Telerehabiltation in Italy During the COVID-19 Lockdown: A Feasibility and Acceptability Study

  • Giada Milani ITF@Unife Center for Translational Neurophysiology, Istituto Iitaliano di Tecnologia; Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, Ferrara, Italy; Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara; Italy
  • Giulia Demattè School of Physiotherapy, Ferrara University, Ferrara, Italy
  • Matilde Ferioli School of Physiotherapy, Ferrara University, Ferrara, Italy
  • Giulia Dallagà Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
  • Susanna Lavezzi Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy.
  • Nino Basaglia Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy.
  • Sofia Straudi Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy https://orcid.org/0000-0002-2061-9922
Keywords: COVID-19, Disability, Physical therapy, Physiotherapy, Technology, Telemedicine, Telerehabilitation

Abstract

This study examined the feasibility and acceptability of a telerehabilitation program during the COVID-19 pandemic in a sample of adult patients with physical disabilities. Of the twenty-three patients enrolled, 11 agreed to participate in a video-based telerehabilitation program. Barriers and facilitators to the adoption of telerehabilitation were identified and clinical, demographic, and psychological variables were analysed as predictors of success. Age, cognitive reserve, and resilience were significant predictors of satisfaction with telerehabilitation (p<0.05). The telerehabilitation program was perceived as feasible and was well accepted by patients, despite some technology challenges. However, patients who took advantage of telerehabilitation perceived differences in the quality of service and preferred traditional in-person treatment to service delivery via telerehabilitation.

  

Author Biography

Sofia Straudi, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
 

References

Adler, R. (2006). Older Americans, broadband and the future of the net. Santa Clara: SeniorNet.

Armfield, N. R., Bradford, M., & Bradford, N. K. (2015). The clinical use of Skype—For which patients, with which problems and in which settings? A snapshot review of the literature. International Journal of Medical Informatics, 84(10), 737-742. https://doi.org/10.1016/j.ijmedinf.2015.06.006

Armfield, N. R., Gray, L. C., & Smith, A. C. (2012). Clinical use of Skype: A review of the evidence base. Journal of Telemedicine and Telecare, 18(3), 125-127. https://doi.org/10.1258/jtt.2012.SFT101

Bandura, A., Freeman, W. H., & Lightsey, R. (1999). Self-efficacy: The exercise of control. W.H. Freeman and Company, New York.

Bangor, A., Kortum, P. T., & Miller, J. T. (2008). An empirical evaluation of the system usability scale. International Journal of Human–Computer Interaction, 24(6), 574-594. https://doi.org/10.1080/10447310802205776

Bartolo, M., Intiso, D., Lentino, C., Sandrini, G., Paolucci, S., & Zampolini, M. (2020). Urgent measures for the containment of the Coronavirus (COVID-19) epidemic in the neurorehabilitation/rehabilitation departments in the phase of maximum expansion of the epidemic. Frontiers in Neurology, 11, 423. https://doi.org/10.3389/fneur.2020.00423

Boldrini, P., Bernetti, A., Fiore, P., & SIMFER Executive Committee. (2020a). Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER). European Journal of Physical and Rehabilitation Medicine, 56(3), 316-318. https://doi.org/10.23736/S1973-9087.20.06256-5

Boldrini, P., Garcea, M., Brichetto, G., Reale, N., Tonolo, S., Falabella, V., ... & Kiekens, C. (2020b). Living with a disability during the Pandemic." Instant paper from the field" on rehabilitation answers to the COVID-19 emergency. European Journal of Physical and Rehabilitation Medicine. https://doi.org/10.23736/S1973-9087.20.06373-X

Bouwstra, H., Smit, E. B., Wattel, E. M., van der Wouden, J. C., Hertogh, C. M., Terluin, B., & Terwee, C. B. (2019). Measurement properties of the Barthel Index in geriatric rehabilitation. Journal of the American Medical Directors Association, 20(4), 420-425. https://doi.org/10.1016/j.jamda.2018.09.033

Brenes, G. A., Penninx, B. W., Judd, P. H., Rockwell, E., Sewell, D. D., & Wetherell, J. L. (2008). Anxiety, depression and disability across the lifespan. Aging and Mental Health, 12(1), 158-163. https://doi.org/10.1080/13607860601124115

Brennan, D., Tindall, L., Theodoros, D., Brown, J., Campbell, M., Christiana, D., Smith, D., Cason, J., & Lee, A. (2010). A blueprint for telerehabilitation guidelines. International Journal of Telerehabilitation, 2(2), 31–34. https://doi.org/10.5195/ijt.2010.6063

Brewster, L., Mountain, G., Wessels, B., Kelly, C., & Hawley, M. (2014). Factors affecting front line staff acceptance of telehealth technologies: A mixed‐method systematic review. Journal of Advanced Nursing, 70(1), 21-33. https://doi.org/10.1111/jan.12196

Bruyneel, M., Van den Broecke, S., Libert, W., & Ninane, V. (2013). Real-time attended home-polysomnography with telematic data transmission. International Journal of Medical Informatics, 82(8), 696-701. https://doi.org/10.1016/j.ijmedinf.2013.02.008

Campbell‐Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor–Davidson Resilience Scale (CD‐RISC): Validation of a 10‐item measure of resilience. Journal of Traumatic Stress, 20(6), 1019-1028. https://doi.org/10.1002/jts.20271

Chiaravalloti, N. D., Amato, M. P., Brichetto, G., Chataway, J., Dalgas, U., DeLuca, J., Meza, C., Moore, N.B., Feys, P., Filippi, M., Freeman, J., Inglese, M., Motl, R., Rocca, M.A., Sandroff, B.M., Salter, A., Cutter, G. & Feinstein, A. (2020). The emotional impact of the COVID-19 pandemic on individuals with progressive multiple sclerosis. Journal of Neurology, 268, 1598–1607. ,https://doi.org/10.1007/s00415-020-10160-7

Choi, N. G., & DiNitto, D. M. (2013). Internet use among older adults: Association with health needs, psychological capital, and social capital. Journal of Medical Internet Research, 15(5), e97. https://doi.org/10.2196/jmir.2333

Cramer, S. C., Dodakian, L., Le, V., See, J., Augsburger, R., McKenzie, A., ... & Scacchi, W. (2019). Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after stroke: A randomized clinical trial. JAMA Neurology, 76(9), 1079-1087. https://doi.org/10.1001/jamaneurol.2019.1604

Cranen, K., Drossaert, C. H., Brinkman, E. S., Braakman‐Jansen, A. L., IJzerman, M. J., & Vollenbroek‐Hutten, M. M. (2012). An exploration of chronic pain patients’ perceptions of home telerehabilitation services. Health Expectations, 15(4), 339-350. https://doi.org/10.1111/j.1369-7625.2011.00668.x

Crotty, M., Killington, M., van den Berg, M., Morris, C., Taylor, A., & Carati, C. (2014). Telerehabilitation for older people using off-the-shelf applications: Acceptability and feasibility. Journal of Telemedicine and Telecare, 20(7), 370-376. https://doi.org/10.1177/1357633X14552382

Czaja, S. J., Charness, N., Fisk, A. D., Hertzog, C., Nair, S. N., Rogers, W. A., & Sharit, J. (2006). Factors predicting the use of technology: Findings from the center for research and education on aging and technology enhancement (create). Psychology and Aging, 21(2), 333. https://doi.org/10.1037/0882-7974.21.2.333

Dantas, L. O., Barreto, R. P. G., & Ferreira, C. H. J. (2020). Digital physical therapy in the COVID-19 pandemic. Brazilian Journal of Physical Therapy, 24(5), 381-383. https://doi.org/10.1016/j.bjpt.2020.04.006

Di Giacomo, D., Palmiero, M., & Passafiume, D. (2013). Cognitive abilities in the use of smart technology: Difference in life span. International Journal of Technology Enhanced Learning, 5(3-4), 299-306. https://doi.org/10.1504/IJTEL.2013.059497

Dias, A. E., Limongi, J., Hsing, W. T., & Barbosa, E. R. (2016). Telerehabilitation in Parkinson's disease: Influence of cognitive status. Dementia & Neuropsychologia, 10(4), 327–332. https://doi.org/10.1590/s1980-5764-2016dn1004012

Fazeli, P. L., Ross, L. A., Vance, D. E., Ball, K. (2013). The relationship between computer experience and computerized cognitive test performance among older adults. Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 68, 337-346. https://doi.org/10.1093/geronb/gbs071

Gindrat, A. D., Chytiris, M., Balerna, M., Rouiller, E. M., & Ghosh, A. (2015). Use-dependent cortical processing from fingertips in touchscreen phone users. Current Biology, 25(1), 109-116. https://doi.org/10.1016/j.cub.2014.11.026

Hamilton, C., McCluskey, A., Hassett, L., Killington, M., & Lovarini, M. (2018). Patient and therapist experiences of using affordable feedback-based technology in rehabilitation: A qualitative study nested in a randomized controlled trial. Clinical Rehabilitation, 32(9), 1258-1270. https://doi.org/10.1177/0269215518771820

Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., &Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. Telemedicine and e-Health, 19(6), 444-454. https://doi.org/10.1089/tmj.2013.0075

Holmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., ... & Ford, T. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(20)30168-1

Jafni, T. I., Bahari, M., Ismail, W., & Hanafi, M. H. (2019). Exploring barriers that affect telerehabilitation readiness: A case study of Rehabilitation Centre in Malaysia. In International Conference of Reliable Information and Communication Technology (pp. 761-771). Springer, Cham. https://doi.org/10.1007/978-3-319-99007-1_70

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Leocani, L., Diserens, K., Moccia, M., & Caltagirone, C. (2020). Disability through COVID‐19 pandemic: Neurorehabilitation cannot wait. European Journal of Neurology. https://doi.org/10.1111/ene.14320

Leochico, C. F. D. (2020). Adoption of telerehabilitation in a developing country before and during the COVID-19 pandemic. Annals of Physical and Rehabilitation Medicine, 63(6), 563-564. https://doi.org/10.1016/j.rehab.2020.06.001

Madden, M., & Fox, S. (2006). Riding the waves of “Web 2.0.” Pew Research Center: Internet and Technology. https://www.pewinternet.org/wp-content/uploads/sites/9/media/Files/Reports/2006/PIP_Web_2.0.pdf.pdf

Mantokoudis, G., Dähler, C., Dubach, P., Kompis, M., Caversaccio, M. D., & Senn, P. (2013). Internet video telephony allows speech reading by deaf individuals and improves speech perception by cochlear implant users. PLoS One, 8(1), e54770. https://doi.org/10.1371/journal.pone.0054770

Melenhorst, A. S., Rogers, W. A., & Bouwhuis, D. G. (2006). Older adults' motivated choice for technological innovation: Evidence for benefit-driven selectivity. Psychology and Aging, 21(1), 190. https://doi.org/10.1037/0882-7974.21.1.190

Meyer, A., Zimmermann, R., Gschwandtner, U., Hatz, F., Bousleiman, H., Schwarz, N., & Fuhr, P. (2015). Apathy in Parkinsons disease is related to executive function, gender and age but not to depression. Frontiers in Aging Neuroscience, 6, 350. https://doi.org/10.3389/fnagi.2014.00350

Mitchell, J. M., Adkins, R. H., & Kemp, B. J. (2006). The effects of aging on employment of people with and without disabilities. Rehabilitation Counseling Bulletin, 49(3), 157-165. https://doi.org/10.1177/00343552060490030301

Negrini, S., Kiekens, C., Bernetti, A., Capecci, M., Ceravolo, M. G., Lavezzi, S., ... & Boldrini, P. (2020). Telemedicine from research to practice during the pandemic. “Instant paper from the field" on rehabilitation answers to the COVID-19 emergency. European Journal of Physical and Rehabilitation Medicine. https://doi.org/10.23736/s1973-9087.20.06331-5

Nucci, M., Mapelli, D., & Mondini, S. (2012). The cognitive Reserve Questionnaire (CRIq): A new instrument for measuring the cognitive reserve. Aging Clinical and Experimental Research, 24, 218-126. https://doi.org/10.3275/7800

Piron, L., Turolla, A., Tonin, P., Piccione, F., Lain, L., & Dam, M. (2008). Satisfaction with care in post-stroke patients undergoing a telerehabilitation program at home. Journal of Telemedicine and Telecare, 14(5), 257-260. https://doi.org/10.1258/jtt.2008.080304

Schwarzer, R & Jerusalem, M. (1995). Generalized Self-Efficacy Scale (GSE). In J. Weinman, S. Wright & M. Johnston. Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSO

Slegers, K., van Boxtel, M. P. J., & Jolles, J. (2012). Computer use in older adults: Determinants and the relationship with cognitive change over a 6-year episode. Computers in Human Behavior, 28, 1-10. https://doi.org/10.1016/j.chb.2011.08.003

Theodoros, D. (2012). A new era in speech-language pathology practice: Innovation and diversification. International Journal of Speech-Language Pathology, 14(3), 189-199. https://doi.org/10.3109/17549507.2011.639390

Tun, P. A., & Lachman, M. E. (2010). The association between computer use and cognition across adulthood: Use it so you won't lose it? Psychology and Aging, 25(3), 560. https://doi.org/10.1037/a0019543

Ulusoy, M., Sahin, N. H., & Erkmen, H. (1998). Turkish Version of the Beck Anxiety Inventory: Psychometric properties. Journal of Cognitive Psychotherapy, 12(2), 163-172.

Wade, V. A., Eliott, J. A., & Hiller, J. E. (2014). Clinician acceptance is the key factor for sustainable telehealth services. Qualitative Health Research, 24(5), 682-694. https://doi.org/10.1177/1049732314528809

Wagnild, G., & Collins, J. A. (2009). Assessing resiliency. Journal of Psychosocial Nursing & Mental Health Services, 47, 28–33. https://doi.org/10.3928/02793695-20091103-01

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729. https://doi.org/10.3390/ijerph17051729

Ware Jr, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 220-233. https://doi.org/10.2307/3766749

Wu, Y. H., Lewis, M., & Rigaud, A. S. (2019). Cognitive function and digital device use in older adults attending a memory clinic. Gerontology and Geriatric Medicine, 5, 2333721419844886. https://doi.org/10.1177/2333721419844886

Ziefle, M., & Wilkowska, W. (2010, March). Technology acceptability for medical assistance. In 2010 4th international conference on pervasive computing technologies for healthcare (pp. 1-9). IEEE. https://doi.org/10.4108/ICST.PERVASIVEHEALTH2010.8859

Published
2021-06-23
How to Cite
Milani, G., Demattè, G., Ferioli, M., Dallagà, G., Lavezzi, S., Basaglia, N., & Straudi, S. (2021). Telerehabiltation in Italy During the COVID-19 Lockdown: A Feasibility and Acceptability Study . International Journal of Telerehabilitation, 13(1). https://doi.org/10.5195/ijt.2021.6334
Section
Clinical Practice -COVID 19