International Journal of Telerehabilitation

Feasibility of Group Telerehabilitation for Older Adults: A Quality Improvement Project

Wed, 15 Jan 2025 00:00:00 -0500

A growing body of evidence suggests group rehabilitation may empower patients to achieve functional goals by leveraging social connectivity. From previous work, we adapted an in-person group for older Veterans to a telerehabilitation group called Fit for Life. The current quality improvement project aimed to evaluate the feasibility of implementing Fit for Life. Eligible Veterans lived in the community and were at risk for falls or hospitalization per functional performance measures. We used convergent parallel mixed methods approach in the evaluation. Eighteen Veterans ≥55 years old (all male, mean 77 years, 39% rural) received a referral to Fit for Life, two did not participate. We analyzed and integrated adaptations posed by clinicians and Veterans in real-time to enhance access to and participation in Fit for Life. Future work will explore clinical effectiveness, tools to identify patients most likely to benefit, and care delivery structures that integrate telerehabilitation groups for older Veterans.

Letter to the Editor – Update from Ukraine: Project Results in Oncology Telerehabilitation Approved at the National Cancer Institute and Showcased at the 4th National PM&R Congress

Kyrylo S. Malakhov — Wed, 15 Jan 2025 00:00:00 -0500

Telerehabilitation has emerged as a vital component of oncology care, particularly under challenging conditions where access to healthcare services may be restricted. This Letter to the Editor provides an update from Ukraine on a pioneering hybrid cloud-based platform designed for the patient-centered telerehabilitation of oncology patients. We summarize the project’s main outcomes, including the development of advanced AI-driven models, comprehensive methodological guidelines, and specialized software services. Notably, the platform underwent clinical approbation at the nonprofit organization “National Cancer Institute,” where its capacity for continuous patient monitoring, real-time data integration, and personalized rehabilitation interventions was demonstrated. Furthermore, the efficacy and innovation of this platform were showcased at the 4th National Congress of Physical and Rehabilitation Medicine in Ukraine, highlighting its potential to optimize resource allocation and improve patient outcomes. By merging mathematical and AI-based methods, the project underscores the importance of interdisciplinary collaboration in developing robust telerehabilitation ecosystems. We hope that this update contributes to the dialogue on expanding and refining telerehabilitation solutions globally, particularly in the realm of oncology care.

Editors' Note

Ellen R. Cohn, Jana Cason — Wed, 15 Jan 2025 00:00:00 -0500

Telehealth as a Substitute for a Usual Source of Care for Prescription Medications

David Shilane, Ashwathi Nair — Wed, 15 Jan 2025 00:00:00 -0500

This study investigates how effectively telehealth utilization (THU) can substitute for a usual source of care (USC) for taking prescription medication using data from the 2020-2022 National Health Interview Survey. We analyzed data for 69,581 patients. Of these, 5,994 patients (8.6%) lacked a USC. THU was 37.3% for patients with a USC and 15.8% for those without. For patients with no USC or THU, 25.4% had taken a prescription medication within 12 months, while patients with THU but no USC had a rate of 75.4%. In essentially all subgroups, telehealth was associated with substantially higher rates of taking prescription medications. Multivariate logistic regression showed that THU was associated with a 7.39-fold increase (95% CI: 6.19-8.84) in the odds of taking a prescription medication.

Exploring the Accessibility of Community-Based Telerehabilitation for Children with Disabilities from Low-Income Households

Wed, 15 Jan 2025 00:00:00 -0500

Community-Based Rehabilitation (CBR) is a rights-based approach that aims to provide equitable health services and participation opportunities for people with disabilities. Telerehabilitation has emerged as a potential methodology for delivering health care within the CBR framework. However, the accessibility of telerehabilitation presents unique challenges for children with disabilities (CWD) in communities with low socioeconomic status. This phenomenological qualitative study explores the barriers and facilitators that influence the participation of families of CWD in telerehabilitation as a method of CBR in urban poor communities. Nine focus group discussions (FGDs) were conducted involving 75 primary caregivers of CWD. Inductive thematic analysis using NVivo software was employed to analyze the collected data, revealing four themes that impact participation in Telerehabilitation: Economic and Social Resources, Self-Competency Affecting Transition, Flexible Service Delivery Mechanism, and Safety and Security as a Threat to Participation. The findings emphasize the intricate interplay of factors influencing the accessibility of telerehabilitation services for CWD from low-income households. Actionable strategies to address these challenges include providing affordable technology and internet access, offering training and support to families, developing culturally sensitive resources, establishing safety protocols, and advocating for inclusive policies and funding mechanisms. Collaboration among healthcare professionals, policymakers, and families is essential in building a resilient and equitable healthcare system that prioritizes the needs of CWD living in poverty. The insights gained from this study can inform the development of targeted interventions and support systems to ensure that no child is left behind in accessing quality care despite the digital and socioeconomic divides.

Telerehabilitation Policy Report: Interprofessional Policy Principles and Priorities

Wed, 15 Jan 2025 00:00:00 -0500

While the public health emergency is over, telehealth and telepractice will continue to play a pivotal role in supporting health equity for diverse and vulnerable individuals in underserved communities. The American Occupational Therapy Association, the American Physical Therapy Association, the American Speech-Language-Hearing Association, and the American Telemedicine Association are professional associations representing the interests of more than 564,000 rehabilitation services professionals in the United States. These organizations have shared priorities including legislative, regulatory, and state-based advocacy efforts. Continued advocacy and promotion by professional organizations, providers and patients alike is necessary to ensure that all rehabilitation providers are included in any telehealth lists of federally and state approved providers. In addition, key health care industry stakeholders want telehealth to be a permanent option for care delivery and ensure that telehealth will remain widely available to support health equity and access to critical rehabilitation services for all.

Describing Caregiver and Clinician Experiences with Pediatric Telerehabilitation Across Clinical Disciplines

Wed, 15 Jan 2025 00:00:00 -0500

Scope: This study describes the high and low points of caregiver and clinician experiences with pediatric telerehabilitation with consideration for the sustainable adoption of pediatric telerehabilitation beyond the COVID-19 pandemic context.

Methods: As part of a larger study, this project analyzed data from qualitative interviews to describe caregivers’ (n = 27) and clinicians’ (n = 27) experiences with pediatric telerehabilitation.

Findings: Caregiver and clinician experiences with pediatric telerehabilitation are described according to four touchpoints identified: (1) child engagement in telerehabilitation; (2) perceived value of telerehabilitation services and caregiver engagement; (3) preparing the people and environment for telerehabilitation services; (4) fit of using a telerehabilitation model; and (5) providing family with choice.

Discussion: Findings highlight the importance of being informed about the telerehabilitation service model, feeling prepared for telerehabilitation appointments and being responsive to families’ choice. Recommendations to address these areas are discussed.

Identifying the Added Value and Requirements of Telerehabilitation in Home-based Geriatric Rehabilitation: An Exploratory Qualitative Study

Wed, 15 Jan 2025 00:00:00 -0500

Geriatric rehabilitation (GR) facilities are turning to innovative tools such as telerehabilitation to support home-based treatment due to challenges with population ageing, staff shortages, and mounting budgetary pressures. This study identified the potential added value as well as the requirements of using telerehabilitation in home-based GR, according to stakeholders and potential end-users. This exploratory qualitative study design conducted semi-structured interviews among nineteen care professionals, three patients and one informal caregiver. The qualitative data from these interviews were transcribed verbatim and analysed with inductive content analysis. Interviewees indicated multiple added values and requirements for telerehabilitation in home-based GR. Overall, there was great emphasis on blended care implementation,
in which telerehabilitation is used in conjunction with in-person care. It is recommended to use the present findings towards developing and implementing a telerehabilitation intervention in home-based GR and assess its feasibility and usability.

Physiotherapy Professionals: A Questionnaire for the Evaluation of Telerehabilitation Services in Egypt

Wed, 15 Jan 2025 00:00:00 -0500

Purpose: This study aimed to evaluate the utilization of telerehabilitation services in Egypt and to investigate the concerns and barriers faced by Egyptian physiotherapists for implementation. Methods: This cross-sectional study recruited 306 Egyptian physiotherapists who were asked to complete an online survey including questions about the utilization of telerehabilitation services, awareness, perception, and attitude. Results: A total of 299 physiotherapists completed the online survey. Within the sample, 38.5% utilized telerehabilitation at work. Telerehabilitation was used frequently to deliver patient advice (17.6%), follow-up (16%), and exercise prescription (15.2%). Pain (16.2%) was the most common outcome assessed utilizing telerehabilitation. Additionally, 85.3% of physiotherapists agreed that the inclusion of telerehabilitation during the rehabilitation program is effective. The main barriers to implementing telerehabilitation in Egypt were lack of awareness (59.9%) and technical issues (58.2%). Conclusion: This study sheds light on the trends and challenges in utilizing telerehabilitation and may help in shaping the future of telerehabilitation in Egypt.

Use and Perceptions of Telehealth by Pediatric Occupational Therapists Post COVID-19 Pandemic

Wed, 15 Jan 2025 00:00:00 -0500

Telehealth was widely adopted in pediatric occupational therapy practice during the COVID-19 pandemic; however, there is limited knowledge on telehealth use post-pandemic. This study collected 132 responses to a mixed-methods survey from March-October 2023 to explore pediatric occupational therapists’ current use and perceptions on telehealth. Results indicated that over half of respondents continue to use telehealth. Frequency of use was differentiated by setting, with a significantly lower proportion of school-based respondents using telehealth compared to outpatient (p<.001) or early intervention (p<.001). The median rate of use was low with 10% of services delivered via telehealth. Respondents view telehealth as moderately effective and satisfactory. Rationale for use of telehealth included parent coaching, access to the natural environment, caregiver involvement, travel convenience, and to accommodate family illness. Challenges included lack of child engagement, limited parent involvement, and regulatory barriers.

Addressing Occupational Dysfunction via Telehealth: A Scoping Review

James T. Foster , Mary Zadnik — Wed, 15 Jan 2025 00:00:00 -0500

Background: This review aims to identify how telehealth was utilized to address occupational dysfunction during the COVID-19 pandemic period. Methods: A scoping review following Arksey and O’Malley’s stages was utilized to explore appropriate research. The scoping review covered articles from January 2020 to December 2022. Results: A total of 23 articles are included in this scoping review which include 15 from the adult age group and eight from the pediatric. Conclusions: The use of telehealth during the COVID-19 pandemic has been shown to improve occupational dysfunction, both within the adult and pediatric settings. Further research is needed to demonstrate the effectiveness of the use of telehealth to address occupational dysfunction.

Self-determination Theory as a Lens to Explore the Implementation Challenges of Telehealth

Yafit Gilboa, Michal Pagis, Kathleen Lyons — Wed, 15 Jan 2025 00:00:00 -0500

Many benefits can be gained from telehealth, including reduced travel time, flexible work schedules, increased patient satisfaction, and a cost-effective method of providing care. Furthermore, telehealth provides rehabilitation professionals with the opportunity to observe people in their natural environment as they conduct their daily activities and identify any barriers to their functioning. Despite these advantages, and after a substantial amount of research supporting its effectiveness, telehealth remains relatively underutilized.

Self-determination theory (SDT) is a theoretical framework for explaining motivation in terms of three basic psychological needs: competence, relatedness, and autonomy. Using the SDT, we suggest analyzing the motivational challenges faced by the therapists when implementing telehealth.

We assert that the transition to a remote treatment model can be advantageous for rehabilitation professionals since it provides them with a greater degree of autonomy. Nevertheless, a turning point can only be achieved if relatedness and competence are maintained.