Patient Expectations for Synchronous Telerehabilitation Visits: A Survey Study of Telerehabilitation-Naive Patients

Exploring the link between clinical, cognitive status, and telerehabilitation experiences in multiple sclerosis: A cross-sectional study

PURPOSE

Evaluating the opinions of patients with multiple sclerosis (MS) about telerehabilitation services and investigating them in detail about their clinical and cognitive status is important for determining and discussing the expectations related to telerehabilitation. The objective of this study was to evaluate the opinions of patients with MS about telerehabilitation services and to correlate these opinions with the clinical and cognitive status of the individuals in question.

METHODS

A prospective cross-sectional study was conducted with 101 individuals with MS. All participants were evaluated with the Multiple Sclerosis Impact Scale (MSIS-29), Cognitive Reserve Index questionnaire (CRIq), Telemedicine Patient Questionnaire (TPQ), Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), Telerehabilitation Beliefs Questionnaire (TBF).

RESULTS

TPQ was weakly correlated with MSIS-29 Physical (r = -0.249, p < 0.05), MSIS-29 Psychological (r = -0.339, p < 0.001) and CRIq-Education (r = 0.257, p < 0.001). TSUQ was only weakly correlated with CRIq-Education (r = 0.205, p < 0.05). TBF was weakly correlated with MSIS-29 Psychological (r = -0.209, p < 0.05), CRIq-Education (r = 0.344, p < 0.001), CRIq-Work (r = 0.242, p < 0.05) and CRIq-Total (r = 0.260, p < 0.001). There was a weak positive correlation between TBF and the participant's age (r = 0.219, p < 0.05).

CONCLUSION

The views of individuals with MS on telerehabilitation were mostly related to psychological and cognitive (education-related) parameters. Age, educational status, and psychological level should be considered during telerehabilitation services in people with MS.

A randomized controlled trial: Mobile app vs videoconference telerehabilitation for rotator cuff tendinopathy

IntroductionThe aim of this study was to compare the effectiveness of two methods of telerehabilitation (TR) delivery: mobile health TR (mHealth-TR) and video conference TR (VC-TR) in improving outcomes for patients with RC tendinopathy.MethodsEighty-five participants diagnosed with RC tendinopathy were randomized into synchronous (VC-TR) and asynchronous (mHealth-TR) groups. Both groups received an identical 8-week exercise programme delivered through their assigned platform. The programme included scapular mobilization, range-of-motion, strengthening, and stretching exercises. The primary outcomes were pain level (Visual Analogue Scale [VAS]), disability (Disabilities of the Arm, Shoulder and Hand [DASH] score), quality of life (Short Form-36 Health Survey [SF-36] score), and shoulder mobility (universal goniometer). The assessments were carried out at baseline, after the treatment (week 8) and at a follow-up of 16 weeks.ResultsThe mean participant age was 51.8 years (SD 9.24), with 27% (n = 23) male. No significant between-group differences were observed for pain (VAS) or shoulder mobility (P > .05 for both). However, a significant group-by-time interaction effect was found for disability, measured by the DASH score (F(1,83) = 10.56, P = .001), and quality of life, measured by the SF-36 overall score (excluding physical role functioning, emotional role functioning, and social function) (Vitality/Energy: F(1,83) = 7.34, P = .006; Pain: F(1,83) = 4.78, P = .034; General Health: F(1,83) = 4.82, P = .032). Post-hoc analysis indicated significant improvements in disability and quality of life scores in the synchronous VC-TR group compared to the asynchronous mHealth-TR group. Specifically, DASH scores in the synchronous group decreased by 9.41 points (95% CI: 3.46 to 15.36, P = .002) from baseline to after treatment, and by 9.34 points (95% CI: 3.48 to 15.20, P = .002) by the 16th week. For quality of life, the VC-TR group showed significant improvements in the Vitality/Energy, Pain, and General Health domains from baseline to follow-up, with mean differences of 6.41, 11.68, and 10.83, respectively (all P < .05).DiscussionThis study suggests that patients with RC tendinopathy may experience greater improvements in pain management, disability, and overall quality of life through synchronous VC-TR compared to asynchronous mHealth-TR.

Physical Therapists' Perspectives on the Use of Telehealth With First Nations Peoples in Canada: A Qualitative Study

OBJECTIVE

This study aims to explore physical therapists' perspectives on providing physical therapy to First Nations peoples in Canada via telehealth, specifically to understand (1) their perspectives on the feasibility of telehealth as a medium for health care delivery and (2) their experiences building trusting therapeutic relationships via telehealth care.

METHODS

This study included 13 physical therapists who provided clinical care via telehealth for First Nations individuals in northern British Columbia in the past 3 years, and 7 master of physical therapy students undergoing or who completed their Indigenous Health clinical placement in the past 3 years and utilized telehealth. In-depth semi-structured interviews were conducted. Interview questions explored: telehealth usage and acceptance, experiences with telehealth, and overall recommendations for telehealth. Audio recordings were transcribed, and reflexive thematic analysis was conducted.

RESULTS

Three overarching themes were identified: "Telehealth can make a huge difference, but it is widely underutilized;" "Telehealth is a little bit less personal and in-depth;" and "There is a time and place for telehealth."

CONCLUSION

Telehealth shows promise in the delivery of physical therapy to First Nations communities in Canada, enhancing accessibility, offering flexible scheduling options, and optimizing therapist time efficiency. However, successful implementation in these communities is contingent upon addressing several challenges, including building trusting therapeutic relationships. Technological glitches, the absence of physical interaction, and a history of trauma may hinder the development of the therapeutic relationship in telehealth encounters. To mitigate these challenges, cultural safety training, initial in-person appointments, community familiarity, and in-person support from a caregiver or other health care provider may play pivotal roles.

IMPACT

This study not only sheds light on the underutilization of telehealth but also underscores its potential to significantly improve the accessibility and efficiency of physical therapy to First Nations peoples in Canada. The findings emphasize the nuanced dynamics of therapeutic relationships in telehealth, offering critical insights for the integration of culturally sensitive practices. Addressing the challenges pinpointed can enhance the quality of telehealth care for First Nations individuals, promote more equitable health care delivery, and foster positive health outcomes.

Understanding Negative and Positive Feelings About Telerehabilitation in People With Chronic Knee Pain: A Mixed-Methods Study

OBJECTIVES: To explore (1) initial feelings of people with knee osteoarthritis who are unexpectedly offered telerehabilitation, and (2) if their experiences met their expectations, and their willingness to use telerehabilitation in the future. DESIGN: Mixed-methods study of 122 people with knee osteoarthritis who were randomized to receive physiotherapist-delivered telerehabilitation in a clinical trial. METHODS: At enrollment in the trial, participants were unaware care would be delivered via telerehabilitation. At completion, quantitative (Likert scales, analyzed descriptively) and qualitative (open-text, underwent content/thematic analysis) questions asked participants about their initial feelings when randomized to telerehabilitation, if experiences met expectations, and willingness to use telerehabilitation in the future. RESULTS: Data were collected between October 2021 to March 2023. At enrollment, 44 (36% of 122) participants initially felt negative toward telerehabilitation (doubts about effectiveness, physiotherapist can't see/touch, believe in-person is better, can't communicate effectively, not good with technology), 18 (15%) were neutral, and 60 (49%) felt positive. After experiencing telerehabilitation, 43 (72%) people who were initially positive and 27 (61%) who were initially negative believed telerehabilitation exceeded their expectations (easier than expected, surprised by benefits/effectiveness, strong rapport with physiotherapist, convenience). Twenty-eight (23% of 122) people were not at all or slightly willing to use telerehabilitation in future (prefer hands-on, doesn't allow adequate assessment/observation, prefer in-person, don't like telerehabilitation). CONCLUSION: One in 2 people were positive about telerehabilitation from the outset, and 6 in 10 people who initially felt negative about telerehabilitation found that their experiences were better than expected. One in 4 people were unwilling to use telerehabilitation in the future, even after they had experienced it. J Orthop Sports Phys Ther 2024;54(9):1-14. Epub 11 June 2024. doi:10.2519/jospt.2024.12383.

Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

BACKGROUND

One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up.

OBJECTIVE

To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients.

MATERIAL AND METHODS

A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent.

RESULTS

The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19.

CONCLUSIONS

Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.

Exploring virtual care clinical experience from non-physician healthcare providers (VCAPE)

COVID-19 has caused an urgent implementation of virtual care (VC). Most research has focused on patient and physician experience with virtual care. Non-physician healthcare providers have played an active role in transitioning to virtual care, yet little is known about their experiences. This study explored their lived experiences in caring for patients virtually. Forty non-physician healthcare providers from local hospitals, community, and home care settings in Kingston, ON, Canada, participated and included nurse practitioners, occupational therapists, physiotherapists, psychologists, registered dietitians, social workers, and speech-language pathologists. Data were collected using semi-structured interviews between February and July 2021 and were analyzed thematically. The study was guided by organizational change theory. Four themes were identified from the data: 1) Quality of care, 2) Resources and training, 3) Healthcare system efficiency, and 4) Health equity and access for patients. Providers suggested that VC increased patient-centredness and had clear benefits for patients. Participants had little to no training in conducting patient care, virtually stating this as a key challenge. They believed that VC increased the efficiency of the healthcare system and was more proactive. Despite concerns regarding inequities across healthcare, participants reported that VC could improve equity as long as patients had access to technology. The study highlights the urgent need to support all healthcare providers in delivering optimal patient-centred care. We should leverage some of the advantages offered by VC to improve the efficiency of healthcare delivery, reduce provider burnout, and increase capacity across organizational systems.

Stakeholders' Experiences Using Videoconferencing for a Group-Based Stroke Intervention During COVID-19: A Thematic Analysis

IMPORTANCE

Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software.

OBJECTIVE

To explore stakeholders' experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom).

DESIGN

Ad hoc exploratory thematic analysis.

SETTING

Community-based telerehabilitation.

PARTICIPANTS

Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4).

INTERVENTION

Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation.

OUTCOMES AND MEASURES

Semistructured interviews.

RESULTS

Stakeholders included group members (ages 26-81 yr), group leaders (ages 32-71 yr), and study staff (ages 23-55 yr). Group members characterized ENGAGE as learning, doing, and connecting with others who shared their experience. Stakeholders identified social advantages and disadvantages to the videoconferencing environment. Attitudes toward technology, past technology experiences, the amount of time allotted for training, group size, physical environments, navigation of technology disruptions, and design of the intervention workbook were facilitators for some and barriers for others. Social support facilitated technology access and intervention engagement. Stakeholders recommended training structure and content.

CONCLUSIONS AND RELEVANCE

Tailored training protocols may support stakeholders who are participating in telerehabilitation interventions using new software or devices. Future studies that identify specific tailoring variables will advance the development of telerehabilitation training protocols. What This Article Adds: These findings provide stakeholder-identified barriers and facilitators, in addition to stakeholder-informed recommendations, for technology training protocols that may support uptake of telerehabilitation in occupational therapy.

Rehabilitation Professional and Patient Satisfaction with Telerehabilitation of Musculoskeletal Disorders: A Systematic Review

Telerehabilitation offers an alternative healthcare delivery remotely in a patient's environment at a lower cost, better accessibility, and equivalent quality to the standard approach. Several studies had examined the effectiveness of telerehabilitation inpatients with musculoskeletal disorders, and although there is evidence that it is at least equally effective as the standard care, the patient and rehabilitation professional satisfaction with the delivery method is not conclusive. A systematic review was conducted to study the patients' and rehabilitation professionals' satisfaction with telerehabilitation for musculoskeletal disorders. A search for relevant studies on 29 April 2021 was carried out in Medline/PubMed, Scopus, and Web of Science (WOS). The search terms included “telerehabilitation,” AND “satisfaction” AND “musculoskeletal disorders,” “telehealth,” “telemedicine,” “patient experience,” and “pain”. Fifteen eligible studies with 12,341 patients were included in this systematic review. A report was included if it (a) assessed the satisfaction of patients or professionals or both as one of the outcomes of a telerehabilitation intervention, (b) included adults 18 years and above with musculoskeletal disorders, and (c) is an intervention study using a quantitative approach. The quality of studies was assessed using the critical appraisal checklist tool developed by Joanna Briggs Institute (JBI). Most of the studies reported that patients were satisfied with both telerehabilitation and face-to-face intervention. However, few studies reported that patients were more satisfied with telerehabilitation compared to face-to-face of intervention. Patients in one study had preferred the incorporation of telerehabilitation and face-to-face sessions. Two of three studies had reported overall satisfaction with telerehabilitation by the professionals. Overall, there is evidence that patients and rehabilitation professional are satisfied with telerehabilitation compared to face-to-face consultation.

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.