service / methodology · business intelligence dashboards have been purposely created to offer...

Service / Methodology

Topic Robotic assisted rehabilitation

Organisation Department/Unit

Don Carlo Gnocchi Foundation (FDG)

Innovation and Development Department

Title Advanced tools and methods for management, monitoring and optimization of rehabilitation processes

Target Group Age

Adults affected by neurological diseases (mainly Stroke, Multiple Sclerosis, Parkinson disease, Polyneuropathy) or orthopedic diseases, with involvement of the upper limb.

Professionals involved: personnel involved in managing or coordinating rehabilitation processes (medical directors, coordinators of therapists etc.) and personnel involved in monitoring the use of resources and strategic decision making (directors of rehabilitation centres, management controller etc).

Description (350 words max)

FDG operates a network of 29 rehabilitation centres throughout Italy, overall serving about 9.000 patients daily in hospital, outpatient and home care. Recently, considerable work has been carried out to optimize rehabilitation processes and clinical protocols, in order to uniform them and achieve standardized procedures with objective measurement on their efficacy and efficiency.

Within this context, the robotic assisted rehabilitation was first implemented in 2015. Nowadays, nine FDG centres are equipped with robots able to deliver rehabilitation by exercise in augmented reality environment. To account for sustainability, an organizational model was developed that includes a therapist to monitor 1 to 4 patients working on robots within 45 minutes individual sessions. The introduction of this model into clinical practice brought about the need to review the management process.

Following a simulation considering the entire process, a scheduling system was developed, able to guarantee the saturation of the robots during each slot of the day by selecting patients at different levels of impairment. Furthermore, a data centralization process was implemented by networking the robots within the Foundation’s IT infrastructure and aggregating their data into a central database.

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Business intelligence dashboards have been purposely created to offer services to managers, clinicians and researchers. The dashboards allow controlling the use of resources and technologies by managers (see Attachment 1), monitoring the patients’ performances and generating reports (see Attachment 2) to be included in the patients’ clinical record; finally, they allow researchers to access anonymized instrumental data and clinical scales for research purposes. This approach allowed to evaluate both the clinical efficacy and the process effectiveness, based on a large set of real‐world data (28.000+ treatments so far), in a value‐based healthcare perspective.

The data analysis system was first used to supervise a Multicenter Randomized Controlled Trial (see Attachment 3: 247 participants in 8 FDG centres along 18 months), which showed the efficacy of robotic rehabilitation for the upper limb treatment in subacute stroke patients (Trial registr.number: http://www.clinicaltrials.gov NCT02879279).

After the trial, the data monitoring system was used to monitor the follow‐up of robotic rehabilitation in the 9 FDG centers, showing an important increase of the robotic rehabilitation sessions (see Attachment 4). The centralized control of the robots’ operational activity also allowed to identify the centers where robots had not been used at their full potential, triggering training actions on clinical managers and operators.

Partners Nine Rehabilitation Centres of the Don Gnocchi Foundation: Milano IRCCS, Rovato, La Spezia, Fivizzano, Firenze, Roma SM Provvidenza, Roma SM Pace, Sant’Angelo dei Lombardi, Acerenza

Staff and Resources

Core group: 3 Engineers, 2 Physicists, 2 Physicians, 1 Physiotherapist

Acknowledgements: all medical doctors and therapist involved in the robotic assistive rehabilitation treatments of all nine centres.

Duration 2 years (ongoing)

Finances FDG

Author Names: Furio Gramatica, Valerio Gower, Filippo Benetti, Irene Aprile, Marco Germanotta, Marta Beorchia Contact Email: [email protected]

URL https://www.dongnocchi.it/@servizi/riabilitazione-robotica-e-con-tecnologie-avanzate (in Italian language

Attachments

Attachment 1: screenshots of the Dashboard for Managers Attachment 2: example of Patient Report generated by the

dashboard Attachment 3: clinical trial workflow Attachment 4: Trend analysis of robotic rehabilitation following the

data system implementation

Relazione attività riabilitazione robotica di Nome fittizio

1

Dati anagraficiNome e Cognome: Nome fittizioLuogo di nascita: MILANOData di nascita: 01/01/1950Sesso: MCodice Fiscale:Centro di riferimento: Milano SMN

Sintesi attività di riabilitazione roboticaNumero totale sessioni di riabilitazione robotica: 30

Mappa accessi alla palestra robotica arto superiore1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

01-201702-201703-201704-201705-201706-201707-2017

Distribuzione attività roboticheNumero Valutazioni Numero Esercizi Distribuzione esercizi (%)

Amadeo 36 35 62,7Pablo 0 53 17,6Diego 2 1 1,3Motore 9 38 18,4Tymo 0 0 0,0Myro 0 0 0,0

Valutazioni strumentaliValutazioni Forza della mano

Data Lato Movimento Pollice [N] Indice [N] Medio [N] Anulare [N] Mignolo [N] Mano [N]20/01/2017 Des Estensione 5,02 0,86 0,51 3,0420/01/2017 Des Flessione 19,83 13,05 5,29 3,44 1,99 32,5120/01/2017 Des Estensione20/01/2017 Des Flessione 12,63 13,21 3,74 1,92 0,51 29,2108/02/2017 Des Estensione 2,31 0,77 1,00 0,9208/02/2017 Des Flessione 6,46 3,32 0,97 1,09 1,55 9,5217/02/2017 Des Estensione 0,36 2,54 1,12 0,06 0,01 2,4617/02/2017 Des Flessione 3,33 14,63 9,27 8,05 16,93 39,2717/02/2017 Des Estensione 3,93 8,88 2,49 0,12 1,41 9,3717/02/2017 Des Flessione 0,64 16,24 9,16 5,50 2,56 31,2903/03/2017 Des Estensione 6,77 1,81 0,20 0,79 7,4103/03/2017 Des Flessione 0,30 13,18 10,46 10,72 6,91 41,2303/03/2017 Des Estensione 0,03 8,37 1,55 0,17 0,24 5,2903/03/2017 Des Flessione 0,36 16,41 12,28 11,80 7,68 47,3603/03/2017 Des Estensione 0,07 8,64 0,91 6,6403/03/2017 Des Flessione 0,30 17,45 11,90 11,29 6,36 46,5407/06/2017 Des Estensione 1,55 3,7507/06/2017 Des Flessione 1,07 9,03 24,29 9,89 5,04 46,73


2

06/02/2017 15/03/2017 21/04/2017 28/05/2017 04/07/20170

20

40

Flessione Mano [N]

Lato sinistroLato destroLato ignoto

06/02/2017 15/03/2017 21/04/2017 28/05/2017 04/07/20170

5

10

Estensione Mano [N]


Valutazioni Range of Motion spallaData Codice Lato Tempo [s] Precisione [%] Area coperta

[m^2]Tasso di successo

20/01/2017 R-1 Des 118,44 89,89 0,11 1,0020/01/2017 R-2 Des 125,47 86,41 0,11 0,9920/01/2017 R-3 Des 103,83 85,36 0,12 1,0017/02/2017 R-4 Des 65,11 90,93 0,11 1,0017/02/2017 R-5 Des 53,53 91,20 0,11 1,0003/03/2017 R-6 Des 49,04 86,84 0,13 1,0009/05/2017 R-7 Des 45,36 71,41 0,13 1,0011/05/2017 R-8 Des 60,77 91,21 0,10 1,0007/06/2017 R-9 Des 57,43 93,24 0,10 1,00

06/02/2017 15/03/2017 21/04/2017 28/05/2017 04/07/20170

50

100

150Tempo [s]


06/02/2017 15/03/2017 21/04/2017 28/05/2017 04/07/20170

50

100

Precisione [%]


06/02/2017 15/03/2017 21/04/2017 28/05/2017 04/07/20170

0,05

0,1

0,15Area coperta [m^2]


06/02/2017 15/03/2017 21/04/2017 28/05/2017 04/07/20170

0,5

1

Tasso di successo



3

Grafici di dettaglio valutazioni ROM e Forza spalla

Data: 20-01-2017 Codice: R-1

Data: 20-01-2017 Codice: R-2


4

Data: 20-01-2017 Codice: R-3

Data: 17-02-2017 Codice: R-4


5

Data: 17-02-2017 Codice: R-5

Data: 03-03-2017 Codice: R-6


6

Data: 09-05-2017 Codice: R-7

Data: 11-05-2017 Codice: R-8


7

Data: 07-06-2017 Codice: R-9

CONSORT 2010 Flow Diagram

Assessed for eligibility (n=631)

Excluded (n=384) Not meeting inclusion criteria (n=348) Declined to participate (n=2) Other reasons (n=34)

Allocated to RTG (n=123)

Received allocated intervention (n= 111)

Did not receive allocated intervention (n=12)

(11 never started treatment, 1 death)

Allocated to CG (n=124)

Received allocated intervention (n=113)

Did not receive allocated intervention (n=11)

(11 never started treatment)

Allocation

Randomized (n=247)

Enrollment

600

800

1000

1200

1400

1600

1800

Num

ber o

f tre

atm

ents

Robotic Rehabilitation Trend Analysis

0

200

400

600

2015 -07

2015 -09

2015 -11

2016 -01

2016 -03

2016 -05

2016 -07

2016 -09

2016 -11

2017 -01

2017 -03

2017 -05

2017 -07

2017 -09

2017 -11

2018 -01

2018 -03

2018 -05

Num

ber o

f tre

atm

ents

Year - Month

END OF CLINICAL TRIAL

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