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The transtheoretical model (TTM) is a promising approach to the promotion of behavior change, but it remains to be established whether there is an association between the TTM approach and intradialytic exercise among patients on hemodialysis (HD) with low motivation to exercise in a real-world setting. This retrospective cohort study, conducted in a regional hospital in Japan, included adult outpatients receiving HD 3 times per week who had never participated in intradialytic pedaling exercise despite the encouragement of the HD personnel. Patients were divided into 2 groups according to HD weekday. Patients undergoing HD on Tuesday, Thursday, and Saturday were encouraged by the HD unit team to exercise during HD based on the TTM (exposure group) and those receiving HD on Monday, Wednesday, and Friday were encouraged to exercise as usual (control group). The primary outcome was sustained intradialytic exercise using a leg ergometer, defined as a total of 72 sessions of 30-minute pedaling exercise (duration of at least 6 months). Overall, 85 patients were included in the analysis (mean age: 67.1 ± 11.9 years, 22% female). Of 33 patients in the exposure group, 10 (30%) maintained intradialytic exercise, compared with 2 of 52 patients (4%) in the control group. Log-binomial regression models with stabilized inverse probability of treatment weighting showed a significant association between the TTM approach and sustained intradialytic exercise (adjusted risk ratio 9.23 [95% confidence interval 2.13–40.00]). There were no exercise-related cardiovascular events. Among patients with low motivation to exercise during HD, use of the TTM approach in clinical practice was associated with sustained intradialytic exercise compared with usual care.

Dental hygienist students require a self-learning simulator to learn the correctness of handscaling techniques. An essential technique in hand scaling is the maintenance of contact between the tip of the hand-scaler blade and the tooth. However, imaging-based methods cannot effectively reveal this contact because the gingiva and buccal mucosa conceal the blade. Therefore, this study aimed to propose a method to identify the appropriate contact state of the blade with the tooth by using an inertial measurement unit (IMU) attached to the hand scaler and a force sensor attached to the target tooth. The hand-scaling motion was measured in an experiment in which participants were instructed to use the tip or middle of the blade to contact the tooth. The contact state of the blade, whether it was the tip or the middle, was identified using 18 features, including the average and standard deviation of nine dimensions of force, acceleration, and angular velocity with a support vector machine (SVM). The results showed that the model using all 18 features could classify the contact state with an accuracy of 97.1%. Furthermore, the accuracy was 95.9% with the 12 features from IMU alone, which was not significantly different from the accuracy with 18 features. The accuracy was 88.8% with six features from the force sensor alone. These results indicate that the IMU alone can identify the correct contact state, highlighting the possibility of creating a realistic simulator for training dental hygienists in evaluating the blade-contact state.