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  • 1.
    Anderberg, Peter
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Barnestein-Fonseca, Pilar
    Hosp Reg Univ Malaga, ESP.
    Guzman-Parra, Jose
    Hosp Reg Univ Malaga, ESP.
    Garolera, Maite
    Consorci Sanitari Terrassa, ESP.
    Quintana, Maria
    Consorci Sanitari Terrassa, ESP.
    Mayoral-Cleries, Fermin
    Hosp Reg Univ Malaga, ESP.
    Lemmens, Evi
    Univ Coll Leuven Limburg, BEL.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled Trial2019In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 6, article id e13711Article in journal (Refereed)
    Abstract [en]

    Background: Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments. Objective: A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination. Methods: A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads-split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information. Results: Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit. Conclusions: This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field.

  • 2.
    Anderberg, Peter
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Eivazzadeh, Shahryar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    A Novel Instrument for Measuring Older People's Attitudes Toward Technology (TechPH): Development and Validation2019In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 5, article id e13951Article in journal (Refereed)
    Abstract [en]

    Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons' technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (chi(2)(8)=21.2, chi(2)/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries.

  • 3.
    Berner, Jesica
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Rennemark, Mikael
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Case Management for Frail Older Adults Through Tablet Computers and Skype2016In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 41, no 4, p. 405-416Article in journal (Refereed)
    Abstract [en]

    Background: Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. Objective: This paper examines frail older adults’ use of tablet computers and Skype, with their case managers.Method: Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. Results: The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Conclusion: Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further. © 2015 Taylor & Francis

  • 4.
    Berner, Jessica
    et al.
    Amsterdam UMC, NLD.
    Comijs, Hannie
    Amsterdam UMC, NLD.
    Elmståhl, Sölve
    Lunds Universitet, SWE.
    Welmer, Anna Karin
    Stockholms universitet, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Deeg, Dorly
    Amsterdam UMC, NLD.
    Maintaining cognitive function with internet use: A two-country, six-year longitudinal study2019In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 31, no 7, p. 929-936Article in journal (Refereed)
    Abstract [en]

    Objectives: Maintaining good cognitive function with aging may be aided by technology such as computers, tablets, and their applications. Little research so far has investigated whether internet use helps to maintain cognitive function over time.Design: Two population-based studies with a longitudinal design from 2001/2003 (T1) to 2007/2010 (T2).Setting: Sweden and the Netherlands.Participants: Older adults aged 66 years and above from the Swedish National Study on Ageing and Care (N = 2,564) and from the Longitudinal Aging Study Amsterdam (N = 683).Measurements: Internet use was self-reported. Using the scores from the Mini-Mental State Examination (MMSE) from T1 and T2, both a difference score and a significant change index was calculated. Linear and logistic regression analysis were performed with difference score and significant change index, respectively, as the dependent variable and internet use as the independent variable, and adjusted for sex, education, age, living situation, and functional limitations. Using a meta-analytic approach, summary coefficients were calculated across both studies.Results: Internet use at baseline was 26.4% in Sweden and 13.3% in the Netherlands. Significant cognitive decline over six years amounted to 9.2% in Sweden and 17.0% in the Netherlands. Considering the difference score, the summary linear regression coefficient for internet use was-0.32 (95% CI:-0.62,-0.02). Considering the significant change index, the summary odds ratio for internet use was 0.54 (95% CI: 0.37, 0.78).Conclusions: The results suggest that internet use might play a role in maintaining cognitive functioning. Further research into the specific activities that older adults are doing on the internet may shine light on this issue. © 2019 International Psychogeriatric Association.

  • 5.
    Berner, Jessica
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Rennemark, Mikael
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Jogreus, Claes
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Sköldunger, Anders
    Wahlberg, Maria
    Elmståhl, Sölve
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden2015In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 21, no 3, p. 237-249Article in journal (Refereed)
    Abstract [en]

    Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

  • 6.
    Brennan, Ciara
    et al.
    University of Iceland, ISL.
    Rice, James Gordon
    University of Iceland, ISL.
    Traustadóttir, Rannveig
    University of Iceland, ISL.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    How can states ensure access to personal assistance when service delivery is decentralized?: A multi-level analysis of Iceland, Norway and Sweden2017In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 19, no 4, p. 334-346Article in journal (Refereed)
    Abstract [en]

    Article 19 of the United Nations (UN) Convention on the Rights of Persons with Disabilities requires states to ensure that persons with disabilities have access to a range of support services, including personal assistance. The Convention is an agreement between state parties and the UN. However, in practice, disability services are often implemented at the local level. Drawing on the findings of qualitative research in Iceland, Norway and Sweden, this paper examines a paradox whereby states commit to ensure access to support services, but decentralize responsibility to autonomous and independent local governments. A multi-level governance framework is applied to analyse the findings of qualitative inquiry with policy-makers, local government officials and leaders of independent living organizations in all three Nordic countries. A multi-level analysis highlights the tensions and contradictions between decentralization and human rights commitments. © 2016 Nordic Network on Disability Research

  • 7. Brennan, Ciara
    et al.
    Traustadóttir, Rannveig
    Rice, James
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Negotiating independence, choice and autonomy: experiences of parents who coordinate personal assistance on behalf of their adult son or daughter2016In: Disability & Society, ISSN 0968-7599, E-ISSN 1360-0508, Vol. 31, no 5, p. 604-621Article in journal (Refereed)
    Abstract [en]

    Article 19 of the UN Convention on the Rights of Persons with Disabilities requires states to provide personal assistance services. This article is based on qualitative research in Iceland, Norway and Sweden, carried out between 2012 and 2013. The overall study focused broadly on the implementation of Article 19. This article, however, reports findings based on a particular group of participants within the larger study: non-disabled parents who coordinate personal assistance schemes for their adult son or daughter. The article examines the various ways in which the parents, the majority of whom were mothers, negotiate principles of independence, choice and autonomy for their adult son or daughter who requires intensive support, including assistance with communicating. The aim is to explore, in the context of the Convention and the principles of the independent living movement, how to acknowledge and conceptualise personal assistance schemes that require another person to manage on behalf of the user. © 2016 Informa UK Limited, trading as Taylor & Francis Group

  • 8.
    Christiansen, Line
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Lindberg, Catharina
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Skär, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Health-related quality of life and related factors among a sample of older people with cognitive impairment2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 849-859Article in journal (Refereed)
    Abstract [en]

    Aim: This study aimed to identify factors affecting health-related quality of life (HRQoL) of older adults with cognitive impairment and to describe the association of these factors with different components of HRQoL. Design: A cross-sectional, descriptive research design was used. Methods: Data were collected from 247 individuals aged 60 years and older from a Swedish longitudinal cohort study. The Short-Form Health Survey-12 (SF-12) and EuroQol (EQ-5D) were used to assess HRQoL. The data were analysed using descriptive and comparative statistics. Results: The present study identified several factors that influenced HRQoL of older adults with cognitive impairment. The results of a multiple logistic regression analysis revealed that the following factors were associated with physical and mental HRQoL: dependency in activities of daily living (ADL), receiving informal care and feelings of loneliness and pain. © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

  • 9.
    Eivazzadeh, Shahryar
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Johan, Berglund
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Tobias, Larsson
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Designing with Priorities and Thresholds for Health Care Heterogeneity: The Approach of Constructing Parametric Ontology2015Conference paper (Refereed)
    Abstract [en]

    Designing systems working in health care needs complying with the heterogeneous, overlapping, non-overlapping, competing, or even contradicting requirements expressed by the various actors of the health care complex environment, including regulatory bodies. The unification method introduced in this paper, utilized ontological struc- tures to unify heterogeneous requirements in different levels of ab- straction. Also the weighting and threshold algorithms defined upon the ontology structure allows to both prioritize the requirements and align design resources upon that priority, at the same time to enforce regulatory requirements in an easy, clear and integrated way and reject designs which cannot comply with them. Application of the method introduced in this paper is not limited to health care, but it might be applied in design for any heterogeneous environment.

  • 10.
    Eivazzadeh, Shahryar
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Larsson, Tobias
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Fricker, Samuel
    Blekinge Institute of Technology, Faculty of Computing, Department of Software Engineering. University of Applied Sciences and Arts Northwestern Switzerland.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Evaluating Health Information Systems Using Ontologies2016In: JMIR Medical Informatics, ISSN 2291-9694, Vol. 4, no 2, article id e20Article in journal (Refereed)
    Abstract [en]

    Background: There are several frameworks that attempt to address the challenges of evaluation of health information systems by offering models, methods, and guidelines about what to evaluate, how to evaluate, and how to report the evaluation results. Model-based evaluation frameworks usually suggest universally applicable evaluation aspects but do not consider case-specific aspects. On the other hand, evaluation frameworks that are case specific, by eliciting user requirements, limit their output to the evaluation aspects suggested by the users in the early phases of system development. In addition, these case-specific approaches extract different sets of evaluation aspects from each case, making it challenging to collectively compare, unify, or aggregate the evaluation of a set of heterogeneous health information systems.

    Objectives: The aim of this paper is to find a method capable of suggesting evaluation aspects for a set of one or more health information systems—whether similar or heterogeneous—by organizing, unifying, and aggregating the quality attributes extracted from those systems and from an external evaluation framework.

    Methods: On the basis of the available literature in semantic networks and ontologies, a method (called Unified eValuation using Ontology; UVON) was developed that can organize, unify, and aggregate the quality attributes of several health information systems into a tree-style ontology structure. The method was extended to integrate its generated ontology with the evaluation aspects suggested by model-based evaluation frameworks. An approach was developed to extract evaluation aspects from the ontology that also considers evaluation case practicalities such as the maximum number of evaluation aspects to be measured or their required degree of specificity. The method was applied and tested in Future Internet Social and Technological Alignment Research (FI-STAR), a project of 7 cloud-based eHealth applications that were developed and deployed across European Union countries.

    Results: The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project.

    Conclusions: The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems.

  • 11.
    Eivazzadeh, Shahryar
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Larsson, Tobias
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Fiedler, Markus
    Blekinge Institute of Technology, Faculty of Computing, Department of Technology and Aesthetics.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Most Influential Qualities in Creating Satisfaction Among the Users of Health Information Systems: A Study in Seven EU Countries2018In: JMIR Medical Informatics, Vol. 6, no 4, p. 3-21Article in journal (Refereed)
    Abstract [en]

    Background:

    Several models suggest how the qualities of a product or service influence user satisfaction. Models, such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success (D&M IS), demonstrate those relations and have been used in the context of health information systems.

    Objective:

    We want to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and if this makes user satisfaction a proxy indicator of those qualities.

    Methods:

    The Unified eValuation using ONtology (UVON) method was utilised to construct an ontology of the required qualities for seven e-health applications being developed in the FI-STAR project, a European Union (EU) project in e-health. The e-health applications were deployed across seven EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. Two similar questionnaires, for 87 patient users and 31 health professional users, were elicited from the ontology. In the questionnaires, user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analysed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, two Partial Least Squares Structural Equation Modelling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method.

    Results:

    Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures which reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems.

    Conclusions:

    For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, while professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users' evaluation of system output and fulfilment of expectations, but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple, fast way to infer if the system has improved the abovementioned qualities in treatment and care.

  • 12. Ekelin, Annelie
    et al.
    Anderberg, Peter
    Reddy, Kishore
    The Augment Project: Co-Constructive Mapping and Support of Accessibility and Participation2010In: Lecture Notes in Computer Science, Springer Verlag , 2010, Vol. 6229/2010, p. 95-103Conference paper (Refereed)
    Abstract [en]

    This paper presents an ongoing multi-disciplinary research-and development project in which we are exploring emerging methods and practices for participatory design of tools and content of accessibility information in India and Sweden, based on user created content. The initial development of the AUGMENT-Project also includes the production of a prototype for sharing information. The joint set up and unfolding of public digital spaces and co-operative creation of processes and infrastructure for user-driven accessibility information is making use of existing handheld mobile phones which offer the possibility to upload pictures and comments via an application with a map-based interface. The research initiative is exploring and comparing cross-cultural participatory methods for cultivation of shared transformational spaces. The paper discusses both the notion of user-driven content and co-creation of tools and methods, drawing upon the tradition of Scandinavian Systems Design, explicitly arguing for direct user-representation in systems development.

  • 13.
    Frögren, Joakim
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Quitana, M.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Designing a model app for older persons with cognitive impairment: insights from a usability perspective2018In: Gerontechnology, ISSN 1569-1101, E-ISSN 1569-111X, Vol. 17, p. 80-Article in journal (Refereed)
    Abstract [en]

    Purpose Research indicates that health-oriented applications on mobile units such as smartphones and PDAs, so called mHealth applications, can be useful to support older persons with cognitive impairment and their informal caregivers1. However, several studies suggest that a prerequisite for older persons to start using computer-based technology is that it offers individual customization according to personal preference 2,3,4. In the ongoing Horizon 2020 project SMART4MD (Support, Monitoring And Reminder Technology for older persons with Mild Dementia), an health-oriented model app has been developed through a user-centered process involving stakeholders in six European countries and with an emphasis on customization to allow for the various needs of older persons with cognitive impairment and their informal caregivers. The aim of this study is to gain insights about the specific needs of the target group and success factors related to the user-centered design process. Method Within the frames of the SMART4MD project, an initial Feasibility study was conducted in two countries (Spain and Sweden) simultaneously, in which in total nineteen persons with cognitive impairment aged 66-93, and their respective informal caregivers, performed a taskbased usability test of the SMART4MD model app individually in a clinical setting, followed by a four-week testing of the app in their home environment. Finally, a usability evaluation was done through individual structured interviews. Results & Discussion The result indicates that less exposure to similar technology affects both ability and self-esteem when confronted with the model app, and that evaluating usability with the target group using standard forms within usability testing requires pre-cautions. © 2018 International Society for Gerontechnology.

  • 14.
    Ghani, Zartashia
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Jarl, Johan
    Lunds universitet, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Andersson, Martin
    Blekinge Institute of Technology, Faculty of Engineering, Department of Industrial Economics.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The Cost Effectiveness of M-health Interventions for Older Adults: Protocol for a Systematic Review2018Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Many studies reported effectiveness of mhealth interventions targeting middle aged and older adults to improve healthcare delivery process, efficacy and management of chronic diseases. However, the knowledge about their cost-effectiveness is important to implement mhealth interventions at large scale for proper allocation of scarce resources. This systematic review will summarize the results from identified studies for the cost effectiveness of mhealth interventions aimed for middle aged and older adults.

    Method: mhealth interventions aimed to improve healthcare delivery process, efficacy and delivering training will be included in this systematic review. A comprehensive electronic search strategy will be used to identify health economic evaluations, published since 2007, and indexed in Pubmed, Scopus and CINAHL. The search strategy will include terms (and synonyms) for the following mhealth devices: mobile phone, smartphone, mhealth. Middle aged and older adults will be used to identify all mhealth interventions introduced to middle aged and older adults. Terms such as economic evaluation, cost effectiveness, cost utility etc will be used to identify economic evaluations of all mhealth interventions.

    Discussion: This systematic review will report evidence on cost effectiveness of mhealth interventions targeting middle aged and older adults.

  • 15.
    Lilje, Stina C.
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Skillgate, Eva
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Negative psychosocial and heavy physical workloads associated with musculoskeletal pain interfering with normal life in older adults: Cross-sectional analysis2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 5, p. 453-459Article in journal (Refereed)
    Abstract [en]

    Aims: Pain is one of the most frequent reasons for seeking health care, and is thus a public health problem. Although there is a progressive increase in pain and impaired physical function with age, few studies are performed on older adults. The aim of this study was to investigate if there are associations between musculoskeletal pain interfering with normal life in older adults and physical and psychosocial workloads through life. Methods: The association of heavy physical workload and negative psychosocial workload and musculoskeletal pain interfering with normal life (SF 12) was analyzed by multiple logistic regression. The model was adjusted for eight background covariates: age, gender, growing-up environment, educational level, if living alone or not, obesity, smoking, and leisure physical activity. Results: Negative psychosocial and heavy physical workloads were independently associated with musculoskeletal pain interfering with normal life (adjusted OR: 4.44, 95% CI: 2.84-6.92), and (adjusted OR: 1.88, 95% CI: 1.20-2.93), respectively. The background covariates female gender and higher education were also associated with musculoskeletal pain interfering with normal life, and physical leisure activity was inversely associated. Conclusions: The findings suggest that negative psychosocial and heavy physical workloads are strongly associated with musculoskeletal pain interfering with normal life in older adults.

  • 16.
    Lilje, Stina
    et al.
    KI, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Palmlöf, Lina
    FoU Nordost Research and Development Unit Northeast Stockholm, SWE.
    Skillgate, Eva
    Naprapathögskolan, SWE.
    The importance of weak physical performance in older adults for the development of musculoskeletal pain that interferes with normal life: A prospective cohort study2019In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879Article in journal (Refereed)
    Abstract [en]

    There are associations between pain, comorbidity and risk of falling, and falling increases the risk of mortality in older persons, but few studies have investigated the development of pain as a result of impaired physical function. The aim of this study was to examine possible associations between weak physical performance and the development of musculoskeletal pain that interferes with normal life in a sample of older adults. The sample derived from a national, longitudinal multicenter study; the Swedish National Study on Ageing and Care; SNAC-B. The participants (n = 490) were between 60 and 78 years at the baseline examinations. Three variables were chosen for the exposure physical function, from the baseline examinations; One Leg Stand, Grip strength and Sit-to-Stand. The outcome musculoskeletal pain that interferes with normal life was measured using EQ5D and SF-12 6 years later, and logistic regression was used to investigate possible associations between the exposures and the outcome. Maximum grip strength (Grippit) was inversely associated with musculoskeletal pain that interferes with normal life (OR 2.31; 95% CI 1.15-4.61), and One-Leg Stand and Sit-to-Stand were not associated with the development of pain (OR 1.30; 95% CI 0.64-2.64) and (OR 0.91; 95% CI 0.45-1.86), respectively. Weak grip strength was inversely associated with the development of musculoskeletal pain that interferes with normal life in older adults. Impaired proprioceptive function, strength and mobility in elderly with pain have been found in earlier research. Since pain increases the risk of falling, it is important to investigate if it may develop as a function of an impaired physical function. The results of the present study could be of importance for future prevention programs aiming to protect elderly from falling. © 2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

  • 17.
    Moraes, Ana Louiza Dallora
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Eivazzadeh, Shahryar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Mendes, Emilia
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Prognosis of Dementia Employing Machine Learning and Microsimulation Techniques: A Systematic Literature Review2016In: Procedia Computer Science / [ed] Martinho R.,Rijo R.,Cruz-Cunha M.M.,Bjorn-Andersen N.,Quintela Varajao J.E., Elsevier, 2016, Vol. 100, p. 480-488Conference paper (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this paper is to investigate the goals and variables employed in the machine learning and microsimulation studies for the prognosis of dementia. METHOD: According to preset protocols, the Pubmed, Socups and Web of Science databases were searched to find studies that matched the defined inclusion/exclusion criteria, and then its references were checked for new studies. A quality checklist assessed the selected studies, and removed the low quality ones. The remaining ones (included set) had their data extracted and summarized. RESULTS: The summary of the data of the 37 included studies showed that the most common goal of the selected studies was the prediction of the conversion from mild cognitive impairment to Alzheimer's Disease, for studies that used machine learning, and cost estimation for the microsimulation ones. About the variables, neuroimaging was the most frequent used. CONCLUSIONS: The systematic literature review showed clear trends in prognosis of dementia research in what concerns machine learning techniques and microsimulation.

  • 18.
    Moraes, Ana Luiza Dallora
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Kvist, Ola
    KI, SWE.
    Mendes, Emilia
    Blekinge Institute of Technology, Faculty of Computing, Department of Software Engineering.
    Ruiz, Sandra
    KI, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Bone age assessment with various machine learning techniques: A systematic literature review and meta-analysis2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 7, article id e0220242Article, review/survey (Refereed)
    Abstract [en]

    Background The assessment of bone age and skeletal maturity and its comparison to chronological age is an important task in the medical environment for the diagnosis of pediatric endocrinology, orthodontics and orthopedic disorders, and legal environment in what concerns if an individual is a minor or not when there is a lack of documents. Being a time-consuming activity that can be prone to inter- and intra-rater variability, the use of methods which can automate it, like Machine Learning techniques, is of value. Objective The goal of this paper is to present the state of the art evidence, trends and gaps in the research related to bone age assessment studies that make use of Machine Learning techniques. Method A systematic literature review was carried out, starting with the writing of the protocol, followed by searches on three databases: Pubmed, Scopus and Web of Science to identify the relevant evidence related to bone age assessment using Machine Learning techniques. One round of backward snowballing was performed to find additional studies. A quality assessment was performed on the selected studies to check for bias and low quality studies, which were removed. Data was extracted from the included studies to build summary tables. Lastly, a meta-analysis was performed on the performances of the selected studies. Results 26 studies constituted the final set of included studies. Most of them proposed automatic systems for bone age assessment and investigated methods for bone age assessment based on hand and wrist radiographs. The samples used in the studies were mostly comprehensive or bordered the age of 18, and the data origin was in most of cases from United States and West Europe. Few studies explored ethnic differences. Conclusions There is a clear focus of the research on bone age assessment methods based on radiographs whilst other types of medical imaging without radiation exposure (e.g. magnetic resonance imaging) are not much explored in the literature. Also, socioeconomic and other aspects that could influence in bone age were not addressed in the literature. Finally, studies that make use of more than one region of interest for bone age assessment are scarce. Copyright: © 2019 Dallora et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • 19.
    Moraes, Ana Luiza Dallora
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Eivazzadeh, Shahryar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Mendes, Emilia
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering. Blekinge Institute of Technology, Faculty of Computing, Department of Software Engineering.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Machine learning and microsimulation techniques on the prognosis of dementia: A systematic literature review2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, article id e0179804Article in journal (Refereed)
    Abstract [en]

    Background Dementia is a complex disorder characterized by poor outcomes for the patients and high costs of care. After decades of research little is known about its mechanisms. Having prognostic estimates about dementia can help researchers, patients and public entities in dealing with this disorder. Thus, health data, machine learning and microsimulation techniques could be employed in developing prognostic estimates for dementia. Objective The goal of this paper is to present evidence on the state of the art of studies investigating and the prognosis of dementia using machine learning and microsimulation techniques. Method To achieve our goal we carried out a systematic literature review, in which three large databases -Pubmed, Socups and Web of Science were searched to select studies that employed machine learning or microsimulation techniques for the prognosis of dementia. A single backward snowballing was done to identify further studies. A quality checklist was also employed to assess the quality of the evidence presented by the selected studies, and low quality studies were removed. Finally, data from the final set of studies were extracted in summary tables. Results In total 37 papers were included. The data summary results showed that the current research is focused on the investigation of the patients with mild cognitive impairment that will evolve to Alzheimer's disease, using machine learning techniques. Microsimulation studies were concerned with cost estimation and had a populational focus. Neuroimaging was the most commonly used variable. Conclusions Prediction of conversion from MCI to AD is the dominant theme in the selected studies. Most studies used ML techniques on Neuroimaging data. Only a few data sources have been recruited by most studies and the ADNI database is the one most commonly used. Only two studies have investigated the prediction of epidemiological aspects of Dementia using either ML or MS techniques. Finally, care should be taken when interpreting the reported accuracy of ML techniques, given studies' different contexts. © 2017 Dallora et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • 20.
    Sandberg, Hanna
    et al.
    Blekinge Hospital, SWE.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Forssell, Henrik
    Blekinge Centre of Competence, SWE.
    Ovhed, Ingvar
    Blekinge Centre of Competence, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Increased Usage of Insulin Pump Functions Not Associated with Improved HbA1c in Children and Adolescents with Type 1 Diabetes Mellitus2016In: Journal of Diabetes Science and Technology, ISSN 1932-2968, Vol. 10, no 4, p. 997-998Article in journal (Refereed)
  • 21.
    Sandberg, Jacob
    et al.
    Lunds Universitet, SWE.
    Lansing, Robert
    University of Arizona, USA.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Currow, David
    Cancer Institute NSW, AUS.
    Sundh, Josefin
    Örebro Universitet, SWE.
    Ahmadi, Zainab
    Lunds Universitet, SWE.
    Palmqvist, Sebastian
    Skåne University Hospital, SWE.
    Ekström, Magnus
    Lunds Universitet, SWE.
    Relating Experienced To Recalled breathlessness Observational (RETRO) study: A prospective study using a mobile phone application2019In: BMJ Open Respiratory Research, ISSN 2052-4439, Vol. 6, no 1, article id e000370Article in journal (Refereed)
    Abstract [en]

    Background: Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient's history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness. Methods: A mobile phone application will be used to collect data during daily life. Medically stable participants, ≥18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0-10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses. Results: Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. Discussion: This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection. © 2019 Author(s).

  • 22.
    Tell, Johanna
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olander, Ewy
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The usage of web-based national guidelines for child healthcare: A web analytic study2018In: Article in journal (Refereed)
    Abstract [en]

    The development and dissemination of information- and communication technologies in healthcare is rapid. The purpose of web-based national guidelines is to support professionals in everyday work providing equivalent, safe and qualitative healthcare. Web-based national guidelines are often not implemented effectively in healthcare why studies reflecting different aspects of use and implementation is needed. The aim of this study was to investigate the usage of web-based national guidelines for child healthcare, Rikshandboken i barnhälsovård. In this case study with cross-sectional design, usage pattern of the web-based guidelineswas studied for one year using the web analytic tool, Google Analytics. The usage data were analysed with descriptive statistics. The study showed the general usage pattern of RHB, changes in usage through the year and various usage pattern in different user groups. The usage of RHB had increased, the web-based guidelines was used in all county councils/regions and the most common visited web-page was the new national child healthcare programme. This tendency suggests a positive direction towards the RHB aim to contribute to equal , equitable and high-qualitative CHC.The result also showed the importance to study different user groups as the usage pattern differs. This provide valuable knowledge in the development of web-based national guidelines making them useful and relevant for all its users. 

  • 23.
    Tell, Johanna
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olander, Ewy
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Implementation of a web-based national child health-care programme in a local context: A complex facilitator role2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 20_suppl, p. 80-86, article id suppl. 20Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate child health-care coordinators’ experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. Methods: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. Results: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme ‘Being a facilitator: a complex role’ was formed to express the child health-care coordinators’ experiences. Conclusions: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context. © 2018, © Author(s) 2018.

  • 24.
    Tell, Johanna
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olander, Ewy
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Nurses´ use and ways of understanding web-based national guidelines for child healthcareIn: Article in journal (Refereed)
    Abstract [en]

    The national Rikshandbokenfor child healthcare, is a web-based guideline for child health care in Sweden containing knowledge- and methodological guidance and a national child health care program in progress to be implemented. The aim with the study was to examine child health care nurses use and ways of understanding the national web-basedRikshandbokenfor child health care.  Mixed method with sequential explanatory design in two phases was used; a web-survey with descriptive statistic followed by telephone interviews with phenomenographic analysis. The study showed variations in use and contribute with deeper knowledge of child healthcare nurse´s ways of understanding the unit RHB whose varied parts interact with each other. To be reliable, useful and relevant for nurses in their context, Rikshandbokenmust be kept updated and involve the end-users in the development process. Access to technical devices and optimal use of the possibilities with information and communication technology, the national web-based Rikshandbokencan be a resource for continuing learning and a tool in everyday work and a possible determinant to an equal child healthcare. The study contributes with valuable knowledge when designing web-based clinical practice guidelines for healthcare, making them useful and relevant for the end-users

  • 25.
    Tell, Johanna
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olander, Ewy
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Nurses’ Use of a Web-Based National Guide for Child Health Care2016In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 5, p. 197-205Article in journal (Refereed)
    Abstract [en]

    Rikshandboken i BarnhÀlsovård is a Swedish Web-based guide for child healthcare, providing quality-ensured guidelines and support contributing to equality in child healthcare among all children. In 2015, a new child healthcare program was implemented and made available in this Web-based guide. The aim of this study was to investigate how child healthcare nurses use Rikshandboken i BarnhÀlsovård and factors affecting its use. The study was a comprehensive Web survey of 2376 child healthcare nurses in Sweden answered by 1309. Statistical processing was performed using descriptive and analytical methods. Rikshandboken i BarnhÀlsovård was widely used by the respondents, but regional differences and number of years in the profession affected the use. Almost all nurses were satisfied with the usability, content, and design and felt that a national guide for child healthcare is important. This indicates that an established Web-based national guide is an appropriate setting when a new national program is implemented. In order to achieve an equal and equitable child healthcare, it is essential that all nurses use the national guide to provide evidence-based practice. The value of main child healthcare units as regional facilitators in the innovation process of Rikshandboken i BarnhÀlsovård should not be underestimated.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

  • 26.
    Wickstrom, Hanna L.
    et al.
    Lund Univ, SWE.
    Oien, Rut Frank
    Blekinge Wound Healing Ctr, Karlshamn, SWE.
    Fagerstrom, Cecilia
    Blekinge Ctr Competence, Karlskrona, SWE.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health. Blekinge Inst Technol, Dept Hlth, Karlskrona, Sweden..
    Jakobsson, Ulf
    Lund Univ, SWE.
    Midlov, Patrik J.
    Lund Univ, SWE.
    Comparing video consultation with inperson assessment for Swedish patients with hard-to-heal ulcers: registry-based studies of healing time and of waiting time2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 2, article id e017623Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate differences in ulcer healing time and waiting time between video consultation and inperson assessment for patients with hard-to-heal ulcers. Setting Patients treated at Blekinge Wound Healing Centre, a primary care centre covering the whole of Blekinge county (150 000 inhabitants), were compared with patients registered and treated according to the Registry of Ulcer Treatment, a Swedish national web-based quality registry. Participants In the study for analysing ulcer healing time, the study group consisted of 100 patients diagnosed through video consultation between October 2014 and September 2016. The control group for analysing healing time consisted of 1888 patients diagnosed through inperson assessment during the same period. In the study for analysing waiting time, the same study group (n=100) was compared with 100 patients diagnosed through inperson assessment. Primary and secondary outcome measures Differences in ulcer healing time were analysed using the log-rank test. Differences in waiting time were analysed using the Mann-Whitney U test. Results Median healing time was 59 days (95% CI 40 to 78) in the study group and 82 days (95% CI 75 to 89) in the control group (P<0.001). Median waiting time was 25 days (range: 1-83 days) in the study group and 32 days (range: 3-294 days) for patients diagnosed through inperson assessment (P=0.017). There were no significant differences between the study group and the control group regarding age, gender or ulcer size. Conclusions Healing time and waiting time were significantly shorter for patients diagnosed through video consultation compared with those diagnosed through inperson assessment.

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