Implementation Of Telerehabilitation Research Articles

MODERN VIEWS OF USE OF TELEREHABILITATION IN URINARY TRACT DYSFUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic disease of the nervous system that often leads to various disorders, including urinary tract dysfunction. This significantly affects the quality of life of patients, causing physical and psychological complications. The term "bladder rehabilitation" summarizes treatment options aimed at restoring its function in patients with neurourological symptoms. A strong contraction of the sphincter of the urethra and/or pelvic floor, as well as anal dilatation, manipulation of the genital area, and physical activity reflexly inhibit urination. A comprehensive physical therapy program for patients with pelvic disoders includes pelvic floor vibration massage, training in proper breathing patterns, pelvic floor muscle relaxation and stabilization exercises and should last several months, during which the patient regularly visits the doctor. The pandemic and war have created barriers that affect almost every aspect of life, treatment and rehabilitation, especially for people with chronic neurological conditions. Traditional rehabilitation methods used to correct urinary tract dysfunction have their limitations, including difficulties in accessing specialists, especially in remote areas. This stimulates the development and implementation of telerehabilitation as an alternative approach. Telerehabilitation involves the use of digital technologies for the remote provision of medical services and patient monitoring. It allows doctors to monitor the condition of patients, provide recommendations and adjust treatment without the need for personal visits. Considering the existing data and our own clinical experience, we consider it appropriate to use telerehabilitation for the correction of disorders of the lower urinary tract, especially in the conditions of war, when access to rehabilitation centers may be difficult. In the department of medical rehabilitation of the University Clinic of the Kharkiv National Medical University, we successfully conducted telerehabilitation using Google Meet video conferencing for 10 patients with urinary incontinence on the background of multiple sclerosis, whose EDSS was no more than 4.0. When conducting online classes under the guidance of a physical therapist, patients noted a desire to strictly follow the recommendations and perform regular exercises. All patients kept a urination diary, according to which the frequency of urination was reduced by an average of 20-25%, which had a positive effect on their quality of life. Although our observations are not representative, in combination with existing studies, we consider telerehabilitation to be a promising direction in complex therapy and rehabilitation of this pathology. Conclusion The use of telerehabilitation for urinary tract dysfunction in patients with multiple sclerosis is a promising direction that requires further research. This approach can significantly improve the quality of life of patients, reduce the burden on the health care system and provide a more affordable and convenient treatment. A multidisciplinary team should be involved, including a neurologist, a urologist, a gynecologist, and a physical therapist to select the optimal tactics of drug treatment and physical therapy. A promising direction of further research is the development of standard protocols for conducting telerehabilitation for patients with lower urinary tract dysfunction against the background of multiple sclerosis and other pathologies.

Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association.

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).

Supporting delivery of remote pulmonary rehabilitation across different healthcare contexts: A multi-national study.

Purpose: This study aimed to understand factors that health professionals, from a variety of healthcare contexts and countries, believed support remote delivery of pulmonary rehabilitation (PR); and to develop a targeted intervention to support implementation of remote PR. Methods: A 3-phase participatory action-research process was employed, across three study hubs in three countries (NZ, India, USA), representing diverse healthcare delivery contexts. Phase 1 employed focus groups of health professionals working in PR; data were analysed qualitatively with transcripts coded against two implementation frameworks (Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR)). Findings informed development of an online toolbox to support delivery of remote PR (Phase 2), which was evaluated using semi-structured interviews (Phase 3). Results: 20 health professionals participated across all study phases. Factors considered to influence implementation of remote PR were consistent across diverse healthcare contexts and related to staffing availability, skills and confidence, and equipment and technology accessibility. An online toolbox provided support for enhancing knowledge and confidence, but was not able to address all implementation barriers. Discussion: Key factors to support clinicians deliver remote PR are common across different healthcare contexts, suggesting broader telerehabilitation implementation strategies may be applicable across healthcare environments.

EFFECT OF COVID-19 PANDEMIC ON OCCUPATIONAL THERAPY PRACTICE AND IMPLEMENTATION OF TELEREHABILITATION INCLUDING HEALTH SECTORS IN AL AHSA CITY

Introduction and Aim: COVID-19 has turned into a worldwide public health emergency involving 223 nations and regions, and it has had a significant impact on public and health service delivery systems [1]. Tele-rehabilitation has developed as a potential strategy for virtually supervising the delivery of a physical, occupational, speech, and other therapies targeted at treating motor, mental, and neuropsychiatric deficiencies caused by sensory and motor impairments [3]. The transition to telerehabilitation offers a wealth of learning opportunities. This viewpoint offers an overview of how a learning health care system (LHS) approach to telerehabilitation research might foster innovation in health care delivery and lead to new scientific findings [4]. Telerehabilitation benefits minimize the need for patients and providers to travel and in-home rehabilitation services can save travel costs and caregiver strain. Patients with mobility issues will appreciate the convenience [5]. The aim of the study was to determine the COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa. Method: COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa assessed by the questionnaire. The purpose of the questionnaire to measure the Effect of Covid-19 pandemic on occupational therapy practice and implementation of telerehabilitation including government hospitals, private hospitals, and clinics in ALAHSA city. We shared the link by distributing it through social media. This study was conducted in Al-Ahsa including government hospitals, private hospitals, and clinics. The data collected from SPSS. 20 questions used to assess different aspects of COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa with five options (Strongly Agree – Agree – Neutral – Disagree – Strongly Disagree. In addition, it is cross-sectional because the study collected data at giving point across the study. Result: There are 108 participants in this study. All of the participants were from Saudi Arabia in Al-Ahsa that met the inclusion criteria in This study. The number of male participants in the research was 85 (78.70%) . Also, the ages of the participants ranged from 16 to 58 and the average age is 30,23. We found that most of the participants agreed that telerehabilitation was effective and had many benefits for patients where the percentage of answers strongly agree and agree in all questions was high. Furthermore, the ages of the participants in the research are all of them from adolescence and adulthood, as the use of electronic technology to conduct therapeutic and rehabilitative sessions is almost non-existent for people in the late adulthood stage. Conclusion: We found that telerehabilitation is effective and benefits both the therapist and the patient. Also, the percentage of use of telerehabilitation by late adult patients was very low. Telerehabilitation had some problems and defects, and we hope that they will be resolved and the remote treatment system will be fully developed.

An examination of geographic access to outpatient stroke rehabilitation services in Tennessee, a stroke belt state

BackgroundWhile over half of US stroke patients were discharged to home, estimates of geographic access to outpatient stroke rehab facilities are unavailable. The objective of our study was to assess distance and travel time to the nearest outpatient stroke rehab facility in Tennessee, a high stroke prevalence state. MethodsWe systematically scraped Google Maps with the terms “stroke”, “rehabilitation”, and “outpatient” to identify Tennessee stroke rehab facilities. We then averaged/aggregated Census block-level travel distance and travel time to determine the mean travel distance/time to a facility for each of the 95 Tennessee counties and the overall state. Comparisons of mean travel time/distance were made between rural and urban counties and between low, medium, and high stroke prevalence counties. ResultsWe found that 79% of facilities were in urban areas. Significantly higher median of mean travel times and distances (p values both <0.001) were observed in rural (22.0 miles, 31.6 min) versus urban counties (10.5 miles, 18.4 min). High (21.5 miles, 32.5 min) and medium (18.7 miles, 28.3 minutes) stroke prevalence counties, which often overlap with rural counties, had significantly higher median of mean travel times and distance than low stroke prevalence counties (7.3 miles, 14.5 min). ConclusionsRural Tennessee counties were faced with high stroke prevalence, inadequate facilities, and significantly greater travel distance and time to access care. Additional efforts to address transportation barriers and accelerate telerehabilitation implementation are crucial for improving equal access to stroke aftercare in these areas.

Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study.

Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identified as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals.

Which factors affect the implementation of telerehabilitation? Study protocol for a mixed-methods systematic review with a framework synthesis.

Telehealth approaches are promising for the delivery of rehabilitation services but may be under-used or under-implemented. To report a review protocol to identify how much telerehabilitation (telehealth approaches to the delivery of rehabilitation services) have been used and implemented, and which factors have affected such implementation. A mixed-methods systematic review with a framework synthesis. Six databases for the scientific literature will be searched, complemented by snowballing searches and additional references coming from key informants (i.e., rehabilitation researchers from a networking group in health services research). We will include English-language empirical research examining the routine use or implementation of telehealth technologies in physical rehabilitation services or by physical rehabilitation professionals from a range of study designs, excepting case studies, case reports, and qualitative studies with n < 5. Two independent reviewers will perform the screenings, quality appraisals (using the Joanna Briggs Institutes' appraisal checklists), and the data extractions. The Consolidated Framework for Implementation Research will be used to synthesize the data on the enablers and barriers of the implementation of telerehabilitation approaches. All the authors will be involved at this synthesis, and key informants will provide feedback. The results can inform further implementation endeavours.

A Brief Report on Telerehabilitation During COVID-19 Outbreak at a Tertiary Care Center in Kerala, India

The unanticipated lockdown following the COVID-19 outbreak significantly impacted the field of rehabilitation, compelling the professionals to switch to tele-mode to continue providing their service without interruption. This article aims to highlight the steps taken to overcome the various challenges that were encountered in this period and to strengthen the opportunities in telerehabilitation services at a tertiary care center in Kerala, India. An average of 1000 clients were served monthly through telerehabilitation in various units at the selected institute during the COVID-19 pandemic. The telerehabilitation services included assessments, intervention, and counseling for clients of all ages with various types of disabilities. A high literacy rate and better access to technology among the general population in Kerala, India were identified as advantages for the rapid implementation of telerehabilitation as a viable form of service delivery.

Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors

Objective: To identify the factors influencing the implementation of telerehabilitation (TR) in a post-stroke early supported discharge (ESD) rehabilitation program as perceived by clinicians and managers. Methods: A descriptive qualitative design was used in collaboration with a Canadian ESD stroke rehabilitation program. After 15 months of pre-COVID-19 implementation and 4 months of COVID-19 implementation, 9 stakeholders (7 clinicians, 1 coordinator and 1 manager) from an ESD program participated in 2 focus groups online or an individual interview. Qualitative data were coded and analyzed semi-deductively for the pre-COVID-19 and COVID-19 phases using the Consolidated Framework for Implementation Research (CFIR). Results: Four categories emerged related to the CFIR, each with themes: (1) Telerehabilitation, which included “Technology” and “Clinical activities”; (2) Telerehabilitation users, which included: “Clients’ characteristics” and “Clinicians’ characteristics”; (3) Society and healthcare system, which included “Changes related to COVID-19” and “ESD program”; and (4) TR implementation process, which included “Planning” and “Factors that influenced practice change”. Conclusions: Factors impacting TR implementation in the ESD program were found to be numerous and varied according to the pre-COVID-19 or COVID-19 phases. Clinicians’ motivation regarding potential gains for them in using TR was key in its implementation during the COVID-19 period.

Telerehabilitation Implementation: Perspectives from Physiotherapists Working in Complex Care

Purpose: The COVID-19 pandemic resulted in a rapid change in ways clinicians deliver physiotherapy services, leading to an important uprise in telerehabilitation implementation. Sharing the experiences of physiotherapists in clinically adopting this technology during this initial wave of the pandemic can influence future implementation. This mixed-method study aimed to identify the barriers and new facilitators of telerehabilitation clinical implementation. Methods: Canadian physiotherapists with and without telerehabilitation experience, working in various clinical settings, were recruited during the first wave of the COVID-19 pandemic. Participants completed the Assessing Determinants of Prospective Uptake of Virtual Reality instrument (ADOPT-VR) adapted for telerehabilitation and participated in online focus groups to explore their experiences with telerehabilitation implementation. Demographic data and ADOPT-VR responses were analyzed descriptively. Qualitative data were analyzed using content analysis. Results: Sixteen physiotherapists completed the study. Scores on the Likert scale showed that physiotherapists enjoyed telerehabilitation (7.5/10) and perceived it as being useful (7.3/10). Physiotherapists disagreed with the necessity to use only minimal mental efforts (4.4/10) and feeling familiar with the evidence (4.7/10). Limited access to telerehabilitation implementation evidence, a reduced hands-on approach, and a lack of validated remote assessments were reported as barriers. Discussion: Clinical practice guidelines, validated remote neurological assessments, changes in physiotherapy curriculum and policymaking are critical to improving telerehabilitation implementation within physiotherapy practices. Conclusion: Participants positively experienced the quick use of telerehabilitation from the beginning of the COVID-19 pandemic, but some important barriers remain.

The state of the art in telerehabilitation for musculoskeletal conditions

BackgroundGiven the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future.Main bodyTelerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users.ConclusionsTelerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.

Staff perspectives on the key elements to successful rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments.

During the COVID-19 pandemic, hospital physiotherapy departments transitioned to telerehabilitation to ensure continuity of care for patients. The purpose of this study is to determine the key elements to successful, rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments in response to COVID-19. This study used a qualitative design. Physiotherapists who delivered telerehabilitation consultations during the COVID-19 restriction period in two Brisbane public hospital physiotherapy departments were eligible to participate in semi-structured interviews. Data were analysed thematically. Twenty-five physiotherapists (22-60years of age; 68% female) with 1-40years of clinical experience provided insights into their perceptions of the rapid uptake of telerehabilitation in the provision of clinical care. Physiotherapists worked across musculoskeletal outpatient (72%), inpatient, community, paediatrics and pelvic health departments. Qualitative analyses in relation to the physiotherapist perceptions ofthe key elements of rapid transition to telerehabilitation, revealed four key themes underpinning success: (1) 'it requires a whole team approach', (2) 'technology issues will be encountered and can be overcome', (3) 'optimise the situation while understanding the differences' and (4) 'modifying your approach doesn't imply inferior quality of care'. Rapid implementation of telerehabilitation in a hospital setting is possible, and is facilitated by organisational, administrative and management support, willingness of physiotherapists to adopt, shared learning experience, quality software and connection, availability of equipment and space and optimised systems and processes. Key factors facilitating successful telerehabilitation consultations include effective communication, demonstration, involving a third party to help, and clients who are well prepared and willing to engage.

Impact of the COVID-19 pandemic on physical therapy practice in Saudi Arabia.

The new Coronavirus (COVID-19) pandemic has caused significant impact on the medical sector worldwide, including physical therapy (PT). The purpose of this study was to investigate the impact of the COVID-19 pandemic on the PT services, and the associated psychological distress endured by PT practitioners in Saudi Arabia. A cross-sectional study was conducted to survey on-duty PT practitioners using a web-based questionnaire. Licensed PT practitioners working in Saudi Arabia (n = 265) participated and completed all the survey questions. The questionnaire comprised 30 questions covering the sociodemographic data and the outcome measures, which included the impact of the pandemic on the PT practice, use of telerehabilitation, administrative response during the pandemic, and PT practitioners' anxiety measured by the General Anxiety Disorder-7 scale. During the lockdown, disruptive impact on the PT practice was reported by most of the participants (80%). The majority of PT clinics/departments were either partially (43.8%) or completely (31.3%) shutdown, and therapists treated patients less than usual. Around 30% of participants reported using a telerehabilitation approach during the pandemic to communicate with patients, and about 33% received online courses and webinars to adapt the PT practice in response to the pandemic. About 21% of participants endured moderate to severe levels of anxiety, which was more pronounced among females. The COVID-19 pandemic significantly impacted the PT services in Saudi Arabia. Consequently, the number of patients treated was reduced, and therapists suffered notable psychological stress. Furthermore, although implemented, adaptive administrative measures were inadequate. Physical therapy practitioners and administrative authorities are encouraged to prioritize training and implementation of telerehabilitation as a likely prospective approach of PT practice.

Examination of Telerehabilitation Knowledge, Awareness, and Opinions of Physical Therapy and Rehabilitation Students.

AimTo encourage students and professionals to use telerehabilitation, it is critical to understand their perspectives on various aspects of using the service. This study aims to evaluate the awareness, knowledge, and opinions of physiotherapy and rehabilitation students about telerehabilitation.MethodIn the cross-sectional survey, an electronic questionnaire was sent to 484 students studying at Manisa Celal Bayar University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation. To assess the student’s awareness, knowledge, and opinions of telerehabilitation, a self-administered questionnaire which was created by researching the literature was sent to students that consisted of three sections: “baseline general characteristics,” “knowledge and awareness categories,” and “opinions” categories.ResultsOnly 322 students who completed questionnaires were received, giving a response rate of 66.5%.The median age of the students is 21. One hundred thirty students (40.4%) are aware of telerehabilitation. Most of the students (240; 74.5%) considered the COVID-19 pandemic had contributed to a greater understanding of the importance of telerehabilitation. More than half of the students (201; 66.2%) agreed that the place of telerehabilitation in the education curriculum should be increased. Two hundred thirty-three students (72.4%) reported that telerehabilitation practices will develop further in the future.ConclusionThe majority of the students stated that they were not aware of telerehabilitation due to the lack of lesson curriculum. Determining students’ thoughts about telerehabilitation can also guide the future of telerehabilitation practices, the development of various strategies for the implementation of telerehabilitation, and the policies related to physiotherapy education.

Accessibility to Telerehabilitation Services for People With Multiple Sclerosis: Analysis of Barriers and Limitations.

In multiple sclerosis (MS), telemedicine improves access to specialized medical care; however, barriers remain, including universal access and effective implementation. Focusing on telerehabilitation, ie, remotely delivered physical therapy, our goal was to identify barriers to telerehabilitation implementation and factors associated with patients completing telerehabilitation physical therapy treatment. Quantitative data included a review of electronic health records of patients with MS treated at the University of California San Francisco Physical Therapy Faculty Practice. We extracted demographic, clinical, and transit-related factors. For patients who scheduled an initial evaluation, we recorded the number of follow-ups, cancellations, completed physical therapy goals, and discharges. Qualitative data included interviews with 3 board-certified neurologic physical therapists and patients' perspectives recorded in the subjective portion of physical therapy notes. We identified 111 patients with at least 1 visit (in-person or telerehabilitation) to physical therapy (82 women; mean ± SD age, 54.2 ± 12.7 years). Patients with no disability (Expanded Disability Status Scale [EDSS] score, 0) were 73% less likely to schedule a follow-up appointment (in-person or telerehabilitation) than those with some disability (EDSS score, >0) (odds ratio, 0.27; 95% CI, 0.09-0.75; P = .012). Neurologic physical therapists identified reduced travel burden and scheduling flexibility as benefits of telerehabilitation vs in-person visits. Barriers to telerehabilitation included low technological literacy, cognitive impairment, and fall risk. Patients described scheduling conflicts and pain/illness as barriers to telerehabilitation. Patients with no disability were least likely to complete physical therapy treatment via telerehabilitation. Although both benefits and barriers to completing physical therapy via telerehabilitation are present, the neurologic physical therapists were supportive of a hybrid model for physical therapy.

From Inception to Implementation: Strategies for Setting Up Pulmonary Telerehabilitation.

BackgroundThe emergence of innovative technology-enabled models of care is an opportunity to support more efficient ways of organizing and delivering healthcare services and improve the patient experience. Pulmonary telerehabilitation started as a promising area of research and became a strategic pandemic response to patients' decreased accessibility to rehabilitation care. Still, in the pre-COVID-19 era, we conducted a participatory study aiming to develop strategies for setting up pulmonary telerehabilitation as a person-centered digitally-enabled model of care.MethodsWe performed operational participatory research between June 2019 and March 2020 with the engagement of all stakeholders involved in the implementation of pulmonary telerehabilitation, including 14 people with Chronic Obstructive Pulmonary Disease. Patients were assessed subjectively and objectively pre and post a 3-month pulmonary rehabilitation program including exercise and education, which started in a face-to-face hospital setting during the first month and continued as a home-based, remotely supervised exercise training intervention.ResultsFive major groups of requirements targeted operational strategies for setting up pulmonary telerehabilitation: (1) pulmonary rehabilitation core principles, (2) quality and security standards, (3) technological functionality, (4) home environment appropriateness, and (5) telesetting skills. There was a statistical significance in the median change in the CAT score from 15.5 to 10.5 (p = 0.004) and in the PRAISE score from 49.5 to 53.0 (p = 0.006). Patients' mean levels of satisfaction regarding rehabilitation goals achievements were 88.1 ± 8.6% and the mean levels of satisfaction regarding the telerehabilitation experienced as a model of care were 95.4% ± 6.3%.ConclusionsThe success of telerehabilitation implementation was grounded on stakeholder engagement and targeted strategies for specific setup requirements, achieving patients' high satisfaction levels. Such operational experiences should be integrated into the redesigning of upgraded telerehabilitation programs as part of the solution to improve the effectiveness, accessibility, and resilience of health systems worldwide.

Providers' Shift to Telerehabilitation at the U.S. Veterans Health Administration During COVID-19: Practical Applications.

Telerehabilitation provides Veteran patients with necessary rehabilitation treatment. It enhances care continuity and reduces travel time for Veterans who face long distances to receive care at a Veterans Health Administration (VHA) medical facility. The onset of the COVID-19 pandemic necessitated a sudden shift to telehealth–including telerehabilitation, where a paucity of data-driven guidelines exist that are specific to the practicalities entailed in telerehabilitation implementation. This paper explicates gains in practical knowledge for implementing telerehabilitation that were accelerated during the rapid shift of VHA healthcare from out-patient rehabilitation services to telerehabilitation during the COVID-19 pandemic. Group and individual interviews with 12 VHA rehabilitation providers were conducted to examine, in-depth, the providers' implementation of telerehabilitation. Thematic analysis yielded nine themes: (i) Willingness to Give Telerehabilitation a Chance: A Key Ingredient; (ii) Creativity and Adaptability: Critical Attributes for Telerehabilitation Providers; (iii) Adapting Assessments; (iv) Adapting Interventions; (v) Role and Workflow Adaptations; (vi) Appraising for Self the Feasibility of the Telerehabilitation Modality; (vii) Availability of Informal, In-Person Support Improves Feasibility of Telerehabilitation; (viii) Shifts in the Expectations by the Patients and by the Provider; and (ix) Benefit and Anticipated Future of Telerehabilitation. This paper contributes an in-depth understanding of clinical reasoning considerations, supportive strategies, and practical approaches for engaging Veterans in telerehabilitation.

Rapid Development and Implementation of Telerehabilitation at Shirley Ryan Abilitylab

<h3>Research Objectives</h3> To collaborate with departments across SRAlab to rapidly implement telerehabilitation and continue to provide high-quality therapy. To provide the blueprint for telerehabilitation implementation across all levels of care at SRAlab. To respond to patient feedback to operationally improve telerehabilitation. <h3>Design</h3> Mixed methods before and after series. <h3>Setting</h3> Hospital-based outpatient therapy. <h3>Participants</h3> Patients participating virtually in Physical Therapy, Occupational Therapy, and Speech Therapy in multiple Outpatient Orthopedic/Neurological, Day Rehabilitation, and Pain Management Clinic sites. <h3>Interventions</h3> In March 2020, outpatient therapy at Shirley Ryan Abilitylab (SRAlab) responded to the suddenly decreased demand for in-person visits due to the rapidly evolving and unclear public health emergency of the COVID-19 pandemic. Therapists from the orthopedic outpatient clinic identified an impending gap in care, so a team of Telerehabilitation Champions formed to pursue options for providing safe and effective therapy virtually. Telerehabilitation was created and offered to patients. Obtain patient feedback to operationally improve telerehabilitation services in the form of a patient satisfaction survey. <h3>Main Outcome Measures</h3> Patient Satisfaction Survey related to patient experience with telerehabilitation. <h3>Results</h3> Telerehabilitation Patient Satisfaction Survey: now IRB approved study. Pilot data from over 200 participants reveals the below, among other data points that will be discussed: 92% rated the care as good/very good. 70% likely to continue with Telerehabilitation visits after COVID-19 pandemic. Patient reported benefits of Telerehabilitation: No travel, Patient chosen location, Improved attendance and exercise compliance, Decreased time away from home. Patient reported opportunities to improve Telerehabilitation: More space available in patient location to participate, Better video connection, Better audio connection, Caregiver to help patient during the session. <h3>Conclusions</h3> Telerehabilitation is a safe, effective method for participation in therapy. It successfully allowed patients to receive care during the uncertainty of the COVID-19 pandemic. Telerehabilitation will have a place in therapy beyond the pandemic. SRAlab will use the Telerehabilitation Patient Satisfaction Survey to continuously improve the Telerehabilitation experience and is committed to contributing to the research for establishing best practice guidelines. <h3>Author(s) Disclosures</h3> None.

Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study.

BackgroundParkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation.ObjectiveThe aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory.MethodsA total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times.ResultsAmong professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time.ConclusionsAcceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool’s lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare.

Implementation of telerehabilitation in Austrian outpatient physiotherapy – A qualitative study / Implementierung von Telerehabilitation in der ambulanten Physiotherapie in Österreich – Eine qualitative Studie

Abstract Background New technologies, for example, telerehabilitation (TR) tools, can support physiotherapists’ work. Even though studies have demonstrated their potential, TR is not yet fully implemented in Austrian outpatient physiotherapy. As a result of the Coronavirus pandemic and the associated lockdowns, physiotherapists in Austria were confronted with the challenge of offering therapies without physical contact. This study aims to investigate opinions and experiences of physiotherapists in Austria regarding TR and its implementation in different clinical fields. Methods A qualitative research design with expert interviews and a focus group discussion were conducted. Data were analysed using content analysis. The categories were formed following a deductive-inductive approach. Results The interview partners considered opportunities for using synchronous TR in internal medicine as well as orthopaedics and traumatology, especially in later, exercise-dominated stages. In addition, using TR can be supportive for patient education. In the field of neurology, synchronous TR is viewed with some criticism, especially when used for people with severe neuropsychological disorders. Asynchronous TR is considered useful across all disciplines and could support physical therapy from the first therapy session and throughout the treatment. Important questions regarding liability, billing, or data protection still need to be clarified. Interdisciplinary approaches in TR should also be pursued to improve care. Conclusion The use of asynchronous TR in addition to regular physiotherapy is seen as promising in all clinical fields. In general, when implementing TR, the needs and requirements of different fields should be considered. Moreover, various framework conditions still need to be clarified for further implementation of TR.