Implementation Of Telerehabilitation Research Articles

The ‘wicked problem’ of telerehabilitation: Considerations for planning the way forward

Telerehabilitation offers great promise to improved access to rehabilitation care. The rising use of technology, the increased expansion of data networks worldwide, and the growing confidence and interest of the general population to incorporate technology into their day-to-day lives via the Internet, smartphones and wearables provide fertile ground for many rehabilitation interventions. Despite this opportunity, telerehabilitation is not integrated into existing health care systems today. Most research is focused on the efficacy of the intervention without addressing the complexity of introducing a system of care that is starkly different from the current health care system in most countries. As such, implementation of telerehabilitation may be considered a ‘wicked problem’ in that it is extremely complex and challenging situation that is intricately linked with the social, economic and political contexts. This paper discusses telerehabilitation implementation while considering the intervention, patient, and health care system contexts in which it occurs.

Economic and social impact of increased cardiac rehabilitation uptake and cardiac telerehabilitation in Belgium – a cost–benefit analysis

Background: Cardiac rehabilitation for ischaemic heart disease effectively reduces cardiovascular readmission rate and mortality. Current uptake rates however, remain low. This study assesses the social and economic impact of increasing centre-based cardiac rehabilitation uptake and the additional value of cardiac telerehabilitation using cost–benefit analysis (CBA) in Belgium.Methods: Cost–benefit analysis was conducted to analyse three scenarios: (1) current situation: 20% uptake rate of cardiac rehabilitation; (2) alternative scenario one: 40% uptake rate of cardiac rehabilitation; and (3) alternative scenario two: 20% uptake of cardiac rehabilitation and 20% uptake of both cardiac rehabilitation and telerehabilitation. Impacts considered included cardiac (tele)rehabilitation programme costs, direct inpatient costs, productivity losses and burden of disease.Results: Compared to the current situation, there was a net total monetised benefit of 9.18 M€ and 9.10 M€ for scenarios one and two, respectively. Disability Adjusted Life Years were 12,805–12,980 years lower than the current situation. This resulted in a benefit–cost ratio of 1.52 and 1.43 for scenarios one and two, respectively.Conclusions: Increased cardiac rehabilitation uptake rates can reduce the burden of disease, and the resulting benefits exceed its costs. This research supports the necessity for greater promotion and routine referral to cardiac rehabilitation to be made standard practice. The implementation of telerehabilitation as an adjunct is to be encouraged, especially for those patients unable to attend centre-based cardiac rehabilitation.

Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study

BackgroundThe Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery. ObjectiveTo evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS. DesignQualitative descriptive study design. MethodsHealthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers. ResultsTemplate analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS. ConclusionThis study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service.

Understanding the Implementation of Telerehabilitation at Pre-Implementation Stage: A Systematic Literature Review

Despite the increased interest of academic scholar in telerehabilitation implementation, there is a scarcity of studies that provide an up to date comprehensive research on it. This study provides a systematic literature review (SLR) on telerehabilitation implementation research. This review explores the processes involved in telerehabilitation implementation, research themes and the factors that influence the implementation of telerehabilitation at pre-implementation stage. In doing this, all relevant articles in the electronic databases of Scopus, ScienceDirect, PubMed, SAGE and Web of Science that published from 2007 to 2017 were reviewed. The results show that four themes have been paid attention by the researchers' including adoption, benefits, readiness and decision making. The factors in the adoption and readiness were found more dominant than others with seven and six factors respectively. Most of the factors from adoption were in the quality aspects (e.g., system quality, information quality and service quality) while change elements (e.g., attributes of the change, attributes of the change targets) in the readiness. Thus, this study suggests that more research is needed for understanding this complex process of telerehabilitation at pre-implementation in a more holistic manner.

Feasibility of Telerehabilitation Implementation as a Novel Experience in Rehabilitation Academic Centers and Affiliated Clinics in Tehran: Assessment of Rehabilitation Professionals' Attitudes.

Introduction. This study aimed to assess rehabilitation professionals' attitude toward implementation and application of telerehabilitation technology as a novel study in rehabilitation academic centers and affiliated clinics in Tehran. Methods. It was a descriptive cross-sectional study. To collect data, a researcher-designed questionnaire was developed. 141 rehabilitation experts participated in the study. Results. A majority of faculty members (78%) and clinicians (89.7%) either were in “definite agreement” or “somewhat agreed” with implementation and application of this technology, which demonstrates an overall positive attitude. Discussion. Based on the positive attitudes of the majority of participants toward implementation and application of this technology and their preferences in offering different telerehabilitation services, it seems that there is an appropriate and desirable acceptance and administrative culture to implement this technology among rehabilitation experts in Tehran. It is thus expected that implementation and application of this technology will be a promising experience in rehabilitation academic centers and affiliate clinics in Tehran.

Telerehabilitation in Scotland: current initiatives and recommendations for future development.

Rehabilitation services are set to become central to modern health care systems as they strive to support an increasingly ageing population to live as independently as possible, while maintaining quality services. Alternative service delivery options such as telerehabilitation may assist in meeting the growing demand for services and many countries are exploring the potential use of telerehabilitation within their health care systems. The Scottish Centre for Telehealth commissioned an independent scoping study and subsequent report into the potential development and realisation of telerehabilitation services across Scotland. The scope of the report was restricted to adult rehabilitation services and aimed to identify opportunities for the use of telerehabilitation and to recommend clear and achievable steps toward implementation of telerehabilitation. This article outlines many of the telerehabilitation initiatives currently underway in Scotland and discusses some of the key recommendations made in the report to the Scottish Centre for Telehealth for the future advancement and application of telerehabilitation across Scotland.