Telerehabilitation Decision Support System: Pilot Testing Protocol

NCT ID: NCT07079787

Last Updated: 2025-07-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-25

Study Completion Date

2025-08-29

Brief Summary

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This study follows the successfully completed HOLOBalance project which was funded by the EU Horizon 2020 scheme. TheHOLOBalance platform delivers exercises demonstrated via a hologram of the physiotherapist and corrected in real time by the hologram prompts based on performance monitoring via sensors. Further information is available at: https://holobalance.eu/. HOLOBalance was developed as a comprehensive rehabilitation protocol for individualised remote (tele)rehabilitation balance physiotherapy programme. It includes different multisensory balance and gait exercises, physical activity and memory training and exergames (video games which are also exercises) to improve balance function in older adults. The system can thus assess and remotely monitor how users are performing the exercises.

This pilot testing of a multisite randomised control trial (TeleRehab DSS, short for TeleRehabilitation Decision Support System) aims to investigating the usability and feasibility among a smaller sample population at each clinical site, identifying any technical bugs, and/or clinical procedural flaws to be remedied before delivery of the full-scale RCT.

Detailed Description

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This is a multi-centre pilot study to test the usability and feasibility of the TeleRehab DSS platform among a sample population across all five clinical sites.

Upon meeting the initial inclusion criteria, eligible participants will be scheduled for an appointment to attend the clinic and complete a cognitive assessment (MoCA) and gait assessment (FGA). If a participant is deemed fully eligible, they will proceed with the onboarding process and clinical assessment, including the collection of personal details and a set of health questionnaires. They will then be randomised into either the high-tech or low-tech TeleRehab DSS intervention group.

All study participants will attend two sessions weekly over 3-weeks at each clinical site, where they will complete a personalised multisensory balance rehabilitation programme using augmented reality while wearing motion tracking sensors. Clinicians will be present to attend to any technical or clinical queries during completion of the program. At the end of the 3-weeks, the artifical intelligence decision support system will suggest exercise progressions, tracking wether the clinical agrees or disagrees with these suggestions.

Participants will receive telephone calls each week to monitor their progress. Participants will also receive remote program reviews at weeks 3, 6 and 9, from a member of the research team to assess and change exercises as required. Participants will be advised to contact the research team by email or by telephone during working hours if they have concerns or questions about their rehabilitation program or the TeleRehab DSS system. The research team will judge whether an additional home visit is required. If a patient does not complete their exercises for three consecutive days, a flag/warning will appear on the patients dashboard as a priority patient to follow up with, within 24 hours.

TeleRehaB DSS supported, prescribed, progressed and delivered intervention. In the TeleRehaB DSS IG, the platform will suggest two possible management strategies, on an individualised basis, based on patient profiles and expected benefit: 1)The high-tech, full TeleRehaB DSS with all components of the intervention consisting of TeleRehaB DSS AI-progressed multisensory balance exercises with the use of the AR avatar, real time feedback, AR gamified intervention, sensor monitored exercise performance and additional cognitive training, 2) the low-tech, basic version of TeleRehaB DSS, with depth camera, sensors and tablet - multisensory balance exercises, real time feedback, sensor monitored exercise performance and cognitive games, with no exergames, no smartwatch, and no mobile phone. The clinician can override the TeleRehab DSS group allocation decision if it is deemed unsafe.

Conditions

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Stroke Mild Cognitive Impairment (MCI) Vestibular Disease Long Covid-19

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

In this pilot testing study, participants will be blinded to their allocation gorup, but due to the nature of the study, assessors will not be. Participants will be randomised by condition (stroke, MCI, long covid-19, vestibular disorders) into either the high-technolog or low-technology solution and will carry out the intervention under the supervision of the assessing clinician.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Participants will be blinded to which study arm participants have been allocated to. Due to the nature of the study, the assessing and treating clinician cannot be blinded.

Study Groups

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High-Technology

All TeleRehab DSS components: multisensory balance exercises, AR avatar, real-time feedback, AR gamified activities, sensor-monitored exercise performance, and additional cognitive training.

Group Type ACTIVE_COMPARATOR

TeleRehab DSS Pilot Test

Intervention Type DEVICE

Participants will perform an individualised multisensory balance rehabilitation program via augmented reality, while wearing motion sensors. The program will consist of multisensory balance exercises, cognitive games, and exergames. All participants will perform 2 sessions per week, carried in at each clinical site, over the course of 3-week.s

Low-Technology

With depth camera, motion sensors and tablet for multisensory balance exercises, real time feedback, sensor monitored exercise performance and cognitive games. No exergames, no smartwatch, no mobile phone.

Group Type ACTIVE_COMPARATOR

TeleRehab DSS Pilot Test

Intervention Type DEVICE

Participants will perform an individualised multisensory balance rehabilitation program via augmented reality, while wearing motion sensors. The program will consist of multisensory balance exercises, cognitive games, and exergames. All participants will perform 2 sessions per week, carried in at each clinical site, over the course of 3-week.s

Interventions

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TeleRehab DSS Pilot Test

Participants will perform an individualised multisensory balance rehabilitation program via augmented reality, while wearing motion sensors. The program will consist of multisensory balance exercises, cognitive games, and exergames. All participants will perform 2 sessions per week, carried in at each clinical site, over the course of 3-week.s

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 40-80 years
* community dwelling able to walk 500-m independently or with a stick
* Depression subscale on Hospital Anxiety and Depression Scale \<10/21 (14-item questionnaire)
* No significant visual impairment (as self-reported by participants)
* Willing to comply with study procedures, proposed training and testing regime
* With capacity to consent
* No acute musculoskeletal or other injuries that would prevent participation in a structured exercise program
* Is not currently, and has not in the past 8-weeks received any falls/balance/vestibular and/or cognitive rehabilitation.
* Does not any implanted medical devices or a cardiac pacemaker.
* Does not have any other co-existing neurological conditions (ie. Multiple sclerosis, Parkinson's disease, neuropathy etc.)
* Does not have any language or communication deficits impairing their ability to communicate and/or express their thoughts.
* Has at least one functional hand for grip function and computer use.
* Fulfilling all of the criteria from one of the below sub-groups

STROKE COHORT who will fulfil the additional criteria:

* Individuals with diagnosis of focal ischaemic or haemorrhagic stroke, as confirmed by a clinical letter.
* Onset \>/= 3 months prior to study.
* Montreal Cognitive Assessment (MoCA) score n \>/=23
* At risk of falls (i.e. Functional Gait Assessment FGA score \</=22/30; FGA is a validated quick balance task assessment) AND/OR having experienced a fall(s) in the last 12 months

MCI COHORT who will fulfil the additional criteria:

* Individuals with new or existing formal diagnosis of MCI, according to the International Classification of Disease 10 (ICD10) , as confirmed by a clinical letter.
* At risk of falls (FGA \</= 22/30) AND/OR having experienced a fall(s) in the last 12 months.

VESTIBULAR COHORT who will fulfill the additional criteria

* Montreal Cognitive Assessment (MoCA) score n \>/=23
* Individuals with a diagnosis of a vestibular disorder (peripheral and/or mixed peripheral and central):
* Peripheral vestibular disorder in which the balance problem lies in the vestibular/balance system within the inner ear.
* Mixed vestibular disorder in which the balance problem lies in the vestibular/balance system within the inner ear (peripheral) and involving the nerves or neuronal network in the brain/brainstem responsible for balance (central).
* Chronic dizziness and/or unsteadiness (\>/= 3 months duration) that started at the time or after the vestibular disorder diagnosis.
* Dizziness handicap inventory (DHI \>34) AND/OR At risk of falls (FGA \</=22/30)

LONG COVID-19 COHORT who will fulfill the additional criteria:

* Montreal Cognitive Assessment (MoCA) score n \>/=23
* Individuals with laboratory confirmed diagnosis of Covid (\>/=6 months prior to study onset), as confirmed by a clinical letter.
* Who have been diagnosed with long Covid, as confirmed by a clinical letter.
* Who have chronic dizziness and/or unsteadiness which started after the Covid illness (self-report by the patient; duration \</=3 months).
* Dizziness handicap inventory (DHI \>34) AND/OR At risk of falls (FGA \</=22/30)

* Unable to provide a clinical letter confirming diagnosis.
* For those with stroke, no visual spatial neglect.

Exclusion Criteria

* Outside of the stated age bracket
* Unable to walk independently (even with use of a walking stick)
* MOCA score \<23
* Score of 10 or higher on depression subscale of HADS
* Unwilling to comply with study procedures, proposed training and testing regime
* No capacity to consent
* Significant visual impairment or homonymous hemianopia (stroke cohort only) (self-reported)
* Orthostatic hypotension or uncontrolled hypertension
* Other neurological problem (e.g. Parkingson's disease, Multiple Sclerosis etc.)
* Language and communication deficits impairing ability to express thoughts (e.g. Aphasia)
* Has participated in a clinical drug trial in the past 6 months.
* Acute musculoskeletal injury that prevents participation in a structured exercise programme (e.g. lower limb fracture).
* Has an implanted medical device or cardiac pacemaker.
* Diagnosis of unstable Meniere's or with more than 4 migraines/month at the time of participating in the study
Minimum Eligible Age

40 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National and Kapodistrian University of Athens

OTHER

Sponsor Role collaborator

University Medical Center Freiburg

OTHER

Sponsor Role collaborator

King Chulalongkorn Memorial Hospital

OTHER

Sponsor Role collaborator

Secretaria Regional de Saúde e Proteção Civil da Região Autónoma da Madeira

UNKNOWN

Sponsor Role collaborator

Institute of Communications and Computer Systems, Athens, Greece

OTHER

Sponsor Role collaborator

University of Ioannina

OTHER

Sponsor Role collaborator

Vilabs

UNKNOWN

Sponsor Role collaborator

BioIRC

UNKNOWN

Sponsor Role collaborator

Activage

UNKNOWN

Sponsor Role collaborator

Institue De Desenvolvimento De Novas Technologiassociacao

UNKNOWN

Sponsor Role collaborator

Quantitas SRL

UNKNOWN

Sponsor Role collaborator

Instituto para o Desenvolvimento e Inovação

UNKNOWN

Sponsor Role collaborator

BRIDG

UNKNOWN

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Doris-Eva Bamiou, PhD

Role: PRINCIPAL_INVESTIGATOR

University College, London

Locations

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University Medical Center Freiberg Neurocenter (UKLFR), Freiberg,

Freiburg im Breisgau, , Germany

Site Status

National and Kapodistrian University of Athens

Athens, , Greece

Site Status

Secretaria Regional de Saúde e Proteção Civil da Região Autónoma da Madeira

Madeirã, , Portugal

Site Status

King Chulalongeorn Memorial Hospital

Bangkok, , Thailand

Site Status

University College London

London, , United Kingdom

Site Status

Countries

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Germany Greece Portugal Thailand United Kingdom

Central Contacts

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Doris-Eva Bamiou, PhD

Role: CONTACT

+44 07813716768

Brooke Nairn, MSc.

Role: CONTACT

+44 07538640838

Facility Contacts

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Isabelle Walz, PhD

Role: primary

Christos Nikitas, PhD

Role: primary

Andreia Pimenta

Role: primary

Pattraporn Pajariyapong

Role: primary

Brooke Nairn, MSc

Role: primary

+44 07538640838

Doris-Eva Bamiou, PhD

Role: backup

Other Identifiers

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UCLondon17413/002

Identifier Type: -

Identifier Source: org_study_id

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