TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation.

Objective: To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression.

Design: The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients' and health professionals' experience of telehealth; a quantitative survey of patients' interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop.

Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review.

Background: Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved.

Purpose: The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth.

Methods: This research performs a narrative synthesis of the results from included studies.

A home daily activity simulation model for the evaluation of lifestyle monitoring systems.

Lifestyle monitoring (LM) technology is part of a new generation of telecare which aims to observe the daily activities of older or vulnerable individuals and determine if a medical or care intervention would be beneficial. The development and validation of new LM systems should ideally involve extensive trials with users in real conditions. Unfortunately, effective user trials are very challenging, generally limited in scope and costly.

Emotive computing may have a role in telecare.

This brief paper sets out arguments for the introduction of new technologies into telecare and lifestyle monitoring that can detect and monitor the emotive state of patients. The significantly increased use of computers by older people will enable the elements of emotive computing to be integrated with features such as keyboards and webcams, to provide additional information on emotional state. When this is combined with other data, there will be significant opportunities for system enhancement and the identification of changes in user status, and hence of need.

A systematic review of lifestyle monitoring technologies.

The evidence base for lifestyle monitoring is relatively weak, even though there are significant numbers of commercial installations around the world. We conducted a literature review to summarize the current position with regard to lifestyle monitoring based on sensors in the home. In total, 74 papers met the inclusion criteria.

A systematic review of digital interactive television systems and their applications in the health and social care fields.

We conducted a systematic review of the applications and technical features of digital interactive television (DITV) in the health and social care fields. The Web of Knowledge and IEEE Xplore databases were searched for articles published between January 2000 and March 2010 which related to DITV systems facilitating the communication of information to/from an individual's home with either a health or social care application. Out of 1679 articles retrieved, 42 met the inclusion criteria and were selected for review.

Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation, and self management.

Telerehabilitation refers to the use of Information and Communication Technologies (ICT) to provide rehabilitation services to people remotely in their homes or other environments. By using ICT, client access to care can be improved and the reach of clinicians can extend beyond the physical walls of a traditional healthcare facility, thus expanding continuity of care to persons with disabling conditions. The concept of telecare, when telerehabilitation is used to deliver services to clients in their homes or other living environments, empowers and enables individuals to take control of the management of their medical needs and interventions by enabling personalized care, choice and personal control.

Predicting need for intervention in individuals with congestive heart failure using a home-based telecare system.

We have studied how well the need for a medical intervention can be predicted by a telecare monitoring system. During a study period of about 18 months, 45 elderly individuals with congestive heart failure used a home health monitor to enter daily information pertaining to their symptoms and health status. A total of 8576 alerts were generated by the monitoring system, although in most cases, patient and service provider interaction was not required.

An evaluation of second and third generation telecare services in older people's housing.

In a controlled study of older people living in sheltered housing (retirement housing), 24 people provided with telecare were compared with a control group of 28 people. The intervention consisted of second generation telecare equipment, such as automatic flood or falls detectors, a third generation lifestyle reassurance system and an Internet café. After a 12-month monitoring period, there was no noticeable change in the fear of falling.

The role of telecare in supporting the needs of elderly people.

A literature review was conducted to identify the 'trigger factors' associated with a need for increased levels of care and support for elderly people. An expert panel then prioritized the trigger factors into one of five bands of importance. The literature review produced 2037 hits.

A speech-controlled environmental control system for people with severe dysarthria.

Automatic speech recognition (ASR) can provide a rapid means of controlling electronic assistive technology. Off-the-shelf ASR systems function poorly for users with severe dysarthria because of the increased variability of their articulations. We have developed a limited vocabulary speaker dependent speech recognition application which has greater tolerance to variability of speech, coupled with a computerised training package which assists dysarthric speakers to improve the consistency of their vocalisations and provides more data for recogniser training.

Automatic fall detectors and the fear of falling.

We studied the effect of automatic fall detection units on the fear of falling. Participants were community alarm users living in the community aged over 75 years or those aged 60-74 years who had experienced a fall in the previous six months. Of those approached, 31% consented to take part; the main reason given for potential participants declining involvement was that they were happy with the technology they already had.