Telerehabilitation Services Research Articles

Telerehabilitation Services in India: an Integrated SWOT and AHP Analysis

Background: Telerehabilitation involves delivering rehabilitation services to patients utilizing information and communication technologies. The objective of this research was to analyze and prioritize strengths, weaknesses, opportunities, and threats (SWOT) for the technology associated with the rehabilitation of patients.Methods: The study's first phase involved enlisting factors relevant to telerehabilitation in India, followed by a Delphi study with a panel of experts to reach a consensus for SWOT analysis. Then, a pairwise comparison among various SWOT factors was made using Analytical Hierarchical Process (AHP). Finally, consistency Ratio (CR) values were calculated.Results: Sixty significant factors relative to the telerehabilitation sector in India were identified from a review of existing literature and presented to experts. After four rounds of Delphi, thirteen strengths, eleven weaknesses, four opportunities, and five threats were selected. CR values in the present study were less than 0.10 for all SWOT subgroups indicating that the pairwise comparisons done by the decision-makers were fairly consistent.Conclusion: Delphi technique helped in identifying various SWOT factors associated with telerehab which were assigned a rank by the Strategic analysis technique. The highest priority strength lies in an online consultation on an urgent basis followed by cost-effectiveness, time-saving and reduced hospitalization. The telerehabilitation model weakens when direct contact for therapy, reliable internet access is required. Funding and grant opportunities to expand tel rehab in India and provide standard expert care for vulnerable populations are viewed as future scope. Threats identified were lack of direct supervision and cybersecurity. Understanding and addressing these factors can help in the successful implementation of telerehabilitation in India.

Lessons Learned from Transitioning to Telerehabilitation During COVID-19 in Alberta, Canada

Research ObjectivesTo better understand rehabilitation practitioner experiences with transitioning to telerehabilitation services during COVID-19, specifically around the use of technology and client assessment and treatment.DesignThis was a qualitative study of cross-sectional design. Rehabilitation practitioners completed semi-structured interviews via Zoom. Transcribed interviews were analyzed for themes.SettingWith the onset of COVID-19, rehabilitation practitioners quickly adapted and started offering telerehabilitation services where they interacted directly with the client and evaluate, diagnose, and treat their condition virtually. These services differed from prior methods of telehealth, where healthcare practitioners delivered care from one healthcare facility to another. Practitioners from both public and private clinics shifted their services to virtual platforms quickly to provide continued care to patients needing acute and prolonged rehabilitation care.ParticipantsTwenty-four rehabilitation practitioners were recruited to participate in the study (14 physiotherapists, 4 occupational therapists, 2 speech language pathologists, 1 psychologist, 1 kinesiologist, 1 social worker, 1 orthopedic surgeon) from rural and urban clinics as well as private and publicly funded practices. Inclusion criteria required practitioners to have transitioned to telerehabilitation, either through video conferencing or telephone.InterventionsN/A.Main Outcome MeasuresN/A.ResultsThe overarching theme which emerged from the data was providing continued access to care. Rehabilitation practitioners quickly transitioned to using the telephone or video conferencing platforms such as Zoom to connect with clients. Multiple subthemes emerged allowing for a better understanding of the transition to telerehabilitation during COVID-19. Barriers to offering telerehabilitation services included adequate access to technology (computer, laptop, tablet) and IT support for the client and sufficient internet bandwidth. Limited availability of validated virtual assessments made the transition difficult for practitioners. However, many benefits emerged such as easier scheduling of interdisciplinary meetings, increased client accountability, better access to group programming, and decreased travel times to clinics.ConclusionsAlthough there were challenges, especially surrounding technology, the switch to telerehabilitation had many benefits and could be a viable method of delivering care that goes beyond the COVID-19 pandemic.Author(s) DisclosuresAuthors have no conflicts of interest to disclose.

Rethinking early intervention rehabilitation services for children with motor difficulties: engaging stakeholders in the conceptualization of telerehabilitation primary care

Purpose Rehabilitation services for children with mild motor difficulties are limited. Telehealth could be a novel avenue through which to provide these services. With the input of various stakeholder groups, this study aimed to develop a logic model for a new primary care telerehabilitation intervention and to identify influencing implementation factors. Methods and materials A participatory research design was used. A logic model, developed in consultation with five healthcare managers, was discussed with four stakeholder groups. Focus groups were conducted with clinicians (n = 9), pediatric healthcare managers (n = 5), and technology information consultants (n = 2), while parents (n = 4) were interviewed to explore their perceptions of the proposed intervention, and factors influencing implementation. Transcribed discussions were analyzed using reflexive thematic analysis. Results Stakeholders supported the delivery of telerehabilitation services for children with mild motor difficulties. Although agreement was generated for each logic model component, important recommendations were voiced related to service relevance and sustainability, parent and community capacity building, and platform dependability, security, and support. Identified factors influencing the implementation encompassed consumer, provider, technological, systemic and contextual barriers and facilitators. Strategies to address them were also suggested. Conclusion This study demonstrates the value of, and a process to engage stakeholders in the designing of pediatric telerehabilitation services and its implementation. IMPLICATIONS FOR PRACTICE Pediatric telerehabilitation service are complex interventions which operate in complicate systems. Designing telerehabilitation services with stakeholders is recommended, yet how to do so often not clear. This study demonstrated that the development of a logic model can provide a systematic framework to helps guide the co-design process with stakeholders. Resulting recommendation underscored a broader vision for the intervention and identified crucial factors and strategies required for its successful implementation and sustainability.

Tele-Rehabilitation to Combat Rehabilitation Service Disruption During COVID-19 in Hong Kong: Observational Study.

BackgroundA tele-rehabilitation platform was developed to improve access to ambulatory rehabilitation services in Hong Kong. The development was completed in October 2019 and rolled out for use to occupational therapists, physiotherapists, and speech therapists. During the COVID-19 pandemic, rehabilitation services were severely interrupted. Tele-rehabilitation was used extensively to meet the demand for rehabilitation service delivery.ObjectiveThe aims of this study were to (1) describe the design and development process of a tele-rehabilitation service, and (2) study how the tele-rehabilitation platform was used to overcome the disruption of rehabilitation service during the COVID-19 pandemic.MethodsTele-rehabilitation was developed utilizing 4 core determinants of Unified Theory of Acceptance and Use of Technology as guiding principles. A generic prescription platform, called the activity-based prescription system, and a mobile app, called the Rehabilitation App, were built. Five outcomes were used to examine the utilization of tele-rehabilitation both before and during the pandemic: throughput, patient demographic, patient conditions, workforce, and satisfaction from patients and staff.ResultsThere was a tremendous increase in the use of tele-rehabilitation during pandemic. The total number of patients (up until July 2020) was 9101, and the main age range was between 51 to 70 years old. Tele-rehabilitation was used for a much wider scope of patient conditions than originally planned. More than 1112 therapists, which constituted 50.6% of the total workforce (1112/2196), prescribed tele-rehabilitation to their patients. Moreover, there was a high satisfaction rate from patients, with a mean rating of 4.2 out of 5, and a high adherence rate to prescribed rehabilitation activities (107840/131995, 81.7%).ConclusionsThe findings of our study suggested that tele-rehabilitation in the form of a generic prescription platform and mobile app can be an effective means to provide rehabilitation to patient. During the COVID-19 pandemic, tele-rehabilitation has been used extensively and effectively to mitigate service disruption. Our findings also provide support that there is a high level of satisfaction with tele-rehabilitation; however, a longer duration study is required to demonstrate the sustained use of tele-rehabilitation, especially after the pandemic.

"We are so close; yet too far": perceived barriers to smartphone-based telerehabilitation among healthcare providers and patients with Chronic Obstructive Pulmonary Disease in India

BackgroundTelerehabilitation is imperative and impending in the management of chronic obstructive pulmonary disease patients. However, its feasibility in low- and middle-income nations such as India remained unclear. ObjectiveTo assess the feasibility of administering a smartphone-based telerehabilitation program for chronic obstructive pulmonary disease patients in India. Material and methodAn online cross-sectional survey was administered to stakeholders of the telerehabilitation program: chronic obstructive pulmonary disease patients, health care professionals including pulmonary care physicians, rehabilitation nurses and physiotherapists. The survey sought to ascertain the causes, barriers, and facilitators associated with the implementation of smartphone-based telerehabilitation, as well as strategies for practice improvement. ResultsWhile 71% (n = 37/52) of the 52 healthcare professionals surveyed were aware of smartphone-based telerehabilitation, implementation was found to be extremely low (n = 4/37; 10%). The majority of patients with chronic obstructive pulmonary disease (n = 21/30; 70%) agreed to accept smartphone-based telerehabilitation as one of their treatment options. In India, challenges to efficient telerehabilitation implementation included a lack of infrastructure, perceived time consumption, a lack of expertise and training, organizational support, and perceived inefficacy. ConclusionWhile knowledge of smartphone-based telerehabilitation is high among healthcare professionals and chronic obstructive pulmonary disease patients, implementation of this novel intervention measure has been limited due to perceived constraints associated with smartphone-based telerehabilitation. Adapting national and organizational policies to support smartphone-based telerehabilitation services is critical during this decade of social isolation.

Telerehabilitation: Has Its Time Come?

Telerehabilitation: Has Its Time Come?

Experiences and effects of telerehabilitation services for physiotherapy outpatients in a resource-constrained public health set-up in the backdrop of the COVID-19 pandemic: A proposal.

BackgroundThe announcement of a national lockdown in South Africa had country-wide impact on the delivery of health services. Strategies included prioritisation of patients and protecting patients who were considered at risk, resulting in the need for cancellation and temporary termination of many outpatient therapy services. This necessitated the urgent need to come up with a way of delivering physiotherapy rehabilitation services to patients in a more non-traditional format. Telerehabilitation allows for the provision of services by using electronic communication, thus ensuring that patients are still able to access necessary rehabilitation services.Methods/designThis is a prospective, mixed method study with participants recruited from the outpatient physiotherapy department of Chris Hani Baragwanath Academic Hospital (CHBAH). Telerehabilitation services will be provided via the patients’ preferred method of communication. On discharge, participants and therapists will be asked about their experiences of telerehabilitation.DiscussionBecause of the current coronavirus disease 2019 (COVID-19) pandemic, patients are unable to receive traditional face-to-face physiotherapy services. Telerehabilitation offers a suitable alternative to treatment, but the feasibility, outcome and experiences of offering these services in the public health system have not been studied.ConclusionThis study will determine whether telerehabilitation is a feasible service that can be offered in the COVID-19 pandemic, as well as post-pandemic, to enable physiotherapists to access those patients who are often unable to attend physiotherapy because of transport costs and various other reasons for non-attendance.Clinical implicationsThe results of this study may indicate a way of managing patients in situations where face to face therapy cannot be undertaken.Protocol identificationPan African Clinical Trial Registry, PACTR202103637993156.

Lessons Learned during a Naturalistic Study of Online Treatment for Pediatric Rehabilitation.

The COVID-19 pandemic forced many health care providers to modify their service model by adopting telehealth and tele-rehabilitation with minimal time to plan for its execution. ALYN—Pediatric Rehabilitation Hospital in Jerusalem, Israel, responded with alacrity by providing a broad range of rehabilitation services to young people via online therapy during the first 5 months of the pandemic. The objectives of this naturalistic study were: (1) to monitor usage and user experience of online rehabilitation provided to young people receiving out-patient sessions of physical therapy, occupational therapy, speech and language therapy and psychology and (2) to consider the advantages and disadvantages of retaining this model of online treatment in full or in part post-COVID-19. The online rehabilitation treatment program was provided to 147 young people, aged 3 months to 20 years (mean 8.5 y; SD 5.3), and monitored and evaluated via data from the medical records as well as interviews, questionnaires and focus groups. The results use descriptive and inferential statistics to analyze data on the types and frequencies of therapy provided to 147 young people. Over a five month-period, 2392 therapy sessions were provided, 61 therapists from four disciplines were involved and 56.4% of the young people received two or more types of therapies via online rehabilitation. A repeated measures ANOVA showed significant differences over time per therapy. Feedback and recommendations about the process from therapists, parents and young people were collected during two focus groups of the professional staff (n = 12), parents and young people (parents n = 5, young people n = 3). Tele-rehabilitation services were perceived to be beneficial and effective by the great majority of young people, their parents and the healthcare professionals. The results are discussed within the context of conventional therapy as well as in comparison to reports of other online services for similar populations. We conclude that a hybrid approach in which in-person therapy sessions are coordinated with synchronous, online sessions, will provide a best-case fit for young people with chronic disabilities.

A Pilot Study Comparing Teletherapy with the Conventional Face-to-Face Therapy for Speech-Language Disorders.

Speech-language therapists along with affected individuals face various challenges for accomplishing the rehabilitation services. In the current COVID19 pandemic scenario, telerehabilitation has emerged as a substitute to the traditional face-to-face therapy, and is the only option possible in some cases. To subjectively assess the feasibility & acceptability of telerehabilitation provided by speech-language pathologist to patients of speech and language disorders. This qualitative study includes 20 patients suffering from disorders of fluency, voice, swallowing and neurogenic disorders. The participants included were undergoing face-to-face therapy at our institute. After the completion of face-to-face session series, telerehabilitation services were provided through a video calling app. The outcomes of teletherapy were assessed subjectively using a structured questionnaire on 11 parameters using a Likert scale. Of the included 20 patients, after completion of teletherapy, four patients chose the physical interaction as the preferred mode of therapy while 16 chose teletherapy as the preferred mode. Except three clients who rated their overall satisfaction as ‘3’, others rated as ‘4’ or ‘5’.The therapists were satisfied with the outcomes in 17 cases, and were pleased with the overall progress of all the clients (rated 4 or 5). Telerehabilitation is a reliable method to deliver speech and language services at community level, on long-term basis, as is proven by the high satisfaction scores among the clients as well as the service providers.Clinical Trial RegistrationThe trial has been registered in Clinical Trials Registry of India (CTRI) vide number CTRI/2018/04/ 012,922 (http://ctri.nic.in/Clinicaltrials/login.php) on 02/04/2018.

Rapid Implementation of Telerehabilitation for Pediatric Patients During Covid-19.

The COVID-19 pandemic necessitated a sudden limitation of in-person outpatient occupational and physical therapy services for most patients at a large, multisite pediatric hospital located in the Midwest, United States. To ensure patient and staff safety, the hospital rapidly shifted to deliver most of these services via telerehabilitation. The purposes of this study were to (1) describe the rapid implementation of telerehabilitation during the COVID-19 pandemic, (2) describe the demographic characteristics of patients who continued in-person services and those who received telerehabilitation, and (3) evaluate the therapists' perceptions of telerehabilitation for physical and occupational therapy. Most of the children (83.4% of n=1352) received telerehabilitation services. A family was more likely to choose to continue in-person visits if their child was <1-year-old, had a diagnosis of torticollis, received serial casting, or was post-surgical. Occupational and physical therapy therapists (n=9) completed surveys to discern their perceptions of the acceptability of telerehabilitation, with most reporting that telerehabilitation was as effective as in-person care.

Upper Limb Home-Based Robotic Rehabilitation During COVID-19 Outbreak.

The coronavirus disease (COVID-19) outbreak requires rapid reshaping of rehabilitation services to include patients recovering from severe COVID-19 with post-intensive care syndromes, which results in physical deconditioning and cognitive impairments, patients with comorbid conditions, and other patients requiring physical therapy during the outbreak with no or limited access to hospital and rehabilitation centers. Considering the access barriers to quality rehabilitation settings and services imposed by social distancing and stay-at-home orders, these patients can be benefited from providing access to affordable and good quality care through home-based rehabilitation. The success of such treatment will depend highly on the intensity of the therapy and effort invested by the patient. Monitoring patients' compliance and designing a home-based rehabilitation that can mentally engage them are the critical elements in home-based therapy's success. Hence, we study the state-of-the-art telerehabilitation frameworks and robotic devices, and comment about a hybrid model that can use existing telerehabilitation framework and home-based robotic devices for treatment and simultaneously assess patient's progress remotely. Second, we comment on the patients' social support and engagement, which is critical for the success of telerehabilitation service. As the therapists are not physically present to guide the patients, we also discuss the adaptability requirement of home-based telerehabilitation. Finally, we suggest that the reformed rehabilitation services should consider both home-based solutions for enhancing the activities of daily living and an on-demand ambulatory rehabilitation unit for extensive training where we can monitor both cognitive and motor performance of the patients remotely.

Telerehabilitation During the COVID-19 Pandemic

After the appearance of COVID-19, the clinical and professional activities of private clinics and public health systems were challenged. Tele rehabilitation system is required to provide rehabilitation services during the COVID 19 pandemic. Tele-rehabilitation services are available for many years, for which necessary infrastructure, laws, and instructions have been considered, but in Iran, there are no regulations or instructions for telerehabilitation services. Professional associations and boards can play an important role in drafting these rules. The COVID-19 can be a good opportunity to start telerehabilitation in Iran.

Exergaming as Part of the Telerehabilitation Can Be Adequate to the Outpatient Training: Preliminary Findings of a Non-randomized Pilot Study in Parkinson's Disease.

Parkinson's disease is a long-term and progressive degenerative disorder of the nervous system, affecting primarily motor coordination, noticeable as a tremor in one hand. Recent studies reported on positive outcomes of intensive physiotherapy of upper extremities. We built a telerehabilitation system with virtual pick and place tasks for small scale hand movements, and designed a pilot study to find whether such exergaming as a telerehabilitation service provides comparable outcomes as an outpatient exergaming service. A non-randomized pilot trial was designed. Hospital outpatients (28/40) with Parkinson's disease were recruited. Those meeting the inclusion criteria were divided into two groups; seven outpatients were assigned to the home (H) group and 21 outpatients to the hospital (URI) group. Both groups received 10 days of exergaming over the course of 2 weeks, each daily session lasting a maximum of 1 h. Primary outcomes were clinical tests; Box and Blocks Test (BBT), Jebsen Hand Function Test (JHFT), and Unified Parkinson's Disease Rating Scale (UPDRS part III) were carried out before and after the study. Secondary outcomes were hand kinematics and exergaming results; number of successfully moved objects and task time. Statistical analysis was carried out to find significant (p < 0.05) differences and Cohen's U3 was used to determine effect sizes. The differences between the groups in gender (p = 0.781), age (p = 0.192), and duration of the disease (p = 0.195) were tested with Bartlett's test and no statistical differences were found with an F test. Both groups demonstrated statistically significant improvements in clinical test UDPRS III (p = 0.006 and p = 0.011) and the hospital group also in BBT (p = 0.002) and JHFT (p = 0.015) and with UDPRS III and JHFT even in favor of the home group (χ2 = 5.08, p = 0.024, χ2 = 7.76, p = 0.005). Nevertheless, the exergaming results show significant improvement after training (U3 > 0.86). Exergaming has already been suggested as an effective approach in the planning of rehabilitation tasks for persons with Parkinson's disease. We have prepared a pilot study demonstrating that exergaming at home with telerehabilitation support may provide comparable clinical outcomes. The study shall be followed by a randomized study with higher statistical power to provide clinical evidence. Nevertheless, carrying out even part of the rehabilitation program at home is crucial for the development of future telerehabilition clinical services.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03175107.

Development of a Low-Cost, Modular Muscle-Computer Interface for At-Home Telerehabilitation for Chronic Stroke.

Stroke is a leading cause of long-term disability in the United States. Recent studies have shown that high doses of repeated task-specific practice can be effective at improving upper-limb function at the chronic stage. Providing at-home telerehabilitation services with therapist supervision may allow higher dose interventions targeted to this population. Additionally, muscle biofeedback to train patients to avoid unwanted simultaneous activation of antagonist muscles (co-contractions) may be incorporated into telerehabilitation technologies to improve motor control. Here, we present the development and feasibility of a low-cost, portable, telerehabilitation biofeedback system called Tele-REINVENT. We describe our modular electromyography acquisition, processing, and feedback algorithms to train differentiated muscle control during at-home therapist-guided sessions. Additionally, we evaluated the performance of low-cost sensors for our training task with two healthy individuals. Finally, we present the results of a case study with a stroke survivor who used the system for 40 sessions over 10 weeks of training. In line with our previous research, our results suggest that using low-cost sensors provides similar results to those using research-grade sensors for low forces during an isometric task. Our preliminary case study data with one patient with stroke also suggest that our system is feasible, safe, and enjoyable to use during 10 weeks of biofeedback training, and that improvements in differentiated muscle activity during volitional movement attempt may be induced during a 10-week period. Our data provide support for using low-cost technology for individuated muscle training to reduce unintended coactivation during supervised and unsupervised home-based telerehabilitation for clinical populations, and suggest this approach is safe and feasible. Future work with larger study populations may expand on the development of meaningful and personalized chronic stroke rehabilitation.

Implementation and Evaluation of the Virtual Graded Repetitive Arm Supplementary Program (GRASP) for Individuals With Stroke During the COVID-19 Pandemic and Beyond.

ObjectiveGiven the uncertainty of the coronavirus disease 2019 (COVID-19) pandemic, implementing telerehabilitation that enables the remote delivery of rehabilitation services is needed to mitigate the spread of COVID-19. We studied the implementation and the effectiveness of the virtual Graded Repetitive Arm Supplementary Program (GRASP) delivered and evaluated via videoconferencing in individuals with stroke.MethodsThe Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework with mixed methods was used to evaluate the implementation of the 2 iterations of the program delivered by a nonprofit organization during the pandemic.Results Reach: Seventeen people were screened, 13 people were eligible, and 11 consented to participate in the study. Effectiveness: Between baseline and posttest, participants with stroke demonstrated significant improvement in upper extremity function (Arm Capacity and Movement Test) and self-perceived upper extremity (UE) function (Stroke Impact Scale). Adoption: Factors that facilitate program uptake by the staff were well-planned implementation, appropriate screening procedure, and helpful feedback from the audits. All staff felt comfortable using videoconferencing technology to deliver the program despite some technical difficulties. Factors contributing to ongoing participation included that the participants liked the group, they perceived improvements, and the instructor was encouraging. Only one participant with stroke was not comfortable using the videoconferencing technology. Implementation: The program was implemented as intended as evaluated by a fidelity checklist. Participants’ adherence was high, as verified by the average attendance and practice time. Maintenance: The organization continued to offer the program.ConclusionThe virtual GRASP program was successfully implemented. Although the program was effective in improving both measured and perceived UE function in a small sample of individuals with stroke, caution should be taken in generalizing the results.ImpactImplementing telerehabilitation is crucial to optimize patient outcomes and reduce the spread of COVID-19. Our findings provide guidance on the process of delivering a UE rehabilitation program remotely via videoconferencing for stroke. Moreover, insights that arise from this study also inform the implementation of other telerehabilitation services.

Development of a Home-Based Telerehabilitation Service Delivery Protocol for Wheelchair Seating and Mobility Within the Veterans Health Administration.

The provision of seating and wheeled mobility devices is a complex process that requires trained professionals and multiple appointments throughout the service delivery process. However, this can be inconvenient and burdensome for individuals with mobility limitations or for individuals who live in rural areas. Rural areas often present unique difficulties regarding the provision of healthcare services including lengthy travel times to medical facilities and lack of specialized providers and medical technology. The purpose of this article is to provide a comprehensive overview of the development and implementation of a service delivery protocol for a home-based telerehabilitation assessment for wheelchair seating and mobility. The telerehabilitation team consists of a trained wheelchair seating and mobility therapist and a telehealth clinical technician (TCT). In order to determine veterans that are appropriate for a home-based telerehabilitation assessment, a three-phase pre-assessment screening process was conducted by the therapist and TCT, including consult, chart, and phone review. Veterans that metall of the predetermined eligibility criteria were recommended for a telerehabilitation wheelchair assessment. The TCT traveled to the veteran's residence with necessary evaluation and safety equipment and connected with the therapist remotely using the VA Video Connect platform. Assessment and veteran data were collected during the initial evaluation and then during a 21-day follow-up. Forty-three veterans were successfully seen via telerehabilitation for a seating and wheeled mobility assessment between November, 2017 and July, 2018. The average travel distance between the veteran's residence and the clinic was 34.1 miles. The total telerehabilitation encounter times ranged from 45 min to 145 min. The implementation of this service delivery protocol for wheelchair seating and mobility assessments demonstrated the benefits of using telehealth services including reaching rural veterans, reducing distance traveled, maximizing efficiency of provider schedules, and conducting realistic assessments in veterans' home environments. Success can be attributed to being able to deliver best practice remotely and to the rapport of the TCT with the providers. Cultivating provider buy-in, selecting appropriate outcome measures, and restructuring workflows were additional lessons learned. The VA Video Connect platform is an accessible tool that can be easily learned by both veterans and providers and used beyond initial wheelchair seating evaluations for improved access to follow-up healthcare services.

Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke—A Scoping Review

ObjectivesThe COVID-19 pandemic has seen a rapid shift to telehealth delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke.MethodsSearches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weightbearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another and results synthesized narratively.ResultsSeven studies (two randomized trials, one mixed-methods and four pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment and two (29%) studies only included participants who walked independently. Adherence (reported in three studies) and satisfaction (reported in four studies) was good, and no serious adverse events (data from four studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance and in-person exercise prescription. However, there is limited high quality evidence of efficacy.ConclusionsWe identified strategies used in research to date which can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services.ImpactThe COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers, and optimize safety and adherence for telehealth interventions involving activities in weightbearing or standing positions.

Rapid Prototyping of Virtual Reality Cognitive Exercises in a Tele-Rehabilitation Context

In recent years, the need to contain healthcare costs due to the growing public debt of many countries, combined with the need to reduce costly travel by patients unable to move autonomously, have captured the attention of public administrators towards tele-rehabilitation. This trend has been consolidated overwhelmingly following the Covid-19 pandemic, which has made it precarious, difficult and even dangerous for patients to access hospital facilities. We present an approach based on the rapid prototyping of virtual reality, cognitive tele-rehabilitation exercises, which reinforce the group of exercises available in the Nu!reha platform. Patients who experienced injury or pathology need to practice continuous training in order to recover functional abilities, and the therapist needs to monitor the outcomes of such practices. The group of new exercises based on the rapid prototyping approach, become crucial especially in this pandemic period. The Virtual Reality exercises are designed on Unity 3D to empower the therapist to set up personalized exercises in an easy way, enabling the patient to receive personalized stimuli, which are essential for a positive outcome in the practice. Furthermore, the reaction speed of the system is of fundamental importance, as the temporal evolution of the scene must proceed parallel to the patient’s movements, to ensure an effective and efficient therapeutic response. So, we optimized the virtual reality application in order to make the loading phase and the startup phase as fast as possible and we have tested the results obtained with many devices: in particular computers and smartphones with different operating systems and hardware. The implemented method powers up the Nu!Reha system®, a collection of tele-rehabilitation services that helps patients to recover cognitive and functional capabilities.

Education, Training, and Practices of Neurorehabilitation in India During the COVID-19 Pandemic.

Background: Corona virus disease (COVID-19) was declared a pandemic by the World Health Organization in March 2020. This has affected service delivery among all medical disciplines in India including neurorehabilitation services.Aims and Objectives: The aims and objectives of the study were to assess the effect of COVID-19 pandemic on neurorehabilitation services across India.Methodology: A prospective nationwide survey study was undertaken by the Indian Federation of Neurorehabilitation during the pandemic. A questionnaire was prepared using Google forms software consisting of four sections: demography, neurorehabilitation practice before COVID-19 pandemic, neurorehabilitation practice during COVID-19 pandemic, and continuing medical education during COVID-19 pandemic.Results: Responses (872) were received from neurorehabilitation professionals across the country out of which 2.2% professionals did not give consent for participating in the survey. Participants (36.6%) were practicing traditional or independent referral basis rehabilitation, while 63.4% participants were practicing multidisciplinary rehabilitation. On an average, respective units were conducting 500–750 therapy sessions per month. Majority of the rehabilitation units in India lacked a physiatrist, rehabilitation nurse, music therapist, cognitive therapist, and urologist. Approximately 80% of the rehabilitation units have the basic rehabilitation modalities and advance technology was present in only 20% of the rehabilitation units. During COVID-19 pandemic, 19.5% centers were providing elective services, 50.3% emergency services, 15.6% new outpatient services, and 22.7% were providing follow-up outpatient services. Centers (51.5%) were providing telerehabilitation services for neurological conditions during the times of COVID-19 pandemic. Professionals (61.1%) providing telerehabilitation were working from home. Among the patients who needed neurorehabilitation, 28% were doing their exercises independently, 31% were supervised by caregivers, 17% were supervised by therapists, and 24% were not receiving any therapy. Participants (95.5%) wanted to receive more training in the field of neurorehabilitation. The participants utilized webinars (71%), online courses (22%), case discussion forums (19%), panel discussions (13%), and literature search (8%) during COVID-19 pandemic to continue education.Conclusion: The study reflects the situation of neurorehabilitation service delivery in India during the pandemic as the respondents were from all parts of the country and included most components of the neurorehabilitation team. Neurorehabilitation services were severely affected across India during the COVID-19 pandemic. Tele-neurorehabilitation has emerged as a new service delivery model during the pandemic. Online means of education has emerged as the primary source of continuing medical education during the pandemic.

Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation

Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.