of care. Current technology platforms delivering interventions are largely mobile apps and online websites, although efforts have been made to create more personalized and embodied technology experiences. To extend and improve on these platforms, the field of robotics has been increasingly included in conversations of how to deliver technology-assisted, interactive, and responsive mental health and psychological well-being interventions. Socially assistive robots (SARs) are robotic technology platforms with audio, visual, and movement capabilities that are being developed to interact with individuals socially while also assisting them with management of their physical and psychological well-being. However, little is known about the empirical evidence or utility of using SARs in mental health interventions. Objective: The review synthesizes and describes the nascent empirical literature of SARs in mental health research and identifies strengths, weaknesses, and opportunities for improvement in future research and practice. Methods: Searches in Medline, PsycINFO, PsycARTICLES, PubMed, and IEEE Xplore yielded 12 studies included in the final review after applying inclusion and exclusion criteria. Abstract and full-text reviews were conducted by two authors independently. Results: This systematic review of the literature found 5 distinct SARs used in research to investigate the potential for this technology to address mental health and psychological well-being outcomes. Research on mental health applications of SARs focuses largely on elderly dementia patients and relies on usability pilot data with methodological limitations. Conclusions: The current SARs research in mental health use is limited in generalizability, scope, and measurement of psychological outcomes. Opportunities for expansion of research in this area include diversifying populations studied, SARs used, clinical applications, measures used, and settings for those applications. ", doi="10.2196/13322", url="http://www.jmir.org/2019/7/e13322/", url="http://www.ncbi.nlm.nih.gov/pubmed/31342908" } @Article{info:doi/10.2196/13729, author="Chita-Tegmark, Meia and Ackerman, M. Janet and Scheutz, Matthias", title="Effects of Assistive Robot Behavior on Impressions of Patient Psychological Attributes: Vignette-Based Human-Robot Interaction Study", journal="J Med Internet Res", year="2019", month="May", day="19", volume="21", number="6", pages="e13729", keywords="robotics", keywords="emotional intelligence", keywords="patient-centered care", abstract="Background: As robots are increasingly designed for health management applications, it is critical to not only consider the effects robots will have on patients but also consider a patient's wider social network, including the patient's caregivers and health care providers, among others. Objective: In this paper we investigated how people evaluate robots that provide care and how they form impressions of the patient the robot cares for, based on how the robot represents the patient. Methods: We have used a vignette-based study, showing participants hypothetical scenarios describing behaviors of assistive robots (patient-centered or task-centered) and measured their influence on people's evaluations of the robot itself (emotional intelligence [EI], trustworthiness, and acceptability) as well as people's perceptions of the patient for whom the robot provides care. Results: We found that for scenarios describing a robot that acts in a patient-centered manner, the robot will not only be perceived as having higher EI (P=.003) but will also cause people to form more positive impressions of the patient that the robot cares for (P<.001). We replicated and expanded these results to other domains such as dieting, learning, and job training. Conclusions: These results imply that robots could be used to enhance human-human relationships in the health care context and beyond. ", doi="10.2196/13729", url="https://www.jmir.org/2019/6/e13729/", url="http://www.ncbi.nlm.nih.gov/pubmed/31199297" } @Article{info:doi/10.2196/12708, author="Barak Ventura, Roni and Nakayama, Shinnosuke and Raghavan, Preeti and Nov, Oded and Porfiri, Maurizio", title="The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation", journal="J Med Internet Res", year="2019", month="May", day="15", volume="21", number="5", pages="e12708", keywords="citizen science", keywords="social interactions", keywords="telerehabilitation", keywords="physical therapy", abstract="Background: Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. Objective: Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. Methods: We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. Results: We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). Conclusions: Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively. ", doi="10.2196/12708", url="http://www.jmir.org/2019/5/e12708/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094338" } @Article{info:doi/10.2196/13203, author="Robinson, Lee Nicole and Cottier, Vaughan Timothy and Kavanagh, John David", title="Psychosocial Health Interventions by Social Robots: Systematic Review of Randomized Controlled Trials", journal="J Med Internet Res", year="2019", month="May", day="10", volume="21", number="5", pages="e13203", keywords="social robot", keywords="healthcare", keywords="treatment", keywords="therapy", keywords="autism spectrum disorder", keywords="dementia", abstract="Background: Social robots that can communicate and interact with people offer exciting opportunities for improved health care access and outcomes. However, evidence from randomized controlled trials (RCTs) on health or well-being outcomes has not yet been clearly synthesized across all health domains where social robots have been tested. Objective: This study aimed to undertake a systematic review examining current evidence from RCTs on the effects of psychosocial interventions by social robots on health or well-being. Methods: Medline, PsycInfo, ScienceDirect, Scopus, and Engineering Village searches across all years in the English language were conducted and supplemented by forward and backward searches. The included papers reported RCTs that assessed changes in health or well-being from interactions with a social robot across at least 2 measurement occasions. Results: Out of 408 extracted records, 27 trials met the inclusion criteria: 6 in child health or well-being, 9 in children with autism spectrum disorder, and 12 with older adults. No trials on adolescents, young adults, or other problem areas were identified, and no studies had interventions where robots spontaneously modified verbal responses based on speech by participants. Most trials were small (total N=5 to 415; median=34), only 6 (22\%) reported any follow-up outcomes (2 to 12 weeks; median=3.5) and a single-blind assessment was reported in 8 (31\%). More recent trials tended to have greater methodological quality. All papers reported some positive outcomes from robotic interventions, although most trials had some measures that showed no difference or favored alternate treatments. Conclusions: Controlled research on social robots is at an early stage, as is the current range of their applications to health care. Research on social robot interventions in clinical and health settings needs to transition from exploratory investigations to include large-scale controlled trials with sophisticated methodology, to increase confidence in their efficacy. ", doi="10.2196/13203", url="http://www.jmir.org/2019/5/e13203/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094357" } @Article{info:doi/10.2196/12629, author="Crowell, R. Charles and Deska, C. Jason and Villano, Michael and Zenk, Julaine and Roddy Jr, T. John", title="Anthropomorphism of Robots: Study of Appearance and Agency", journal="JMIR Hum Factors", year="2019", month="May", day="10", volume="6", number="2", pages="e12629", keywords="psychology, social", keywords="social perception", keywords="theory of mind", keywords="cognitive science", keywords="perception", keywords="cognition", keywords="robotics", keywords="telerobotics", keywords="human factors engineering", abstract="Background: As the prevalence of robots increases each year, understanding how we anthropomorphize and interact with them is extremely important. The three-factor theory of anthropomorphism, called the Sociality, Effectance, Elicited agent Knowledge model, guided this study. As anthropomorphism involves a person making attributions of human likeness toward a nonhuman object, this model implies that anthropomorphism can be influenced either by factors related to the person or the object. Objective: The aim of this study was to explore factors influencing the anthropomorphism of robots, specifically the robot's appearance (humanoid vs nonhumanoid) and agency (autonomous vs nonautonomous). We expected a humanoid robot would be anthropomorphized to a greater extent than one that was nonhumanoid. In addition, we expected that inducing an agency belief to the effect that a robot was making its own decisions would increase anthropomorphism compared with a nonagency belief that the robot was being remotely controlled by a human. We also sought to identify any role gender might play in anthropomorphizing the robot. Methods: Participants (N=99) were primed for agency or nonagency belief conditions and then saw a brief video depicting either a humanoid or nonhumanoid robot interacting with a confederate. After viewing the video, they completed 4 measures: perception to humanoid robots scale (PERNOD), the Epley anthropomorphic adjectives measure, the Fussel anthropomorphic adjective checklist, and the Anthropomorphic Tendencies Scale (ATS). Results: Findings with the PERNOD scale indicated subjects did perceive the 2 robots differently, F6,86=6.59, P<.001, which means the appearance manipulation was effective. Results with the Epley adjectives indicated that participants were more willing to attribute humanlike behavioral traits to the nonhumanoid rather than the humanoid robot, F1,91=5.76, P=.02. The Fussel adjective checklist results showed that subjects were more willing to attribute humanlike social qualities to the remote controlled than the autonomous robot, F1,91=5.30, P=.02. Finally, the ATS revealed the only gender effects in this study, with females reporting more endorsement of anthropomorphism for pets (P=.02) and less for showing negative emotions toward anthropomorphized objects (P<.001) if they had witnessed the humanoid rather than the nonhumanoid robot. Conclusions: Contrary to our expectations, participants were less willing to make humanlike attributions toward a robot when its morphology was more humanlike and were more willing to make those attributions when they were told that the robot was being remotely controlled by a person rather than acting on its own. In retrospect, these outcomes may have occurred because the humanoid robot used here had a smaller overall stature than the nonhumanoid robot, perhaps making it seem more toylike and because subjects made attributions toward the person behind the remote-controlled robot rather than toward the robot itself. ", doi="10.2196/12629", url="http://humanfactors.jmir.org/2019/2/e12629/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094323" } @Article{info:doi/10.2196/13216, author="Fiske, Amelia and Henningsen, Peter and Buyx, Alena", title="Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy", journal="J Med Internet Res", year="2019", month="May", day="09", volume="21", number="5", pages="e13216", keywords="artificial intelligence", keywords="robotics", keywords="ethics", keywords="psychiatry", keywords="psychology", keywords="psychotherapy", keywords="medicine", abstract="Background: Research in embodied artificial intelligence (AI) has increasing clinical relevance for therapeutic applications in mental health services. With innovations ranging from `virtual psychotherapists' to social robots in dementia care and autism disorder, to robots for sexual disorders, artificially intelligent virtual and robotic agents are increasingly taking on high-level therapeutic interventions that used to be offered exclusively by highly trained, skilled health professionals. In order to enable responsible clinical implementation, ethical and social implications of the increasing use of embodied AI in mental health need to be identified and addressed. Objective: This paper assesses the ethical and social implications of translating embodied AI applications into mental health care across the fields of Psychiatry, Psychology and Psychotherapy. Building on this analysis, it develops a set of preliminary recommendations on how to address ethical and social challenges in current and future applications of embodied AI. Methods: Based on a thematic literature search and established principles of medical ethics, an analysis of the ethical and social aspects of currently embodied AI applications was conducted across the fields of Psychiatry, Psychology, and Psychotherapy. To enable a comprehensive evaluation, the analysis was structured around the following three steps: assessment of potential benefits; analysis of overarching ethical issues and concerns; discussion of specific ethical and social issues of the interventions. Results: From an ethical perspective, important benefits of embodied AI applications in mental health include new modes of treatment, opportunities to engage hard-to-reach populations, better patient response, and freeing up time for physicians. Overarching ethical issues and concerns include: harm prevention and various questions of data ethics; a lack of guidance on development of AI applications, their clinical integration and training of health professionals; `gaps' in ethical and regulatory frameworks; the potential for misuse including using the technologies to replace established services, thereby potentially exacerbating existing health inequalities. Specific challenges identified and discussed in the application of embodied AI include: matters of risk-assessment, referrals, and supervision; the need to respect and protect patient autonomy; the role of non-human therapy; transparency in the use of algorithms; and specific concerns regarding long-term effects of these applications on understandings of illness and the human condition. Conclusions: We argue that embodied AI is a promising approach across the field of mental health; however, further research is needed to address the broader ethical and societal concerns of these technologies to negotiate best research and medical practices in innovative mental health care. We conclude by indicating areas of future research and developing recommendations for high-priority areas in need of concrete ethical guidance. ", doi="10.2196/13216", url="https://www.jmir.org/2019/5/e13216/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094356" } @Article{info:doi/10.2196/12625, author="Shen, Lining and Wang, Shimin and Dai, Wei and Zhang, Zhiguo", title="Detecting the Interdisciplinary Nature and Topic Hotspots of Robotics in Surgery: Social Network Analysis and Bibliometric Study", journal="J Med Internet Res", year="2019", month="Mar", day="26", volume="21", number="3", pages="e12625", keywords="robotics", keywords="robotic surgery", keywords="interdisciplinary collaboration", keywords="topic hotspot", keywords="topic bursts", keywords="co-word analysis", keywords="bibliometric analysis", keywords="bibliometrics", keywords="social network analysis", keywords="robotic surgical procedures", keywords="laparoscopy", abstract="Background: With the widespread application of a robot to surgery, growing literature related to robotics in surgery (RS) documents widespread concerns from scientific researchers worldwide. Although such application is helpful to considerably improve the accuracy of surgery, we still lack the understanding of the multidiscipline-crossing status and topic distribution related to RS. Objective: The aim of this study was to detect the interdisciplinary nature and topic hotspots on RS by analyzing the current publication outputs related to RS. Methods: The authors collected publications related to RS in the last 21 years, indexed by the Web of Science Core Collection. Various bibliometric methods and tools were used, including literature distribution analysis at the country and institution level and interdisciplinary collaboration analysis in the different periods of time. Co-word analysis was performed based on the keywords with high frequency. The temporal visualization bar presented the evolution of topics over time. Results: A total of 7732 bibliographic records related to RS were identified. The United States plays a leading role in the publication output related to RS, followed by Italy and Germany. It should be noted that the Yonsei University in South Korea published the highest number of RS-related publications. Furthermore, the interdisciplinary collaboration is uneven; the number of disciplines involved in each paper dropped from the initial 1.60 to the current 1.31. Surgery; Engineering; Radiology, Nuclear Medicine, and Medical Imaging; and Neurosciences and Neurology are the 4 core disciplines in the field of RS, all of which have extensive cooperation with other disciplines. The distribution of topic hotspots is in imbalanced status, which can be categorized into 7 clusters. Moreover, 3 areas about the evolution of topic were identified, namely (1) the exploration of techniques that make RS implemented, (2) rapid development of robotic systems and related applications in surgery, and (3) application of a robot to excision of tissues or organs targeted at various specific diseases. Conclusions: This study provided important insights into the interdisciplinary nature related to RS, which indicates that the researchers with different disciplinary backgrounds should strengthen cooperation to publish a high-quality output. The research topic hotspots related to RS are relatively scattered, which has begun to turn to the application of RS targeted at specific diseases. Our study is helpful to provide a potential guide to the direction of the field of RS for future research in the field of RS. ", doi="10.2196/12625", url="http://www.jmir.org/2019/3/e12625/", url="http://www.ncbi.nlm.nih.gov/pubmed/30912752" } @Article{info:doi/10.2196/jmir.9460, author="Cavallo, Filippo and Esposito, Raffaele and Limosani, Raffaele and Manzi, Alessandro and Bevilacqua, Roberta and Felici, Elisa and Di Nuovo, Alessandro and Cangelosi, Angelo and Lattanzio, Fabrizia and Dario, Paolo", title="Robotic Services Acceptance in Smart Environments With Older Adults: User Satisfaction and Acceptability Study", journal="J Med Internet Res", year="2018", month="Sep", day="21", volume="20", number="9", pages="e264", keywords="social robotics", keywords="active and healthy aging", keywords="acceptability models", abstract="Background: In Europe, the population of older people is increasing rapidly. Many older people prefer to remain in their homes but living alone could be a risk for their safety. In this context, robotics and other emerging technologies are increasingly proposed as potential solutions to this societal concern. However, one-third of all assistive technologies are abandoned within one year of use because the end users do not accept them. Objective: The aim of this study is to investigate the acceptance of the Robot-Era system, which provides robotic services to permit older people to remain in their homes. Methods: Six robotic services were tested by 35 older users. The experiments were conducted in three different environments: private home, condominium, and outdoor sites. The appearance questionnaire was developed to collect the users' first impressions about the Robot-Era system, whereas the acceptance was evaluated through a questionnaire developed ad hoc for Robot-Era. Results: A total of 45 older users were recruited. The people were grouped in two samples of 35 participants, according to their availability. Participants had a positive impression of Robot-Era robots, as reflected by the mean score of 73.04 (SD 11.80) for DORO's (domestic robot) appearance, 76.85 (SD 12.01) for CORO (condominium robot), and 75.93 (SD 11.67) for ORO (outdoor robot). Men gave ORO's appearance an overall score higher than women (P=.02). Moreover, participants younger than 75 years understood more readily the functionalities of Robot-Era robots compared to older people (P=.007 for DORO, P=.001 for CORO, and P=.046 for ORO). For the ad hoc questionnaire, the mean overall score was higher than 80 out of 100 points for all Robot-Era services. Older persons with a high educational level gave Robot-Era services a higher score than those with a low level of education (shopping: P=.04; garbage: P=.047; reminding: P=.04; indoor walking support: P=.006; outdoor walking support: P=.03). A higher score was given by male older adults for shopping (P=.02), indoor walking support (P=.02), and outdoor walking support (P=.03). Conclusions: Based on the feedback given by the end users, the Robot-Era system has the potential to be developed as a socially acceptable and believable provider of robotic services to facilitate older people to live independently in their homes. ", doi="10.2196/jmir.9460", url="http://www.jmir.org/2018/9/e264/", url="http://www.ncbi.nlm.nih.gov/pubmed/30249588" } @Article{info:doi/10.2196/10410, author="Cresswell, Kathrin and Cunningham-Burley, Sarah and Sheikh, Aziz", title="Health Care Robotics: Qualitative Exploration of Key Challenges and Future Directions", journal="J Med Internet Res", year="2018", month="Jul", day="04", volume="20", number="7", pages="e10410", keywords="robotics", keywords="health care", keywords="sociotechnical", abstract="Background: The emergence of robotics is transforming industries around the world. Robot technologies are evolving exponentially, particularly as they converge with other functionalities such as artificial intelligence to learn from their environment, from each other, and from humans. Objective: The goal of the research was to understand the emerging role of robotics in health care and identify existing and likely future challenges to maximize the benefits associated with robotics and related convergent technologies. Methods: We conducted qualitative semistructured one-to-one interviews exploring the role of robotic applications in health care contexts. Using purposive sampling, we identified a diverse range of stakeholders involved in conceiving, procuring, developing, and using robotics in a range of national and international health care settings. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically, supported by NVivo 10 (QSR International) software. Theoretically, this work was informed by the sociotechnical perspective, where social and technical systems are understood as being interdependent. Results: We conducted 21 interviews and these accounts suggested that there are significant opportunities for improving the safety, quality, and efficiency of health care through robotics, but our analysis identified 4 major barriers that need to be effectively negotiated to realize these: (1) no clear pull from professionals and patients, (2) appearance of robots and associated expectations and concerns, (3) disruption of the way work is organized and distributed, and (4) new ethical and legal challenges requiring flexible liability and ethical frameworks. Conclusions: Sociotechnical challenges associated with the effective integration of robotic applications in health care settings are likely to be significant, particularly for patient-facing functions. These need to be identified and addressed for effective innovation and adoption. ", doi="10.2196/10410", url="http://www.jmir.org/2018/7/e10410/", url="http://www.ncbi.nlm.nih.gov/pubmed/29973336" } @Article{info:doi/10.2196/rehab.9535, author="Elnady, Ahmed and Mortenson, Ben W. and Menon, Carlo", title="Perceptions of Existing Wearable Robotic Devices for Upper Extremity and Suggestions for Their Development: Findings From Therapists and People With Stroke", journal="JMIR Rehabil Assist Technol", year="2018", month="May", day="15", volume="5", number="1", pages="e12", keywords="qualitative research", keywords="focus group", keywords="wearable devices", keywords="rehabilitation", keywords="upper extremity", abstract="Background: Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limited and there are questions regarding how well these devices address users' (therapists and patients) needs. Objective: The aims of this study were to (1) describe users' perceptions about existing wearable robotic devices for the upper extremity; (2) identify if there is a need to develop new devices for the upper extremity and the desired features; and (3) explore obstacles that would influence the utilization of these new devices. Methods: Focus groups were held to collect data. Data were analyzed thematically. Results: A total of 16 participants took part in the focus group discussions. Our analysis identified three main themes: (1) ``They exist, but...'' described participants' perceptions about existing devices for upper extremity; (2) ``Indeed, we need more, can we have it all?'' reflected participants' desire to have new devices for the upper extremity and revealed heterogeneity among different participants; and (3) ``Bumps on the road'' identified challenges that the participants felt needed to be taken into consideration during the development of these devices. Conclusions: This study resonates with previous research that has highlighted the importance of involving end users in the design process. The study suggests that having a single solution for stroke rehabilitation or assistance could be challenging or even impossible, and thus, engineers should clearly identify the targeted stroke population needs before the design of any device for the upper extremity. ", doi="10.2196/rehab.9535", url="http://rehab.jmir.org/2018/1/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/29764799" } @Article{info:doi/10.2196/jmir.7737, author="Galv{\~a}o Gomes da Silva, Joana and Kavanagh, J. David and Belpaeme, Tony and Taylor, Lloyd and Beeson, Konna and Andrade, Jackie", title="Experiences of a Motivational Interview Delivered by a Robot: Qualitative Study", journal="J Med Internet Res", year="2018", month="May", day="03", volume="20", number="5", pages="e116", keywords="robotics", keywords="counseling", keywords="motivational interviewing", keywords="motivation", keywords="exercise", keywords="qualitative research", keywords="computer-assisted therapy", keywords="person-centered therapy", abstract="Background: Motivational interviewing is an effective intervention for supporting behavior change but traditionally depends on face-to-face dialogue with a human counselor. This study addressed a key challenge for the goal of developing social robotic motivational interviewers: creating an interview protocol, within the constraints of current artificial intelligence, which participants will find engaging and helpful. Objective: The aim of this study was to explore participants' qualitative experiences of a motivational interview delivered by a social robot, including their evaluation of usability of the robot during the interaction and its impact on their motivation. Methods: NAO robots are humanoid, child-sized social robots. We programmed a NAO robot with Choregraphe software to deliver a scripted motivational interview focused on increasing physical activity. The interview was designed to be comprehensible even without an empathetic response from the robot. Robot breathing and face-tracking functions were used to give an impression of attentiveness. A total of 20 participants took part in the robot-delivered motivational interview and evaluated it after 1 week by responding to a series of written open-ended questions. Each participant was left alone to speak aloud with the robot, advancing through a series of questions by tapping the robot's head sensor. Evaluations were content-analyzed utilizing Boyatzis' steps: (1) sampling and design, (2) developing themes and codes, and (3) validating and applying the codes. Results: Themes focused on interaction with the robot, motivation, change in physical activity, and overall evaluation of the intervention. Participants found the instructions clear and the navigation easy to use. Most enjoyed the interaction but also found it was restricted by the lack of individualized response from the robot. Many positively appraised the nonjudgmental aspect of the interview and how it gave space to articulate their motivation for change. Some participants felt that the intervention increased their physical activity levels. Conclusions: Social robots can achieve a fundamental objective of motivational interviewing, encouraging participants to articulate their goals and dilemmas aloud. Because they are perceived as nonjudgmental, robots may have advantages over more humanoid avatars for delivering virtual support for behavioral change. ", doi="10.2196/jmir.7737", url="http://www.jmir.org/2018/5/e116/", url="http://www.ncbi.nlm.nih.gov/pubmed/29724701" } @Article{info:doi/10.2196/jmir.8640, author="Broadbent, Elizabeth and Garrett, Jeff and Jepsen, Nicola and Li Ogilvie, Vickie and Ahn, Seok Ho and Robinson, Hayley and Peri, Kathryn and Kerse, Ngaire and Rouse, Paul and Pillai, Avinesh and MacDonald, Bruce", title="Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Feb", day="13", volume="20", number="2", pages="e45", keywords="robotics", keywords="chronic obstructive pulmonary disease", keywords="hospitalization", keywords="medication adherence", keywords="telehealth", keywords="rehabilitation exercise", abstract="Background: Socially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization. Objective: This pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group. Methods: At discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted. Results: Intention-to-treat and per protocol analyses showed no significant differences in the number of respiratory-related hospitalizations between groups. The intervention group was more adherent to their long-acting inhalers (mean number of prescribed puffs taken per day=48.5\%) than the control group (mean 29.5\%, P=.03, d=0.68) assessed via electronic recording. Self-reported adherence was also higher in the intervention group after controlling for covariates (P=.04). The intervention group increased their rehabilitation exercise frequency compared with the control group (mean difference ?4.53, 95\% CI ?7.16 to ?1.92). There were no significant differences in quality of life. Of the 25 patients who had the robot, 19 had favorable attitudes. Conclusions: This pilot study suggests that a homecare robot can improve adherence to medication and increase exercise. Further research is needed with a larger sample size to further investigate effects on hospitalizations after improvements are made to the robots. The robots could be especially useful for patients struggling with adherence. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000259549; http://www.anzctr.org.au (Archived by WebCite at ?http://www.webcitation.org/6whIjptLS) ", doi="10.2196/jmir.8640", url="https://www.jmir.org/2018/2/e45/", url="http://www.ncbi.nlm.nih.gov/pubmed/29439942" } @Article{info:doi/10.2196/jmir.6553, author="Provoost, Simon and Lau, Ming Ho and Ruwaard, Jeroen and Riper, Heleen", title="Embodied Conversational Agents in Clinical Psychology: A Scoping Review", journal="J Med Internet Res", year="2017", month="May", day="09", volume="19", number="5", pages="e151", keywords="eHealth", keywords="review", keywords="embodied conversational agent", keywords="human computer interaction", keywords="clinical psychology", keywords="mental disorders", keywords="intelligent agent", keywords="health behavior", abstract="Background: Embodied conversational agents (ECAs) are computer-generated characters that simulate key properties of human face-to-face conversation, such as verbal and nonverbal behavior. In Internet-based eHealth interventions, ECAs may be used for the delivery of automated human support factors. Objective: We aim to provide an overview of the technological and clinical possibilities, as well as the evidence base for ECA applications in clinical psychology, to inform health professionals about the activity in this field of research. Methods: Given the large variety of applied methodologies, types of applications, and scientific disciplines involved in ECA research, we conducted a systematic scoping review. Scoping reviews aim to map key concepts and types of evidence underlying an area of research, and answer less-specific questions than traditional systematic reviews. Systematic searches for ECA applications in the treatment of mood, anxiety, psychotic, autism spectrum, and substance use disorders were conducted in databases in the fields of psychology and computer science, as well as in interdisciplinary databases. Studies were included if they conveyed primary research findings on an ECA application that targeted one of the disorders. We mapped each study's background information, how the different disorders were addressed, how ECAs and users could interact with one another, methodological aspects, and the study's aims and outcomes. Results: This study included N=54 publications (N=49 studies). More than half of the studies (n=26) focused on autism treatment, and ECAs were used most often for social skills training (n=23). Applications ranged from simple reinforcement of social behaviors through emotional expressions to sophisticated multimodal conversational systems. Most applications (n=43) were still in the development and piloting phase, that is, not yet ready for routine practice evaluation or application. Few studies conducted controlled research into clinical effects of ECAs, such as a reduction in symptom severity. Conclusions: ECAs for mental disorders are emerging. State-of-the-art techniques, involving, for example, communication through natural language or nonverbal behavior, are increasingly being considered and adopted for psychotherapeutic interventions in ECA research with promising results. However, evidence on their clinical application remains scarce. At present, their value to clinical practice lies mostly in the experimental determination of critical human support factors. In the context of using ECAs as an adjunct to existing interventions with the aim of supporting users, important questions remain with regard to the personalization of ECAs' interaction with users, and the optimal timing and manner of providing support. To increase the evidence base with regard to Internet interventions, we propose an additional focus on low-tech ECA solutions that can be rapidly developed, tested, and applied in routine practice. ", doi="10.2196/jmir.6553", url="http://www.jmir.org/2017/5/e151/", url="http://www.ncbi.nlm.nih.gov/pubmed/28487267" } @Article{info:doi/10.2196/resprot.4189, author="Yu, Ruby and Hui, Elsie and Lee, Jenny and Poon, Dawn and Ng, Ashley and Sit, Kitty and Ip, Kenny and Yeung, Fannie and Wong, Martin and Shibata, Takanori and Woo, Jean", title="Use of a Therapeutic, Socially Assistive Pet Robot (PARO) in Improving Mood and Stimulating Social Interaction and Communication for People With Dementia: Study Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2015", month="May", day="01", volume="4", number="2", pages="e45", keywords="dementia", keywords="elderly", keywords="PARO", keywords="randomized controlled trial", keywords="robot-assisted therapy", keywords="socially assistive robots", abstract="Background: Socially assistive robotics is a growing area for geriatric research. Objective: This single-blind, randomized controlled trial (RCT) aims to investigate the use of PARO, a therapeutic, socially assistive pet robot, in improving mood, and stimulating social interaction and communication for people with dementia in the community. Methods: For the study, 40 community-dwelling older Chinese adults (?60 years) with mild to moderate dementia will be recruited and randomly assigned to the PARO therapy group or the psychosocial activities control group. Both treatments consist of six, 30-minute weekly sessions, which will be conducted in a geriatric day hospital. Subjects in both groups will be assessed by a trained research assistant at baseline (pre-), during, and post-treatment. Mood (assessed with a simplified face scale), social interaction, and communication (ie, facial expressions and reactions towards each treatment, assessed with an observation table) will be the primary outcome measures. Secondary outcome measures will include assessments on cognitive function (Mini-Mental State Examination) and depressive symptoms (Cornell Scale for Depression in Dementia), as well as caregiver burden (Zarit Burden Inventory). Subjective impression towards each treatment and qualitative comments from the caregivers, facilitator, and therapists will also be obtained. Results: Recruitment to the pilot study began in 2014 and the last subject is expected to complete their post-treatment assessment in 2015. Conclusions: This will be the first RCT using PARO to improve mood, and stimulate social interaction and communication in the care of older people with dementia, as well as provide an evidence basis for the use of PARO in dementia care in Hong Kong. Trial Registration: The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000037606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000037606 (Archived by WebCite at http://www.webcitation.org/6Xi7uXdu9). ", doi="10.2196/resprot.4189", url="http://www.researchprotocols.org/2015/2/e45/", url="http://www.ncbi.nlm.nih.gov/pubmed/25934173" } @Article{info:doi/10.2196/rehab.3151, author="Calderita, Vicente Luis and Manso, J. Luis and Bustos, Pablo and Su{\'a}rez-Mej{\'i}as, Cristina and Fern{\'a}ndez, Fernando and Bandera, Antonio", title="THERAPIST: Towards an Autonomous Socially Interactive Robot for Motor and Neurorehabilitation Therapies for Children", journal="JMIR Rehabil Assist Technol", year="2014", month="Oct", day="07", volume="1", number="1", pages="e1", keywords="rehabilitation", keywords="cognitive robotics", keywords="interactive games", abstract="Background: Neurorehabilitation therapies exploiting the use-dependent plasticity of our neuromuscular system are devised to help patients who suffer from injuries or diseases of this system. These therapies take advantage of the fact that the motor activity alters the properties of our neurons and muscles, including the pattern of their connectivity, and thus their functionality. Hence, a sensor-motor treatment where patients makes certain movements will help them (re)learn how to move the affected body parts. But these traditional rehabilitation processes are usually repetitive and lengthy, reducing motivation and adherence to the treatment, and thus limiting the benefits for the patients. Objective: Our goal was to create innovative neurorehabilitation therapies based on THERAPIST, a socially assistive robot. THERAPIST is an autonomous robot that is able to find and execute plans and adapt them to new situations in real-time. The software architecture of THERAPIST monitors and determines the course of action, learns from previous experiences, and interacts with people using verbal and non-verbal channels. THERAPIST can increase the adherence of the patient to the sessions using serious games. Data are recorded and can be used to tailor patient sessions. Methods: We hypothesized that pediatric patients would engage better in a therapeutic non-physical interaction with a robot, facilitating the design of new therapies to improve patient motivation. We propose RoboCog, a novel cognitive architecture. This architecture will enhance the effectiveness and time-of-response of complex multi-degree-of-freedom robots designed to collaborate with humans, combining two core elements: a deep and hybrid representation of the current state, own, and observed; and a set of task-dependent planners, working at different levels of abstraction but connected to this central representation through a common interface. Using RoboCog, THERAPIST engages the human partner in an active interactive process. But RoboCog also endows the robot with abilities for high-level planning, monitoring, and learning. Thus, THERAPIST engages the patient through different games or activities, and adapts the session to each individual. Results: RoboCog successfully integrates a deliberative planner with a set of modules working at situational or sensorimotor levels. This architecture also allows THERAPIST to deliver responses at a human rate. The synchronization of the multiple interaction modalities results from a unique scene representation or model. THERAPIST is now a socially interactive robot that, instead of reproducing the phrases or gestures that the developers decide, maintains a dialogue and autonomously generate gestures or expressions. THERAPIST is able to play simple games with human partners, which requires humans to perform certain movements, and also to capture the human motion, for later analysis by clinic specialists. Conclusions: The initial hypothesis was validated by our experimental studies showing that interaction with the robot results in highly attentive and collaborative attitudes in pediatric patients. We also verified that RoboCog allows the robot to interact with patients at human rates. However, there remain many issues to overcome. The development of novel hands-off rehabilitation therapies will require the intersection of multiple challenging directions of research that we are currently exploring. ", doi="10.2196/rehab.3151", url="http://rehab.jmir.org/2014/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582242" }