Implementing Telerehabilitation Research For Stroke Rehabilitation With Community Dwelling Veterans: Lessons Learned

Neale R Chumbler, Patricia Quigley, Jon Sanford, Patricia Griffiths, Dorian Rose, Miriam Morey, E. Wesley Ely, Helen Hoenig

Abstract


Telerehabilitation (TR) is the use of telehealth technologies to provide distance support, rehabilitation services and information exchange between people with disabilities and their clinical providers. This article discusses the barriers experienced when implementing a TR multi-site randomized controlled trial for stroke patients in their homes, and the lessons learned from conducting the study. The barriers are divided into two sections: those specific to TR and those pertinent to research overall. The TR specific barriers included the rapidly changing telecommunications and health care environment and inconsistent equipment functionality. The barriers applicable to research overall included the need for telehealth research to meet regulations in diverse departments and the rapidly expanding and changing research regulations. Solutions to the barriers included having various telehealth equipment available to allow for functionality with the currently diverse telecommunications infrastructure, rigorous pilot testing all equipment in different situations, and having biomedical engineering staff on-call and on-site.

References


AHRQ highlights benefits, challenges of telehealth. (2009). Healthcare Benchmarks and Quality Improvements, 16, 16-18.

Barrett, M., Larson, A., Carville, K., & Ellis, I. (2009). Challenges faced in implementation of a telehealth enabled chronic wound care system. Rural and Remote Health, 9, 1154 (Online).

Burdea, G.C. (2003). Virtual rehabilitation – benefits and challenges. Methods of Information in Medicine, 42,519-23.

Castro, C. & King, A.C. (2002). Telephone-assisted counseling for physical activity. Exercise and Sport Sciences Reviews, 30, 64-68.

Darkins, A.W. & Cary, M.S. (2000). Telemedicine and Telehealth. Springer Publishing Company, 173-179.

Demiris, G., Shigaki, C.L., & Schopp, L.H. (2005). An evaluation framework for a rural home-based telerehabilitation network. Journal of Medical Systems, 29,595-603.

Dhurjaty S. (2004). The economics of telerehabilitation. Telemedicine Journal & E-Health, 10, 196-199.

Granger, C.V & Hamilton, B.B. (1996). Measuring Health: A guide to rating scales and questionnaires. In C. Newell & I. MacDowell (Eds). Measuring health: A guide to rating scales and questionnaires, (2nd ed.). Oxford University Press, (pp. 115-121).

Green, B.B., McAfee, T., Hindmarsh, M., Madsen, M., Caplow, M., & Buist. D. (2002). Effectiveness of telephone support in increasing physical activity levels in primary care patients. American Journal of Preventive Medicine, 22, 177-183.

Jette , A.M. & Branch, L.G. (1984). Musculoskeletal impairment among the non-institutionalized aged. International Rehabilitation Medicine. 6, 157-161.

Johnson, J.E., Weinert, C., & Richardson, J.K. (1998). Rural residents’ use of cardiac rehabilitation programs. Public Health Nursing, 15, 288-296.

Kairy, D., Lehoux, P., Vincent, C., & Visintin M. (2009). A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and Rehabilitation, 31, 427-447.

LaFramboise, L.M., Woster, J., Yager, A., & Yates, B.C. (2009). A technological life buoy: patient perceptions of the Health Buddy. Journal of Cardiovascular Nursing, 24, 216-24.

Lai, J.C.K, Woo, J., Hui, E., & Chan, W.M. (2004). Telerehabilitation- a new model for community-based stroke rehabilitation. Journal of Telemedicine and Telecare, 10, 199-205.

Lutz, B.J., Chumbler, N.R., Lyles, T., Hoffman, N., & Kobb, R. (2009). Testing a home-telehealth programme for US veterans recovering from stroke and their family caregivers. Disability and Rehabilitation, 31, 402-9.

May, C.R., Williams, T.L., Mair, F.S., Mort, M.M., Shaw, N.T., & Gask, L. (2002). Factors influencing the evaluation of telehealth interventions: preliminary results from a qualitative study of evaluation projects in the UK. Journal of Telemedicine and Telecare, 8, 65-67.

McCant, F., McKoy, G., Grubber, J., Olsen, M.K., Oddone, E., et al. (2009). Feasibility of blood pressure telemonitoring in patients with poor blood pressure control. Journal of Telemedicine and Telecare, 15, 281-85.

Nelson, E.L. & Palsbo, S. (2006). Challenges in telemedicine equivalence studies. Evaluation and Program Planning, 29, 419-425.

Reker, D.M., Duncan, P., Horner, R.D., Hoenig, H., Samsa, G.P., Hamilton, B.B., & Dudley, T.K. (2002). Postacute stroke guideline compliance is associated with greater patient satisfaction. Archives of Physical Medicine and Rehabilitation, 83, 750-756.

Reker, D.M., Reid, K., Duncan, P.W., Marshall, C., Couper, D., et al. (2005). Development of an integrated stroke outcomes database within Veteran Health Administration. Journal of Rehabilitation Research and Development, 42, 77-92.

Russell, T.G. (2007). Physical rehabilitation using telemedicine. Journal of Telemedicine and Telecare, 13, 217-220.

Salyers, S.P., Jette, A. M., Haley, S.M., Heeren, T.C., Guralnik, J.M., & Fielding, R.A. (2004). Validation of the Late-Life Function Disability Instrument. Journal of the American Geriatrics Society, 52, 1554-1559.

Sanford, J.A., Griffiths, P.C., Richardson, P., Hargraves, K., Butterfield, T., & Hoenig, H. (2006). The effects of in-home rehabilitation on task self-efficacy in mobility-impaired adults: a randomized clinical trial. Journal of the American Geriatrics Society, 5, 1641-8.

Schwamm, LH., Holloway, R.G., Amarenco, P., Audebert, H.J., Bakas, T., et al. (2009). A review of the evidence for the use of telemedicine within stroke systems of care. A scientific statement from the American Heart Association/ American Stroke Association. Stroke, 40, 2616-34.

Smith, P., Hamilton, B.B., & Granger, C.V. (1990). Functional independence measure decision tree. The FONE FIM. Buffalo, NY: Research Foundation, State University of New York.

Talley, K.M., Wyman, J.F., & Gross, C.R. (2008). Psychometric properties of the activities specific balance confidence scale and the survey of activities and fear of falling in older women. Journal of the American Geriatrics Society, 56, 328-333.

Tinetti, M.E. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34, 119-126.




DOI: https://doi.org/10.5195/ijt.2010.6047

  

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.