User satisfaction with rehabilitation services delivered using Internet video

Clinical telerehabilitation: applications for physiatrists

Telemedicine offers an innovative approach to increase access to rehabilitation medicine services for patients who live in areas where physiatrists are scarce or absent. This article reviews the current status of telerehabilitation services delivered through real-time videoconferencing to provide support, assessment, and interventions to individuals with impairments or disabilities. A literature review demonstrates various uses of telerehabilitation by physical therapists, occupational therapists, speech and language pathologists, audiologists, recreational therapists, neuropsychologists, nurses, other physician specialists, and physiatrists. We also provide more in-depth examples of 2 current programs that involve physiatrists: One furnishes telerehabilitation services to adult stroke survivors, and the other addresses the special health care needs of children with developmental disabilities. We discuss the benefits of using telemedicine via real-time videoconferencing to care for individuals with disabilities, outline the challenges of successfully implementing a physiatric telerehabilitation program, and finish with a list of potential applications for physiatrists interested in incorporating telemedicine into their practice. Further investigation of the use of telehealth technologies to deliver physiatric services, care coordination, and education is needed. We recommend that our professional societies develop and publish guidelines to facilitate development and use of telerehabilitation technologies to increase access to physiatric services.

Wheelchair Seating Assessment and Intervention: A Comparison Between Telerehabilitation and Face-to-Face Service

This study compared outcomes of wheelchair seating and positioning interventions provided by telerehabilitation (n=10) and face-to-face (n=20; 10 in each of two comparison groups, one urban and one rural). Comparison clients were matched to the telerehabilitation clients in age, diagnosis, and type of seating components received. Clients and referring therapists rated their satisfaction and identified if seating intervention goals were met. Clients recorded travel expenses incurred or saved, and all therapists recorded time spent providing service. Wait times and completion times were tracked. Clients seen by telerehabilitation had similar satisfaction ratings and were as likely to have their goals met as clients seen face-to-face; telerehabilitation clients saved travel costs. Rural referring therapists who used telerehabilitation spent more time in preparation and follow-up than the other groups. Clients assessed by telerehabilitation had shorter wait times for assessment than rural face-to-face clients, but their interventions took as long to complete.

Physiotherapy at a distance: a controlled study of rehabilitation at home after a shoulder joint operation

We explored the benefit of video communication in home rehabilitation after shoulder joint replacement and compared it to referral for physiotherapy in the conventional way. A total of 22 patients were included in the study. The intervention group ( n = 10) had training at home under the supervision of a physiotherapist at the hospital using videoconferencing. The control group ( n = 12) had physiotherapy training in a conventional way in their home town. All patients had the same postoperative, three-phase-programme for two months. The outcome measures were a Visual Analogue Scale (VAS) for pain, range of motion (ROM), shoulder function ability (Constant score and SRQ-S) and health-related quality of life (SF-36). Questions about areas of priority for improvement and general satisfaction with the shoulder were also included. The telemedicine group received a greater number of treatments compared to the control group. After the intervention, there were significant improvements in VAS-pain, Constant score and SRQ-S for both groups. The telemedicine group improved significantly more in all three measurements than the control group ( P < 0.001 for all). When changes from baseline to follow-up were compared, the telemedicine group improved significantly more in terms of decrease in pain ( P = 0.004) and vitality ( P = 0.001) than the control group. Despite some limitations, there seem to be clear benefits from physiotherapy at a distance with a telemedicine technique that allows patients to obtain access to physiotherapy at home.

Using telehealth technology to improve the delivery of health services to people who are deaf

The use of technology to access sign language interpreters from a remote location can have a significant impact on the timely access of such services for people who are deaf. The potential integration of such services is contingent on factors such as the availability of suitable equipment and the acceptance of the technological solution by people who are deaf, sign language interpreters and the health professionals. A system was assembled to address the needs of the users while maintaining focused on the requirement of the system being feasible such that it remains an option for small clinics and even medical offices. The technological solution was tested using simulated sessions involving people who are deaf, health professionals and sign language interpreters. The sessions simulated typical health conditions seen in hospital emergency rooms, medical clinics and doctor offices. Data collected from all participants indicate the technology proved to be acceptable in most simulated situations.

Home telehealth--current state and future trends

OBJECTIVE

The purpose of this paper is to give an overview about the state of the art in research on home telehealth in an international perspective.

METHOD

The study is based on a review of the scientific literature published between 1990 and 2003 and retrieved via Medline in January/February 2004. All together, the abstracts of 578 publications have been analyzed.

RESULTS

The majority of publications (44%) comes from the United States, followed by UK and Japan. Most publications deal with vital sign parameter (VSP) measurement and audio/video consultations ("virtual visits"). Publications about IT tools for improved information access and communication as well as decision support for staff, patients and relatives are relatively sparse. Clinical application domains are mainly chronic diseases, the elderly population and paediatrics.

CONCLUSIONS

Internationally, we observe a trend towards tools and services not only for professionals but also for patients and citizens. However, their impact on the patient-provider relationship and their design for special user groups, such as elderly and/or disabled needs to be further explored. In general, evaluation studies are rare and further research is critical to determine the impacts and benefits, and limitations, of potential solutions and to overcome a number of hinders and restrictions, such as - the lack of standards to combine incompatible information systems; - the lack of an evaluation framework considering legal, ethical, organisational, clinical, usability and technical aspects; - the lack of proper guidelines for practical implementation of home telehealth solutions.