Telerehabilitation: lessons from the COVID-19 pandemic and future perspectives

Maintaining the use of telehealth for delivering rehabilitation services in a regional hospital post-COVID19: Learning from telehealth delivery rates and staff experiences

ObjectiveTo examine what delivery format had been used to facilitate rehabilitation services over recent years and to identify barriers and enablers to using telehealth in the future.DesignMultiple method research approach.Setting:Outpatient rehabilitation service in a large regional hospital in Australia.Participants:Clinicians that deliver rehabilitation interventions including allied health professionals and nurses.Main measuresFirst, a retrospective audit of data examining the rate of telehealth use. Second, semi-structured focus groups with clinical staff to identify barriers and enablers to using telehealth. Data were thematically analysed and mapped to a behaviour change framework.ResultsPre-pandemic, 82% (n = 45,960) of rehabilitation services were delivered in-person; during peak restrictions, in-person delivery was 54% (n = 49,337). Following the ease of restrictions, 71% (n = 49,337) of the rehabilitation services were delivered in-person, 28% (n = 21,624) via phone and 1% (n = 493) via video. Telehealth use increased 11% from pre-pandemic to when restrictions were eased, driven by increased use of phone consultations. Six themes related to barriers and four themes related enablers to using telehealth were identified. Using the behaviour change framework, five interventions functions (education, training, environmental restructure, modelling and enablement) were recommended to facilitate telehealth use.ConclusionsTelehealth-delivered rehabilitation rates increased post-pandemic, primarily via phone consultations. Reported barriers and enablers highlight the need for targeted strategies, with five intervention functions identified that may support increased telehealth adoption in rehabilitation settings. Future efforts should address clinician-raised barriers to optimise telehealth integration into service delivery.

Healthcare professionals' knowledge and perceptions of post-stroke rehabilitation in the peripandemic period: an online cross-sectional survey

The COVID-19 pandemic has profoundly affected healthcare systems, particularly post-stroke rehabilitation centers. The elevated severity of strokes and delayed hospital admissions caused numerous hurdles to rehabilitation administration during the peri-pandemic period. This study surveyed healthcare professionals' knowledge and perceptions of post-stroke rehabilitation during this period. An online cross-sectional survey was administered from September 17, 2023 to February 23, 2024, utilizing the SurveyMonkey platform. The questionnaire included 30 questions addressing participant baseline characteristics, knowledge of definitions and experiences, post-stroke rehabilitation procedures, obstacles encountered during the peri-pandemic period, and the utilization of telerehabilitation. Only complete responses from health professionals were considered. This report utilized convenience sampling. Data were analyzed via descriptive statistics and chi-square tests, with a significance threshold of p < 0.05. A total of 79 health professionals, predominantly physiatrists, neurologists, and physiotherapists, from eight countries participated in the study. Over half of the participants (64.6%) indicated the existence of a dedicated department for post-stroke rehabilitation. Significant obstacles comprised an absence of advanced rehabilitative treatments (60.8%), inadequately skilled workers (50.6%), and restricted space for rehabilitation (46.8%). Telerehabilitation was regarded as a feasible option by 45.6% of participants; nonetheless, obstacles, including patients' telecommunication proficiency and the possibility of diagnostic inaccuracies, were acknowledged. Complementary therapies, such as music and dance therapy, received favorable evaluations from 67.1% to 63.3% of respondents, respectively. The pandemic reduced rehabilitation admissions due to infection concerns (75.9%) and increased multimorbidity cases among patients (48.1%). The study underscores the pandemic's negative effect on post-stroke rehabilitation, emphasizing the necessity for multidisciplinary, customized therapy and enhanced integration of telerehabilitation to overcome access barriers. Addressing obstacles regarding infrastructure, training, and access to advanced approaches, particularly in a post-pandemic context, is essential to improving rehabilitation outcomes.

Nurses' roles, interventions, and implications for management of rheumatic diseases

Nurses have become integral members of multidisciplinary teams in managing rheumatic diseases, departing from their traditional patient care roles. This article provides a comprehensive review of nurses' roles, interventions, and impacts in several rheumatic diseases, including rheumatoid arthritis, osteoarthritis, spondyloarthritis, gout, systemic lupus erythematosus, and polymyalgia rheumatica. It has been demonstrated that care under nursing supervision is effective and safe, with benefits including disease management, quality of life, and treatment adherence. In addition, nurses play a crucial role in promoting health, educating patients, and administering biological disease-modifying anti-rheumatic drugs. The COVID-19 pandemic has highlighted the significance of telehealth services and nurses' role in delivering remote care. However, nursing education and training challenges persist, particularly in standardization and access to postgraduate education. Efforts to enhance the role of nurses in rheumatology care are necessary to optimize patient outcomes and meet the evolving needs of individuals with rheumatic diseases. Collaboration across healthcare institutions, professional groups, and educational facilities is necessary for promoting the continual growth and advancement of rheumatology nurse practice. By equipping nurses with the requisite knowledge, expertise, and resources to deliver top-notch care, we can enhance the well-being of individuals with rheumatic diseases and foster improved overall health outcomes.

Effectiveness of Telerehabilitation in Dizziness: A Systematic Review with Meta-Analysis

Dizziness can be a debilitating condition with various causes, with at least one episode reported in 17% to 30% of the international adult population. Given the effectiveness of rehabilitation in treating dizziness and the recent advancements in telerehabilitation, this systematic review aims to investigate the effectiveness of telerehabilitation in the treatment of this disorder. The search, conducted across Medline, Cochrane Central Register of Controlled Trials, and PEDro databases, included randomized controlled trials assessing the efficacy of telerehabilitation interventions, delivered synchronously, asynchronously, or via tele-support/monitoring. Primary outcomes focused on dizziness frequency/severity and disability, with secondary outcomes assessing anxiety and depression measures. Seven articles met the eligibility criteria, whereas five articles contributed to the meta-analysis. Significant findings were observed regarding the frequency and severity of dizziness (mean difference of 3.01, p < 0.001), disability (mean difference of -4.25, p < 0.001), and anxiety (standardized mean difference of -0.16, p = 0.02), favoring telerehabilitation. Telerehabilitation shows promise as a treatment for dizziness, aligning with the positive outcomes seen in traditional rehabilitation studies. However, the effectiveness of different telerehabilitation approaches requires further investigation, given the moderate methodological quality and the varied nature of existing methods and programs.

Joint Expedition: Exploring Telehealth and the Digital Healthcare Landscape as a Team Integration

The TeleHealth and digital healthcare domains have witnessed remarkable advancements in recent years (Contribution 1), propelled by the evolution of digitization processes, both in mobile [...].