Why is Now the Time to Embrace Telerehab in Your Care?
Telehealth has been around for years, but it has now become significantly more widely-used due to COVID-19. There was a considerable increase in the use of telehealth during the pandemic in 2020 as seen by how telehealth claim lines increased 2,980% nationally from September 2019 to September 2020, according to data from FAIR Health’s Monthly Telehealth Regional Tracker. It is no surprise telehealth use has increased, as patients want to have access to quality medical care from the safety of their homes. This is especially true for people with neurological impairments, who are considered high-risk for more severe COVID-19 symptoms. Although telehealth technology has increased, legislation and payment models have been one of the factors that have made telehealth challenging in the past. New tools and platforms are here to help the transition to bringing quality rehabilitative care to each patient's home. If you are thinking about embracing telerehab as part of your plan of care, here are some considerations for making the addition as easy as possible.
History
Telehealth started around 20 years ago, and, thanks to incredible improvements in technology since then, has expanded. This expansion has led to easier access to health professionals for some patients. Synchronous telerehabilitation, sometimes shortened to telerehab, is the real-time, on-demand delivery of rehabilitation services to a patient or client by a rehab professional over telecommunications or the internet. Some companies or health care institutions have been using telerehab for many years, even prior to the pandemic in 2020.
Benefits of telerehab
The use of telerehab has many benefits. For some, telerehab can provide a service to people that would otherwise not be able to receive the service due to geographic location or difficulty getting to therapy appointments. While there is support for seeing patients in the clinic, there are some patients who may prefer to exercise in their homes. Providing a telerehab option would also allow some people to not have to travel to appointments and navigate the difficulties of parking or transportation. And, until COVID-19 is better controlled, telerehab would decrease exposure to a virus that could have horrific effects for people at high-risk for life-threatening symptoms.
Providing telerehab would help to fill in the gaps that can sometimes occur during the transition from one rehab setting to another by ensuring patients are continuously followed. This could also have an impact on lowering the risk of hospital readmission. A study by Sarfo, et al in 2018 found that telerehab interventions have either better or equal effects on motor, cognitive, and mood disorders compared to traditional in-person therapy for people post-stroke. A similar study by Khan, et al in 2015 found that there is some evidence that telerehab can improve functional activities in persons with Multiple Sclerosis. Some research shows patients who engage in telerehab services could have better adherence to exercise programs because they are being followed outside of the clinic or hospital setting. A study by Rimmer, et al supports this by finding “that home-based tele-exercise interventions can achieve better participant adherence than conventional onsite exercise programs, leading to better health benefit”. Participants in the study reported that convenience and easy access to a health professional improved their motivation. Therefore, exercise and adherence to lifestyle modification could prevent a secondary decline in function due to inactivity.
There is also a benefit to being able to do an assessment in a person’s own environment instead of a clinic. And telerehab offers the option for a holistic approach to patient care, including incorporating education, sensor data collection, and regular structured interactions with therapists.
Considerations for telerehab
While telerehab has many pros, it is not without some considerations. Some people may not be ready to incorporate telerehab into the plans of care, for various reasons, and it is the duty of therapists to make an informed decision, in collaboration with their patient, on whether or not to implement telerehab. Also, a perceived barrier exists in our society as to how physical therapists can provide therapy without touch, so it is important to educate people on how this can be done. There is also the responsibility of the therapist to determine which tests and measures would be safe to perform via telerehab due to the inability to provide hands-on assistance. Another factor to consider is some patients may miss the in-person interaction with other patients and with therapists that occurs naturally in a clinic setting, but perhaps we could explore new ways to connect patients. Lastly, the lack of ability to reach some people due to limited technology and the question of potential lack of exercise equipment or space in the home is to be considered, and these would need to be addressed on an individual basis.
Telerehab for a better health outcome
A final benefit of telerehab services is the ability to enhance self-efficacy for physical activity engagement. Speaking from the perspective of a physical therapist, one of the goals is to maximize the abilities of patients. Therefore, by incorporating telerehab we are showing our patients that they can exercise safely without someone standing right next to them. Improved self-efficacy and self-management can lead to improved quality of life and better health outcomes, which can lead to decreased strain on our health economy. So, given the ongoing pandemic, advancements in technology and some research to suggest telerehab is beneficial there is no better time than now to consider incorporating telerehab into your care.
About the Authors:
Lisa Donahue, PT, MPT, NCS is Director of Clinical Services at Evolution Devices. She is a physical therapist with 13 years of experience treating in a variety of clinical settings. She received her Neurologic Clinical Specialist certification from the American Board of Physical Therapy Specialists in 2016.
Pierluigi Mantovani is the co-founder and CEO of Evolution Devices. Pierluigi is a healthcare entrepreneur and a former Neuroscience researcher at UCSF. Pierluigi received his BA in Cognitive Science from UC Berkeley. He was inspired to build Evolution Devices initially to help his father, who lives with Multiple Sclerosis. Pierluigi and The Evolution Devices team have been recognized by the NIH, NSF, and the Toyota Mobility Foundation for their innovations.
Sources:
https://www.fairhealth.org/states-by-the-numbers/telehealth
