Wendy Grevink, auteur op RRD

Looking back at RehabWeek 2022

It was a special RehabWeek this year. It was the first in three years because of the covid pandemic. It was also my first physical conference since covid, and the last one prior to all the lockdowns was RehabWeek 2019. So we came full circle last week. And it was 'at home', in the Netherlands. It felt somewhat like a reunion. And whether it was a psychological post-covid effect, or the longer 3-year period in between two RehabWeeks, or just that a lot of developments are happening, it felt like more news was shared than normally, there was more to catch up on with people, and more plans discussed for future collaborations. All in all, it was great to meet our colleagues again and talk about how they are doing and to hear about their latest developments. The fact that the social programme also involved water cabs and the SS Rotterdam topped it all off.

Showcasing RRD at Rehabweek

When Rotterdam was announced as the location for the next RehabWeek (2021, originally) at the previous conference in Toronto, we said we should have a good representation of RRD at this edition. Well, we kept our promise. RRD presented in 6 workshops, Hans Rietman delivered a keynote and was expert panel member, Erik Prinsen and Hans Rietman were involved in parallel programme of ISPO-NLand NSRM, we had 4 presentations in various conference sessions, RRD chaired 5 sessions, and had 3 posters on display. The poster from Robert Schulte was nominated for Best Poster Award and he pitched his research findings on smart signal processing from the MyLeg project. Additionally, Claudia Haarman presented her work in one of the ICORR sessions about GRIP, a collaboration with Anke Kottink, where Hankamp Rehab and RRD evaluated a very small and smart wearable device that supports key grasp for people with spinal cord injury, for example.

Inspirational topics

In between latest developments and research findings of rehabilitation robots, electrical stimulation, VR, eHealth applications etc., in various combinations, there were a few transdisciplinary topics that came back in many presentations and discussions. A lot was said about the need and benefits of involving end-users, either patients or therapists or other stakeholders, in early stages of technology development. Although this is definitely not news to RRD (glad to hear that we've been doing the right thing all along), it is nice to see this catching on across the RehabWeek audience. It was fitting that Stephanie Kosterink presented (twice) about using the Societal Return on Investment (SROI) method to elicit the impact of technology in a broad sense, including quality and process improvements. One of our examples for an SROI was the Innovation Lab of Roessingh Centrum voor Revalidatie, which gained a lot of interest as a means to implement rehabilitation technology in clinical practice and to gauge its impact. Another topic that stood out was the Medical Device Regulation (MDR). Its challenges was a frequent topic of discussion on the exhibition floor with developers of rehabilitation technology. Besides this, we had two presentations about it's practical implications for research with medical devices; once in relation to safety requirements for rehabrobots and using instrumented dummy limbs to solve this, once in relation to following MDR during a multi-center clinical evaluation of the effect of a soft-robotic glove (Carbonhand) used unsupervised at home. We hope our contributions gave some inspiration for how to deal with the discussed challenges.

Looking forward to the next RehabWeek, next year in Singapore!

Are you interested in the above mentioned topics, but missed our contributions at Rehabweek?
Feel free to contact us! Tel +31 (0)88 0875 777 / E-mail: g.prange@rrd.nl

Cheers, Gerdienke

08/02/2022

Social robots and rehabilitation care: What is the added value?

For the past 15 months, Roessingh Research and Development, BLEUCOMPANION and Roessingh, Center for Rehabilitation have been working together in the SCOTTY project to investigate what the added value of social robots in rehabilitation care might be.

The roles and functionalities of the PEPPER robot for rehabilitation care

The SCOTTY project, funded by DIH-HERO, started in March 2021 to define the functionalities of the PEPPER robot for rehabilitation care. The PEPPER robot is Softbank Robotics' social robot. Robot PEPPER is designed to communicate with people and is attentive to people's emotion. During two co-creation sessions, we worked with healthcare professionals to come up with four roles for the PEPPER robot. PEPPER as an assistant to the nurse, as a supporter of the physical therapist, as a host and as a companion.

Acceptance of the Pepper Robot in rehabilitation care

After all content for these roles was available, BLEUCOMPANION (technical partner in the project) started programming the PEPPER robot in the summer of 2021. By the end of 2021, the time had finally come and first user tests could be started at RRD with technical experts, healthcare professionals and patients. These first tests were mainly needed to detect all usability issues and also gave a lot of insight into the interaction between humans and robots. The expectations around the social robot were very high, but also critical. To gain more insight into the acceptance of a social robot in rehabilitation care, an acceptance study at Roessingh, center for rehabilitation among 10 care professionals and 6 patients was started in the spring of 2022. From these acceptance tests it appeared that the functionalities of the PEPPER robot are not sufficient to play a role in a clinical department now. The care professionals and patients certainly saw positive points, such as the friendly appearance of the robot.

An alternative role: The Pepper robot in the waiting room

To gain insight into the possibility of the PEPPER robot in the waiting room, a flash mob study was conducted in the last month of the project. In this study, we asked 23 waiting clients to have a conversation with the robot and fill out a questionnaire together. A role in a static setting, such as a waiting room seems to be a better fit for the PEPPER robot.

What is the social value of the PEPPER robot?

Through the Social Return on Investment (SROI) Method. A social business case for the PEPPER robot has been prepared. These analyses show that that social value of the PEPPER robot is currently very low and that social business case can only become positive when:

Expand the roles and functionalities of the robot
More patients can use the robot
The purchase and operating costs of the robot are lower

In order to share the outcomes of the SCOTTY project with others, an animation was created of the path the PEPPER robot took within the project. This animation of over 10 minutes gives a good overview of all project activities and results: https://youtu.be/pTcftwoA_T8

The June issue of Robot Magazine focuses on the SCOTTY project. For an article, researchers Marian Hurmuz and Stephanie Jansen-Kosterink were interviewed.

Click here to read the article.

Want to know more?

Have social robots and their application in healthcare worked your interest and would you like to know more about this topic? Then feel free to contact Sr. researcher Stephanie Jansen - Kosterink (s.jansen@rrd.nl - 0880 875 717).

07/28/2022

Evaluating E-Health: How do you go about it?

In practice and in science, there is still much ambiguity about how to properly evaluate eHealth. Especially when the technology (underlying the eHealth application) is still in development. Roessingh Research and Development (RRD) has years of experience in guiding such developmental processes, including the evaluation of innovative eHealth technologies. Under the leadership of senior researcher Stephanie Jansen - Kostering, RRD has developed its own method for eHealth evaluations and published it in Digital Health.

Continuous evaluation of eHealth

RRD's approach is characterized by the continuous evaluation of eHealth starting from the maturity of the technology with attention to different perspectives. These perspectives are; the user perspective, the clinical perspective and the societal perspective. The maturity of the technology is determined by the Technology Readiness Levels (TRLs). The 9 TRL levels (TRL 1 = low and TRL 9 = high) can be distinguished into three phases; TRL 1 to 3 is the research phase, TRL 4 to 6 is the development phase and TRL 7 to 9 is the implementation phase. In the research phase, for example, the user perspective is central and formative user testing in a laboratory is important to have a good alignment between the user and the technology. The paper gives several examples of studies in the different TRL phases.

Method of e-Health Evaluation

The RRD methodology for e-Health evaluation is published in Digital Health. Interested? Read the publication here: "Time to act mature - Gearing eHealth evaluations toward technology readiness levels"

Are you or will you be conducting an evaluation study of an e-Health application?

RRD is happy to think along with you. You can contact us for advice and/or to conduct evaluation studies.

For questions about evaluation studies, please contact Sr. researcher Stephanie Jansen - Kosterink (s.jansen@rrd.nl - 0880 875 717).

07/21/2022

The Gamification App - our work on the BIONIC project

By Valentina Bartali and Monique Tabak

Four years ago, RRD (with different partners from all around Europe) started working on the European project BIONIC. In May, this project came to an end and, now, we would like to look back at our work and what we have achieved in these years.

The description of the project is written in this way: Personalized Body Sensor Networks with Built-In Intelligence for Real-Time Risk Assessment and Coaching of Ageing workers.

I can imagine that, from an outsider, with this description, it can be complicated to understand what BIONIC actually is.

BIONIC was a project aiming to develop a technological innovation able to detect real-time risks in the workplace (think, for example, about the industrial sector or factories) and in everyday life. Additionally, this technology has monitoring and coaching functions in order to help preventing musculoskeletal disorders. The system consists of a suit with sensors in different parts of the body, a smartwatch to measure heart rate and steps, and two applications. One application was developed to give feedback on the user's movements, while the other application, Gamification app, was developed by RRD to motivate and coach users to live a healthy lifestyle, also outside the work environment.

On the picture on your left, you can see how the suit is and what is shown on the computer. On the picture on your right, you can see the smartwatch and the application we created.

In BIONIC, our work was focused on estimating fatigue from sensors by machine learning algorithms (which you can read more about in the papers [1] and [2] in the reference list below) and the development of coaching strategies for healthy lifestyle for the gamification application.

In this blog article, I would like to tell you a bit more about this gamification application we developed, which has the following components (to get a better idea, see video below):

Overview of measured daily activity: users can get insights on their daily activities (step counts). The application (through an algorithm) can estimate the moments in which the user shows sedentary behavior (staying too much sitting) and the periods in which (s)he is doing some activity.
Overview of subjective fatigue: Every day, users will be asked, with a question in the app, how tired they feel that day. The answers to this question will be shown in a graph.
Personalized exercise program: physiotherapy exercises advised to users in form of trainings and depending on which part of the body a user has the most issues (for instance, back, neck, or legs).
Motivational support via virtual coach bill and gamification elements: Proposing physiotherapy exercises according to the feedback received from the BIONIC system and the needs of the users. These exercises are given by a virtual coach, Bill, who guides, motivates, and supports users. The Gamification App has gamification features to prompt users to do the exercises proposed and to change their physical activity (when needed). These gamification features entail earning points through:
- Challenges: a set of goals that the user can set up for him-/herself
- Achievements: a set of tasks that the user can achieve whilst using the Gamification App

The Gamification App was also evaluated in clinical settings at Roessingh to investigate if this technology could be of added value. From this evaluation, we discovered that the application could really help patients to be more aware of their activity patterns and it could motivate them to change their activity behaviors and facilitate rehabilitation.

We are really proud of what we achieved in these years considering that we were able to develop a working application of which added value was seen. The project is now finished, but we will bring with us what we have learnt during these years and we hope to further develop and use the application for other purposes.

Reference list

[1] Marotta L, Buurke JH, van Beijnum B-JF, Reenalda J. Towards Machine Learning-Based Detection of Running-Induced Fatigue in Real-World Scenarios: Evaluation of IMU Sensor Configurations to Reduce Intrusiveness. Sensors. 2021; 21(10):3451.

[2] Marotta L, Scheltinga BL, van Middelaar R, Bramer WM, van Beijnum B-JF, Reenalda J, Buurke JH. Accelerometer-Based Identification of Fatigue in the Lower Limbs during Cyclical Physical Exercise: A Systematic Review. Sensors. 2022; 22(8):3008

07/14/2022

RE-SAMPLE: AI-powered care for patients with COPD and other chronic diseases

Written by Eline Te Braake and Christiane Grünloh

RE-SAMPLE is a European project targeting people with COPD and other chronic conditions. The goal of RE-SAMPLE is to develop a technology that supports patients and their caregivers. This technology will help patients manage their COPD and other chronic conditions. Along with 9 other partners, RRD is collaborating on this project to shape and develop the RE-SAMPLE technology. The project started in March 2021 and will run for a total of 4 years. RE-SAMPLE has received funding from Horizon (Grant agreement No. 965315).

USER-ORIENTED. When designing an eHealth intervention, it is important to consider the needs and desires of those who will use it. Ultimately, we want RE-SAMPLE to have an added value in practice for both people with COPD and their healthcare professionals. Of course, we also want that after the project, RE-SAMPLE is actually successfully implemented in the health care system. To do this, we need to learn from the attitudes, experiences, and needs of people with COPD and their caregivers. Since they are all experts in the field, they know best what is currently missing or what is already going very well. This information can help us develop a technology that is actually useful to them.

Since the inception of RE-SAMPLE, we have conducted many different surveys. We had the opportunity to talk to many people with COPD and caregivers to learn more about COPD, the experiences of living and coping with COPD, and preferences regarding COPD management. This provided a lot of useful information. This input helped us a lot in shaping the RE-SAMPLE technology. To give you an idea of what we have discovered so far, RRD has created a summary video with some highlights.

You can watch this video below!

Although much information is already being collected, we will also need ongoing input from both healthcare providers and people with COPD in the future! After hearing about RE-SAMPLE, would you like to join us and give us feedback?

Then feel free to contact us!

You can do this by sending an e-mail to Christiane Grünloh (c.grunloh@rrd.nl) or Eline te Braake (e.tebraake@rrd.nl)

07/05/2022

PhD Defence of Marian Hurmuz: eHealth - in or out of our daily lives?

While there are many different eHealth services (being) developed, its use among the target population is still low. Marian Hurmuz aimed within her PhD to increase our understanding about the (non-)use of eHealth services among the target population in a real-world setting. After a bit more than 3 years, she finalised her PhD thesis and, last week Thursday, she had her PhD defence.

Her thesis is available online on our website here. The studies described within this thesis cover the following topics:

Exploring demographics and personality traits of older adults which can predict dropping out of an eHealth service.
Investigating which determinants of the Technology Acceptance Model explain older adults' use and intention to continue using a gamified eHealth service.
A case study which shows how you can evaluate an eHealth service in a real-world setting with mixed methods.
Qualitatively investigating barriers and facilitators adults with neck and/or low back pain perceive when using an mHealth app.
Identifying the reasons of potential end-users to participate in eHealth studies, the influence of these reasons on the use of eHealth, and their expectations about these studies.

This thesis ends with a general discussion about the main findings. This discusses the use of eHealth and the intensity of use among different eHealth services, the different aspects which can be used to measure eHealth use, how eHealth use can be improved, recommendations on improving summative eHealth evaluations, and finally it discusses topics for future studies.

We are very proud of Marian that she completed her work at RRD in this fantastic way. In recent years she has done a lot of work in various European projects and we are grateful for that.

With the ends of her PhD, we are looking forward to see how she will go on working on this important topic!

06/23/2022

RRD at Supporting Health by Tech 2022

By Lena Brandl

At RRD, we do not do research by locking ourselves in an ivory tower to brood over the next scientific breakthrough. Part of our work is getting out into the world to meet other researchers and interested people and to discuss the progress of eHealth, while communicating our latest findings. The Supporting Health by Technology symposium brings together healthcare professionals, people from academia and organizations that develop eHealth - a perfect stage to present and discuss RRD's latest eHealth research with fellow colleagues across The Netherlands and beyond. For the 11th edition of the symposium, RRD colleagues Lena Brandl, Marian Hurmuz and Stephanie Jansen-Kosterink joined the event at Martini Plaza in Groningen, The Netherlands.

During the conference, current and important developments and challenges for eHealth were discussed:

The world has seen a rapid increase in the development of individual eHealth applications. Google's Play Store and Apple's App Store nowadays offer a wide range of eHealth apps with varying degrees of functionalities and pricing for all sorts of health problems. But it is less clear how we can join forces and develop a global eHealth strategy to exploit technology's potential to improve modern healthcare.
The inclusion of people from all regional, educational and ethnic backgrounds, including people who suffer from more than one disease (called multi-morbidity) is crucial for developing eHealth that actually helps people manage their health problems in everyday life. How can we include difficult-to-reach groups in eHealth research, and thereby prevent that the technology we develop makes today's digital divide worse?
What is the state of machine learning in eHealth, what tasks can it do and how can it be optimized for supporting healthcare professionals in their work?

These are some of the questions addressed at Supporting Health by Technology. RRD contributed to the discussion by presenting some of our recent eHealth research:

Marian Hurmuz presented the results of a social robot acceptance study conducted with patients and nurses in the Roessingh rehabilitation center, summarizing their acceptance and intention to use the social robot for daily care activities (SCOTTY project).
Stephanie Jansen - Kosterink demonstrated the value of the SROI (Social Return on Investment) method to access the societal impact of innovations in healthcare and how the method can help decide whether the societal impacts of employing a social robot in rehabilitation care outweigh the robot's monetary investments (SCOTTY project).
Lena Brandl presented an automatic decision-making algorithm using a method called Fuzzy Cognitive Maps (FCMs) in a self-help eHealth service for older mourners. The aim of the decision making algorithm is to guide the older mourner to offline support in case they find themselves in need of support beyond the online service (LEAVES project).

With new ideas and questions buzzing in our heads, we return to RRD to continue our work on eHealth!

05/19/2022

Flash mobs as a research method?

By Kira Oberschmidt

When you hear the words "flash mob" you probably think of people suddenly starting to dance inside a mall. Or maybe an orchestra giving an impromptu concert in a market square? A few years ago such seemingly spontaneous social activities were very popular. And now the 'flash mob' has found its way into research.

In academia, a "flash mob" of course doesn't include dancing or music. Instead it means trying to involve many different participants in a short period of time. And not only the conduction of the research is fast-paced, the analysis and reporting should also be done quickly.

The relatively new method came on our path when we were planning a final study for the SALSA project, and we decided to give it a shot. Within the SALSA Health project, we evaluate a technology that stimulates exercise in rehabilitation through the use of games. The system can be adjusted to the range of motion of a patient, and individual exercise schemes can be added and saved. After a previous six month testing period at a physiotherapist's, we were now interested in the potential of SALSA Health for the rehabilitation context.

So at the beginning of April, we set up a big tv screen and a Kinect sensor in the entry hall at Roessingh, Centre for Rehabilitation, Enschede. Patients and therapist could spontaneously stop by and try out the SALSA Health system. Then, they were asked to complete a short survey on their experience, and whether they would like to make use of SALSA Health in their treatment.

Both patients and healthcare professionals liked SALSA Health and saw its potential to enhance rehabilitation care. But what was equally important for us was the successful conduction of our first flash mob study. As expected, there were some teething problems, but also a lot of things that went well. Based on our experience, we came up with some tips for anybody who wants to conduct similar flash mob studies:

Give people time. In Dutch we call it 'kat uit de boom kijken' (see which way the cat jumps). People might walk by and look four times, and hopefully the fifth time they will stop and ask what you are doing. So allow enough time for this in your study.
Create awareness. Of course, a researcher should be present at all times to explain what you are doing there. But you should also make use of materials like banners or flyers for those who want to learn about your research, but don't want to commit to anything yet.
Involve insiders. The best way to get people to join is by having a peer (in our case another patient or a colleague) tell them about it. So stimulate participants to tell others! Maybe a therapist can email his colleagues, or a patient can bring her roommate along later.
Keep it short. Participation in the flash mob is meant to be short and spontaneous, so limit what you ask of people. This also allows you to involve those who have little time or walk by in between meetings.
Adjust the location to your target group. Find a place where your target group is sure to find you, but where they also feel comfortable to participate. Being seen by everybody is nice to draw attention to your research, but may also scare people off.

We will also be implementing these tips ourselves in the future, since this definitely wasn't our last flash mob. Actually we are planning a new one right now, so keep an eye out! And if you are interested or have any questions, get in touch!

If interested, you can learn more about the flash mob method here:

Moons, P. (2021). Flash mob studies: a novel method to accelerate the research process.

Or read about an example of a flash mob study here:

van Nassau, S. C., Bond, M. J., Scheerman, I., Van Breeschoten, J., Kessels, R., Valkenburg-van Iersel, L. B., ... & Roodhart, J. M. (2021). Trends in Use and Perceptions About Triplet Chemotherapy Plus Bevacizumab for Metastatic Colorectal Cancer. JAMA network open, 4(9), e2124766-e2124766.

05/09/2022

INFINITECH: Project and research

By Marian Hurmuz and Kira Oberschmidt

RRD is part of the European project INFINITECH. This project is funded by the European Union's Horizon 2020 research and innovation program (No. 856632). Within INFINITECH, many partners work together to lower the barriers to BigData, Internet of Things, and artificial intelligence-driven innovation, promote regulatory compliance, and encourage additional investment.

RRD's role within this project is to investigate users' willingness to share data with health insurers and to collect information on the use of an eHealth application.

Sharing data with health insurance companies?

To achieve the first goal, RRD conducted a questionnaire survey. In this survey, RRD examined the extent to which adults are open to sharing medical or lifestyle data with their health insurer. From the Netherlands, Germany and 34 other countries, a total of 180 people (57.8% female) participated in this survey. The results were:

The majority of participants indicated that they would not share data with their health insurance company, regardless of what benefit might be derived.
Looking at the people who are open to sharing, the group is larger in terms of sharing lifestyle data (e.g., steps taken per day) than sharing medical data (e.g., self-measured blood pressure readings).
Participants were most likely to share data when they received a personal health risk analysis for doing so.
Participants were least likely to share data when given a free product in return.

Would you like to test eHealth?

Another study is currently being conducted at RRD to collect data regarding the use of an eHealth app. Within this study, participants are given access to the Healthentia app (see Figure 1 below). This app allows users to monitor their health. This is done by tracking their physical activity and completing questionnaires.

Participants can use the Healthentia app for an extended period of time (up to one year). The purpose of this study for RRD is to find out how the app is used over a long period of time, why the app is used, and by whom the app is used for an extended period of time. Currently, 61 adults have signed up for this study.

RRD is permanently looking for new participants 18 years of age or older for this study. Would you like to help us within this study? If so, please visit for more information: https://www.rrd.nl/infinitech/

04/21/2022

Festive farewell to Hermie Hermens: Twente pioneer in care innovation

On April 1, Roessingh Research and Development (RRD), together with many (former) RRD staff members and other colleagues from the Roessingh group, inaugurated the retirement of Hermie Hermens. Hermie was (together with Gerrit Zilvold) one of the founders of RRD and has since its inception been one of the pillars on which the current success of RRD is built.

In all these years, Hermie has contributed to leading research in various fields (from electromyography to serious gaming, and from prosthetics to clinical decision support systems).

It is thanks to Hermie that RRD is a well-known player within the European innovation landscape; he has also put RRD on the map at the local level, for example through his appointment as professor in the Biomedical Signals & Systems group at the University of Twente, and as co-founder of organizations such as Vitaal Twente and the Technology and Care Academy. The fact that everyone in Twente involved with healthcare technology knows who Hermie is shows how great the impact of his work has been and how closely he has been linked to the region.

His farewell was centered on the things Hermie has always attached great importance to: interest in your colleagues, good food, and star wars. For the time being, Hermie will remain connected to the University of Twente for a few days a week.

04/20/2022