Impact of Functional Rehabilitation on Digital Independence: Validation of a Novel Smartphone Use Score as an Indicator of Discharge Readiness in Medical Care and Rehabilitation.

• TSHN-SMR (Test Standardisé d'Habileté Numérique sur Dispositif Dédié) (Other), also known as Standardized Test of Digital Skills on a Dedicated Device: The TSHN-SMR score (Standardized Test of Digital Skills on a Dedicated Device) is a proposed assessment tool that we aim to investigate in this study. The test is performed using a standardized smartphone provided by the rehabilitation unit and contains no personal digital data. The score comprises six domains: * Immediate/procedural memory and motor skills * Language, executive functions, and accuracy * Planning and visual attention * Fine motor skills and coordination * Planning, temporal orientation, and fine motor skills * Short-term memory and social recognition For each domain, the patient is asked to complete a task on the smartphone corresponding to an activity they may be required to perform on their personal device in everyday life : * Unlock a phone, * Send a text message , * Search on the internet, * Zoom on a personal photo, * Set up an alarm, * Call a contact , Patients may choose between an Android or iOS smartphone according to their usual device preference.
• Barthel scale (Other): The Barthel Index is a validated measure of functional independence in activities of daily living. It assesses ten domains, including feeding, bathing, grooming, dressing, bowel and bladder control, toilet use, transfers, mobility, and stair climbing. Scores range from 0 to 100, with higher scores indicating greater independence. Widely used in rehabilitation settings, the Barthel Index provides a simple and reliable assessment of functional status and is commonly employed to monitor recovery and support discharge planning. (≈ 490 characters)

Primary outcomes

• Change in TSHN-SMR Total Score Between Admission and Discharge [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]: Change in digital skills performance measured by the TSHN-SMR (Standardized Test of Digital Skills on a Dedicated Device) between admission and discharge from the SMR unit.

Secondary outcomes

• Correlation between the TSHN-SMR score measured at discharge and the occurrence of rehospitalization within 3 months following discharge ( [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]: (binary outcome: yes/no) Rehospitalization will be defined as any unplanned admission to a healthcare facility within 3 months after discharge from the SMR unit. The primary reason for rehospitalization will be collected when available from the medical record.
• Predictive performance of the discharge TSHN-SMR score, [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]: Assessed using receiver operating characteristic (ROC) curve analysis and estimation of the area under the curve (AUC).
• Identification of a discharge TSHN-SMR score threshold [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]: Identification of a discharge TSHN-SMR score threshold associated with an increased risk of rehospitalization.
• Correlation between the TSHN-SMR score (at admission and/or discharge) and patient characteristics [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]: Relationships between the TSHN-SMR score (at admission and/or discharge) and patient characteristics, including age, Barthel Index score, and level of digital technology use.
• Inter-rater reliability of the TSHN-SMR score [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]: Inter-rater reliability of the TSHN-SMR score, assessed by two independent evaluators.
• Correlation between the TSHN-SMR score and the Barthel Index [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]
• Correlation between the TSHN-SMR score and the level of digital technology use [Between admission and discharge from the SMR unit (average duration approximately 3 weeks, variable according to clinical condition)]

Sex: All, ages: 65 Years to any

Inclusion Criteria:

* Reason for admission: Any patient admitted to an SMR unit for a neurological condition (e.g., stroke or mild traumatic brain injury) or an orthopedic condition (e.g., joint replacement or fall-related injury) requiring functional rehabilitation.
* Ownership of a smartphone for at least 6 months prior to admission, to ensure that the assessment measures the recovery of previously acquired digital skills rather than the learning of a new device.

Exclusion Criteria:

* Major sensory impairment: Blindness or profound untreated hearing loss that makes smartphone use impossible.
* Pre-existing motor impairment: Advanced Parkinson's disease or severe digital osteoarthritis (deforming stage) that could bias the assessment of acute functional recovery.
* Cognitive impairment: Mini-Mental State Examination (MMSE) score < 20/30, as a score below 20 may indicate that the patient is unable to understand the simple instructions required to complete the test.
* Language barrier: Inability to understand instructions in French, unless the smartphone is configured in the patient's native language.

• Jean Abou Ayache, MD, Principal investigator, Artois Private Hospital