Evaluating Efficiency of a Provincial Telerehabilitation Service in Improving Access to Care During the COVID-19 Pandemic
Keywords:artificial intelligence, call utilization, machine learning, qualitative description
Scope: Early in the COVID-19 pandemic, community rehabilitation stakeholders from a provincial health system designed a novel telerehabilitation service. The service provided wayfinding and self-management advice to individuals with musculoskeletal concerns, neurological conditions, or post-COVID-19 recovery needs. This study evaluated the efficiency of the service in improving access to care.
Methodology: We used multiple methods including secondary data analyses of call metrics, narrative analyses of clinical notes using artificial intelligence (AI) and machine learning (ML), and qualitative interviews.
Conclusions: Interviews revealed that the telerehabilitation service had the potential to positively impact access to rehabilitation during the COVID-19 pandemic, for individuals living rurally, and for individuals on wait lists. Call metric analyses revealed that efficiency may be enhanced if call handling time was reduced. AI/ML analyses found that pain was the most frequently-mentioned keyword in clinical notes, suggesting an area for additional telerehabilitation resources to ensure efficiency.
Alberta Health Services Provincial Rehabilitation Forum. (2016). Rehabilitation Strategic Plan 2016-2019.
Amin, J., Ahmad, B., Amin, S., Siddiqui, A. A., & Alam, M. K. (2022). Rehabilitation professional and patient satisfaction with telerehabilitation of musculoskeletal disorders: A systematic review. BioMed Research International, 2022, 1–10. https://doi.org/10.1155/2022/7366063
Barbosa, I. de A., & Silva, M. J. P. da. (2017). Nursing care by telehealth: What is the influence of distance on communication? Revista Brasileira de Enfermagem, 70(5), 928–934. https://doi.org/10.1590/0034-7167-2016-0142
Bodenreider, O. (2004). The Unified Medical Language System (UMLS): Integrating biomedical terminology. Nucleic Acids Research, 32(DATABASE ISS.). https://doi.org/10.1093/nar/gkh061
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238
Brehon, K., Carriere, J., Churchill, K., Loyola-Sanchez, A., O’Connell, P., Papathanasoglou, E., MacIsaac, R., Tavakoli, M., Ho, C., & Manhas, K. P. (2022). Evaluating the impact of a novel telerehabilitation service to address neurological, musculoskeletal, or coronavirus disease 2019 rehabilitation concerns during the coronavirus disease 2019 pandemic. DIGITAL HEALTH, 8, 205520762211016. https://doi.org/10.1177/20552076221101684
Brehon, K., Carriere, J., Churchill, K., Loyola-Sanchez, A., O’Connell, P., Papathanasoglou, E., MacIsaac, R., Tavakoli, M., Ho, C., & Pohar Manhas, K. (2021). Evaluating community-facing virtual modalities to support complex neurological populations during the COVID-19 pandemic: A protocol. JMIR Research Protocols.
Buabbas, A. J., Albahrouh, S. E., Alrowayeh, H. N., & Alshawaf, H. (2022). Telerehabilitation during the COVID-19 pandemic: Patients’ attitudes and satisfaction and physical therapists’ experiences. Medical Principles and Practice. https://doi.org/10.1159/000523775
Caffery, L. J., Farjian, M., & Smith, A. C. (2016). Telehealth interventions for reducing waiting lists and waiting times for specialist outpatient services: A scoping review. Journal of Telemedicine and Telecare, 22(8), 504–512. https://doi.org/10.1177/1357633X16670495
Carriere, J., Shafi, H., Brehon, K., Pohar Manhas, K., Churchill, K., Ho, C., & Tavakoli, M. (2021). Case Report: Utilizing AI and NLP to assist with healthcare and rehabilitation during the COVID-19 pandemic. Frontiers in Artificial Intelligence, 4(February), 1–7. https://doi.org/10.3389/frai.2021.613637
Feinberg, R. A., Kim, I. S., Hokama, L., de Ruyter, K., & Keen, C. (2000). Operational determinants of caller satisfaction in the call center. International Journal of Service Industry Management, 11(2), 131–141. https://doi.org/10.1108/09564230010323633
Gadenz, S. D., Basso, J., de Oliviera, P. R. B. P., Sperling, S., Zuanazzi, M. V. D., Oliveira, G. G., da Silva, I. M., Motta, R. M., Gehres, L. G., de Brito Mallmann, É., Rodrigues, Á. S., Pachito, D. v., & de Faria Leao, B. (2021). Telehealth to support referral management in a universal health system: A before-and-after study. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-07028-5
Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits and barriers. Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013
Health Quality Council of Alberta. (2005). Alberta Quality Matrix for Health. www.hqca.ca
Henry, B. W., Block, D. E., Ciesla, J. R., McGowan, B. A., & Vozenilek, J. A. (2017). Clinician behaviors in telehealth care delivery: A systematic review. Advances in Health Sciences Education, 22(4), 869–888. https://doi.org/10.1007/s10459-016-9717-2
Johansson, T., & Wild, C. (2011). Telerehabilitation in stroke care - A systematic review. Journal of Telemedicine and Telecare, 17(1), 1–6. https://doi.org/10.1258/jtt.2010.100105
Lee, A., Davenport, T., & Randall, K. (2018). Telehealth physical therapy in musculoskeletal practice. Journal of Orthopedic & Sports Physical Therapy, 48(10), 736–739.
Lifeline Research Foundation. (2013). Summary of Research and Evaluation of Crisis Helplines.
Moffet, H., Tousignant, M., Nadeau, S., Mérette, C., Boissy, P., Corriveau, H., Marquis, F., Cabana, F., Belzile, É. L., Ranger, P., & DImentberg, R. (2017). Patient satisfaction with in-home telerehabilitation after total knee arthroplasty: Results from a randomized controlled trial. Telemedicine and E-Health, 23(2), 80–87. https://doi.org/10.1089/tmj.2016.0060
Pastora-Bernal, J. M., Martín-Valero, R., Barón-López, F. J., & Estebanez-Pérez, M. J. (2017). Evidence of benefit of telerehabilitation after orthopedic surgery: A systematic review. Journal of Medical Internet Research, 19(4), 1–13. https://doi.org/10.2196/jmir.6836
Pfeil, J. N., Rados, D. v., Roman, R., Katz, N., Nunes, L. N., Vigo, Á., & Harzheim, E. (2020). A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X20963935
Richter, A. N., & Khoshgoftaar, T. M. (2018). A review of statistical and machine learning methods for modeling cancer risk using structured clinical data. In Artificial Intelligence in Medicine, 90, 1–14. https://doi.org/10.1016/j.artmed.2018.06.002
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23(4), 334–340. https://doi.org/10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g
Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Research in Nursing and Health, 33(1), 77–84. https://doi.org/10.1002/nur.20362
Savova, G. K., Masanz, J. J., Ogren, P. v., Zheng, J., Sohn, S., Kipper-Schuler, K. C., & Chute, C. G. (2010). Mayo clinical Text Analysis and Knowledge Extraction System (cTAKES): Architecture, component evaluation and applications. Journal of the American Medical Informatics Association, 17(5), 507–513. https://doi.org/10.1136/jamia.2009.001560
Seron, P., Oliveros, M. J., Gutierrez-Arias, R., Fuentes-Aspe, R., Torres-Castro, R. C., Merino-Osorio, C., Nahuelhual, P., Inostroza, J., Jalil, Y., Solano, R., Marzuca-Nassr, G. N., Aguilera-Eguía, R., Lavados-Romo, P., Soto-Rodríguez, F. J., Sabelle, C., Villarroel-Silva, G., Gomolán, P., Huaiquilaf, S., & Sanchez, P. (2021). Effectiveness of telerehabilitation in physical therapy: A rapid overview. Physical Therapy, 101(6). https://doi.org/10.1093/ptj/pzab053
Tavakoli, M., Carriere, J., & Torabi, A. (2020). Robotics, smart wearable technologies, and autonomous intelligent systems for healthcare during the COVID‐19 pandemic: An analysis of the state of the art and future vision. Advanced Intelligent Systems, 2(7), 2000071. https://doi.org/10.1002/aisy.202000071
Taylor-Gjevre, R., Nair, B., Bath, B., Okpalauwaekwe, U., Sharma, M., Penz, E., Trask, C., & Stewart, S. (2018). Addressing rural and remote access disparities for patients with inflammatory arthritis through video-conferencing and innovative inter-professional care models. Musculoskeletal Care, 16(1), 90–95.
Tousignant, M., Boissy, P., Moffet, H., Corriveau, H., Cabana, F., Marquis, F., & Simard, J. (2011). Patients’ satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists’ satisfaction toward technology for post-knee arthroplasty: An embedded study in a randomized trial. Telemedicine and E-Health, 17(5), 376–382. https://doi.org/10.1089/tmj.2010.0198
Tsvyakh, A. I., & Hospodarskyy, A. J. (2017). Telerehabilitation of patients with injuries of the lower extremities. Telemedicine and E-Health, 23(12), 1011–1015. https://doi.org/10.1089/tmj.2016.0267
Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., Curtis, S., Roman, M., Poon, E. G., Ferranti, J., Katz, J. N., & Tcheng, J. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957–962. https://doi.org/10.1093/jamia/ocaa067
How to Cite
Copyright (c) 2023 Katelyn Brehon, Jay Carriere, Katie Churchill, Adalberto Loyola-Sanchez, Elizabeth Papathanassoglou, Rob MacIsaac, Mahdi Tavakoli, Chester Ho, Kiran Pohar Manhas
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.