Background: Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. Objective: To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. Methods: We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients’ perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. Results: Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality–based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. Conclusions: The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders.

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中文翻译：

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混合无处不在的教练与针对家庭锻炼的移动和全息会话代理的新颖结合：四个设计和评估研究

背景：针对肥胖，心脏病或腰痛等各种疾病的有效治疗不仅需要卫生保健专家进行个人现场指导，还需要大量的家庭锻炼。但是，不坚持家庭锻炼仍然是一个严重的问题，因为长期治疗会导致费用增加。目的：为了提高对家庭锻炼的依从性，我们提出，实施和评估了混合型无处不在教练（HUC）的新颖教练概念。在HUC中，医疗保健专家辅以对话代理（CA），该代理通过智能手机提供心理教育和个性化的激励消息，以及在免提增强现实环境中的实时运动支持，监视和反馈。方法：我们将HUC应用于理疗领域，并与一个跨学科团队进行了4个设计和评估循环，以评估患者和理疗师如何看待HUC以及HUC是否导致治疗依从性。35位理疗患者在实验室环境中评估了HUC的第一个版本，以识别患者对HUC的看法。此外，还对11名物理治疗师进行了关于HUC的采访，并评估了CA是否可以帮助他们与患者建立工作联盟。然后，在受试者内部实验中，由15位患者测试了第二个版本，以确定HUC解决依从性的能力以及在患者和CA之间建立工作联盟的能力。最后，对1名患者进行了为期4周的n-of-1试验，以显示其深层HUC经验，从而有可能揭示现实世界中的益处和挑战。结果：患者认为HUC有用，易于使用且令人愉悦，他们选择HUC替代最新方法，并表达了使用它的意图。此外，患者与CA建立了工作联盟。与目前的方法相比，物理治疗师看到了HUC的相对优势，但最初并没有看到工作联盟方面的潜力，在看到该领域的HUC结果后，这种合作关系发生了变化。来自患者的定性反馈表明，他们喜欢使用基于增强现实的CA进行锻炼，并且更好地了解了如何使用HUC正确进行锻炼。而且，物理治疗师强调，HUC将有助于在治疗过程中使用。纵向田间研究的坚持率为92％（11/12次； 330/360次重复； 33/36套），并且在4周内运动准确性大大提高。结论：来自患者和医疗保健专家的总体积极评估表明，HUC是一种有希望的工具，可用于各种相关的家庭锻炼疾病。但是，未来的研究必须进行各种练习，并对患有不同疾病的患者进行HUC测试。来自患者和医疗保健专家的总体积极评估表明，HUC是一种有希望的工具，可用于一系列相关的家庭锻炼中的各种疾病。但是，未来的研究必须进行各种练习，并对患有不同疾病的患者进行HUC测试。来自患者和医疗保健专家的总体积极评估表明，HUC是一种有希望的工具，可用于一系列相关的家庭锻炼中的各种疾病。但是，未来的研究必须进行各种练习，并对患有不同疾病的患者进行HUC测试。

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