Transcultural and Multidimensional validation of dIgital Rehabilitation Intervention of COgnitive Resources Domain-Oriented – MI-RICORDO

Among NCD-related disabilities, cognitive impairment significantly burdens patients and their caregivers with specific long-term rehabilitation needs. Technology-enabled continuity of care may scale up the healthcare services to a broader target of people, that could benefit from telerehabilitation interventions able to deliver care at home. New digital solutions implementation is often validated and regulated within the local or regional contexts, becoming viable, effective healthcare systems, without a large-scale global impact. The knowledge to design sustainable and accessible healthcare services remains locally confined, not transferable to different contexts needing a reorganization of the healthcare system, a procedures/processes contextualization, an adaptation of professional figures involved, and a local definition of the reimbursement tariffs of reference. A local adaptation could not be sufficient: the rehabilitation programs contents should also reflect the beliefs, attitudes, life background, typical of different geographical settings and therefore can be different from area to area. Moreover, the rehabilitation contents should be updated and diversified according to the transcultural characteristics of patients and the transnational features (such as attitudes, habits, life-styles, etc). The MI RICORDO Project aims to purpose a multidimensional model that, starting from the MAST (Model for Assessment of Telemedicine) approach, could support the effective validation and adaptation of telemedicine digital solutions in the different countries, considering safety, clinical effectiveness, patient perspectives, economic aspects, organizational domains, socio-cultural, legal, ethical aspects, finally acceptability, and reimbursement concerns. This goal will be achieved by studying and redesigning an innovative digital healthcare solution, able to offer continuity of care for people with cognitive impairment, already developed in the Italian context, for its transferability and adaptation in 3 different transnational contexts (Italy, Portugal and France). Partners will be firstly engaged in the translation, contents and transcultural adaptation of the innovative RICORDO (Rehabilitation Intervention of COgnitive Resources Domain-Oriented) rehabilitation care pathway. RICORDO is based on a technology-enabled digital solution for the cognitive rehabilitation of people currently experiencing (such as acquired brain injury) or likely to experience cognitive disability (such as early neurodegenerative conditions). This solution could be delivered through a telerehabilitation platform (web-based) or as a digital therapeutic (app-based), with an adaptable level of cognitive activities incremental difficulty. The cognitive rehabilitation content covers most of the DSM-5 neurocognitive domains and can be organized into different rehabilitation program templates to meet tailored rehabilitation needs. The RICORDO telerehabilitation path model has been previously pilot-tested (Rossetto et al., 2023) in a group of people with neurodegenerative disease (Mild Cognitive Impairment) in Italy. The cognitive rehabilitation program was a specific intervention delivered with telerehabilitation platform (patients homes), intensive frequency (five days per week, 30-40 min per day) and limited duration (6 weeks) to promote cognitive abilities. The clinical Partners will test the acceptability and feasibility of this care pathway model. The solution efficacy could be tested in three pilot settings (such as hospital, nursing home, and home care setting), in different transnational contexts (Italy, Portugal and France). Two feasibility study and one randomized controlled trial will be designed and implemented for validating the digital solution effectiveness. Digital solution and care pathway will be validated also through the MAST model, with a multidimensional approach.