Telehealth in Physical Medicine and Rehabilitation: A Narrative Review

Agreement between 3D Motion Analysis and Tele-Assessment Using a Video Conferencing Application for Telerehabilitation

The global pandemic of the coronavirus disease 2019 (COVID-19) has highlighted the need for remote healthcare services. This study aimed to evaluate the concurrent validity and reliability of tele-assessment using 3D motion analysis and video conferencing applications. The subjects of this study were 14 Pilates instructors and 14 healthy adults, who repeated five exercises of “side spine stretch”, “bridge”, “toe taps”, “quadruped leg raise”, and “cat and cow” five times each. We performed 3D kinematic analysis with 16 infrared cameras while the subject performed each exercise, and the image captured by one webcam was transmitted to the evaluators through a video conferencing application, and eight raters evaluated the mobility, stability, and symmetry of the movement. The result was then compared with the gold standard 3D motion analysis to evaluate the teleassessment system. The concurrent validity of the data obtained using both methods was analyzed. In addition, the inter-rater reliability of the data from the eight raters was evaluated. As a result, mobility showed excellent (ICC > 0.75, ICCs: intraclass correlation coefficients) or good agreement (ICC = 0.6–0.74) with 3D motion analysis and tele-assessment in all motions. The analysis of stability showed high agreement in general, but it was not significant in “cat and cow.” Symmetry showed moderate agreement only in “bridge” and “toe taps”, showing low agreement compared to other components. In addition, the inter-rater reliability of the tele-assessment showed good agreement (ICC = 0.744). Although there were few components with weaker agreements, the results of this study confirmed that it is a valid and reliable method of tele-assessment using video conferencing applications and showed feasibility as an alternative to the existing face-to-face examination.

Inpatient telehealth experience of limited English proficient patients: a cross-sectional survey and semi-structured interview (Preprint)

Background

Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians.

Objective

This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth.

Methods

We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth.

Results

A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access.

Conclusions

Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP.

Factors Affecting the Delivery and Acceptability of the ROWTATE Telehealth Vocational Rehabilitation Intervention for Traumatic Injury Survivors: A Mixed-Methods Study

Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. Methods: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP); interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. Results: Surveys: pre-training, the only barrier was therapists’ intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access); beliefs about capabilities (e.g., building rapport, complex assessments, knowledge/confidence, third-party feedback and communication style); optimism (e.g., impossible assessments, novel working methods, perceived importance and patient/therapist reluctance) and social/professional role/identity (e.g., therapeutic methods). Training and experience of intervention delivery addressed some barriers and increased facilitators. The intervention was acceptable to trauma survivors and therapists. Conclusion: Despite training and experience in intervention delivery, some barriers remained. Providing some face-to-face delivery where necessary may address certain barriers, but strategies are required to address other barriers.

Low hospital mobility-resurgence of an old epidemic within a new pandemic and future solutions

Low mobility during hospitalization poses risks of functional decline and other poor outcomes for older adults. Given the pervasiveness of this problem, low mobility during hospitalization was first described as ‘dangerous’ in 1947 and later described as an epidemic. Hospitals have made considerable progress over the last half-century and the last two decades in particular, however, the COVID-19 pandemic presents serious new challenges that threaten to undermine recent efforts and progress towards a culture of mobility. In this special article, we address the question of how to confront an epidemic of immobility within a pandemic. We identify 4 specific problems for creating and advancing a culture of mobility posed by COVID-19: social distancing and policies restricting patient movement, personnel constraints, PPE shortages, and increased patient hesitancy to ambulate. We also propose 4 specific solutions to address these problems. These approaches will help support a culture of healthy mobility during and after hospitalization and help patients to keep moving during the pandemic and beyond.

A Multicenter Evaluation of the Feasibility, Patient/Provider Satisfaction, and Value of Virtual Spine Consultation During the COVID-19 Pandemic

Objective

To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic.

Methods

Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected.

Results

A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation.

Conclusions

This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.

A Pilot Study Delivering Physiotherapy Support for Rett Syndrome Using a Telehealth Framework Suitable for COVID-19 Lockdown

Background: Rett syndrome (RTT) is a genetically caused neurodevelopmental disorder associated with severe disability. We assessed the feasibility of a telehealth program supporting gross motor skills in RTT.Methods: Five girls with RTT were assessed and a home-based exercise program developed in response to functional goals. Families then participated in monthly Skype sessions for 6 months, guided by a physiotherapist to monitor progress and adjust the program as necessary. Goal Attainment Scaling was used to evaluate progress and a parental satisfaction questionnaire was administered.Results: Four goals were established for each participant and progress was greater than would be expected in 16 of 20 goals. Parents evaluated the program as feasible and useful for their daughters.Discussion: A telehealth model of home-based intervention supported individuals with RTT to achieve gross motor skills and was found to be feasible. This model is important at present times during COVID-19 outbreak and lockdown.

Use of Telemedicine for subspecialty support in the NICU setting

The regionalization of neonatal care was implemented with an overarching goal to improve neonatal outcomes.¹ This led to centralized neonatal care in urban settings that jeopardized the sustainability of the community level 2 and level 3 Neonatal Intensive Care Units (NICU) in medically underserved areas.² Coupled with pediatric subspecialist and allied health professional workforce shortages, regionalization resulted in disparate and limited access to subspecialty care.^3-6 Innovative telemedicine technologies may offer an alternative and powerful care model for infants in geographically isolated and underserved areas. This chapter describes how telemedicine offerings of remote pediatric subspecialty and specialized programs may bridge gaps of access to specialized care and maintain the clinical services in community NICUs.

Delivering Virtual Cancer Rehabilitation Programming During the First 90 Days of the COVID-19 Pandemic: A Multimethod Study

OBJECTIVE

To describe the adaptations made to implement virtual cancer rehabilitation at the onset of the coronavirus disease 2019 pandemic, as well as understand the experiences of patients and providers adapting to virtual care.

DESIGN

Multimethod study.

SETTING

Cancer center.

PARTICIPANTS

A total of 1968 virtual patient visits were completed during the study period. Adult survivors of cancer (n=12) and oncology health care providers (n=12) participated in semi-structured interviews.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Framework-driven categorization of program modifications, qualitative interviews with patients and providers, and a comparison of process outcomes with the previous 90 days of in-person care via referrals, completed visits and attendance, method of delivery, weekly capacities, and wait times.

RESULTS

The majority of program visits could be adapted to virtual delivery, with format, setting, and content modifications. Virtual care demonstrated an increase or maintenance in the number of completed visits by appointment type compared with in-person care, with attendance ranging from 80%-93%. For most appointment types, capacities increased, whereas wait times decreased slightly. Overall, 168 patients (11% of all assessments and follow-ups) assessed virtually were identified by providers as requiring an in-person appointment because of reassessment of musculoskeletal and/or neurologic impairment (n=109, 65%) and lymphedema (n=59, 35%). The interviews (n=24) revealed that virtual care was an acceptable alternative in some circumstances, with the ability to (1) increase access to care; (2) provide a sense of reassurance during a time of isolation; and (3) provide confidence in learning skills to self-manage impairments.

CONCLUSIONS

Many appointments can be successfully adapted to virtual formats to deliver cancer rehabilitation programming. Based on our findings, we provide practical recommendations that can be implemented by providers and programs to facilitate the adoption and delivery of virtual care.

Rapid Implementation of Telerehabilitation for Pediatric Patients During Covid-19

The COVID-19 pandemic necessitated a sudden limitation of in-person outpatient occupational and physical therapy services for most patients at a large, multisite pediatric hospital located in the Midwest, United States. To ensure patient and staff safety, the hospital rapidly shifted to deliver most of these services via telerehabilitation. The purposes of this study were to (1) describe the rapid implementation of telerehabilitation during the COVID-19 pandemic, (2) describe the demographic characteristics of patients who continued in-person services and those who received telerehabilitation, and (3) evaluate the therapists' perceptions of telerehabilitation for physical and occupational therapy. Most of the children (83.4% of n=1352) received telerehabilitation services. A family was more likely to choose to continue in-person visits if their child was <1-year-old, had a diagnosis of torticollis, received serial casting, or was post-surgical. Occupational and physical therapy therapists (n=9) completed surveys to discern their perceptions of the acceptability of telerehabilitation, with most reporting that telerehabilitation was as effective as in-person care.

Connecting People with People: Diagnosing Persons with Fetal Alcohol Spectrum Disorder Using Telehealth

Fetal alcohol spectrum disorder (FASD) is a diagnostic term used to describe an array of structural, neurocognitive, and behavioral effects that result from prenatal alcohol exposure. While ongoing efforts have been made to increase the capacity of communities to provide early FASD diagnosis, there continues to be on-going challenges, particularly for remote and rural communities. Telehealth is the use of technology to connect communities at a distance and has been effectively used in medicine for several decades. This literature review describes the use of telehealth in FASD and other developmental disabilities and makes recommendations for how telehealth can be used to facilitate the assessment and diagnosis of FASD in rural and remote communities.

Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study

BACKGROUND

Occupational therapy (OT) is a vital service that supports older adults' ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood.

OBJECTIVE

This study examines VHA OT practice using video telehealth with older veterans using an implementation framework.

METHODS

A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth.

RESULTS

Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0% response rate). Most were female (196/259, 75.7%) occupational therapists (281/305, 92.1%) with a master's degree (147/259, 56.8%) and 10 years or fewer (165/305, 54.1%) of VHA OT practice. Less than half (125/305, 41.0%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84%) and willingness to try innovative approaches (76/92, 83%).

CONCLUSIONS

Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians' attitudes to understand how they are driving the implementation of video telehealth.

Parking Meters to Touch Screens: The Unforeseen Barriers that Expansion of Telemedicine Presents to the Disability Community

ABSTRACT

Over 25% of annual health care expenditures in the United States are associated with the medical needs of people with disabilities. People with disabilities often experience inequalities with access to healthcare services, resulting in increased costs of living with disability. The economic burden of living with a disability results in nearly $400 billion spent annually from combined public and private payor sources. Historically, disparities in healthcare are associated with intersections between race, culture, and environmental factors. Minority status also plays a significant role in health outcomes and studies have highlighted the additional burdens faced at the junction of race and disability status. COVID-19 changed the landscape of healthcare delivery in the United States, resulting in a drastic increase in telehealth utilization. Traditional non-medical barriers to persons with disability, such as unforeseen parking fees, are documented in the literature. However, conditions surrounding access to the necessary technology required to participate in a telehealth driven medical landscape are less clear. This paper addresses the non-medical barriers and costs associated with living with a disability and discusses potential solutions in the evolving healthcare system.

Spine Examination during COVID-19 Pandemic via Video Consultation

INTRODUCTION

During the current COVID-19 pandemic video consultations are increasingly common in order to minimize the risk of infection for staff and patients. The aim of this study was to evaluate the feasibility of a spine examination via video.

METHODS

A total of 43 patients were recruited. Each participant underwent a video-based (VB) and a conventional face-to-face (FTF) spine examination. Pain intensity, active range of motion, inspection, a neurophysiologic basic exam and provocations tests were evaluated using video-based and face-to-face methods.

RESULTS

The intra-rater reliability (IRR) was measured between both examinations. Good to very good IRR values were obtained in inspection (Kappa between 0,752 und 0,944), active range of motion and basic neurophysiological examination (Kappa between 0,659 und 0,969). Only moderate matches were found in specific provocation tests (Kappa between 0,407 und 0,938). A video-based spine examination is a reliable tool for measuring pain intensity, active range of motion and a basic neurophysiologic exam.

CONCLUSION

A basic spine examination during a video consultation is possible. A good agreement of the test results between video-based and face-to-face examination could be found.

Telemedicine for Musculoskeletal Rehabilitation and Orthopedic Postoperative Rehabilitation

Telehealth visits result in high-quality care, with high patient and provider satisfaction. Strong evidence suggests that virtual physical therapy is noninferior to conventional face-to-face physical therapy for a variety of musculoskeletal disorders. Postoperative telerehabilitation has a strong positive effect on clinical outcomes, and the increased intensity telerehabilitation programs offer is a promising option for patients. Studies demonstrate effective virtual postoperative management. The novel coronavirus disease 2019 pandemic has led to improved reimbursement for telehealth visits and accelerated widespread implementation of telemedicine. This article establishes experience and evidence-based practice guidelines for conducting telemedicine visits, with emphasis on the virtual physical examination.

Experiences of telehealth e-mentoring within postgraduate musculoskeletal physical therapy education in the UK and Canada: a protocol for parallel mixed-methods studies and cross-cultural comparison

INTRODUCTION

Mentored clinical practice is central to demonstrating achievement of International Educational Standards in advanced musculoskeletal physical therapy. While traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative to offering this unique pedagogy to facilitate mentee critical reflection, deeper learning and enhanced knowledge translation to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to mentors often limited by geography or cost, the potential value of telehealth e-mentoring needs investigating. To investigate the experiences and outcomes of multiple stakeholders (student mentees, mentors and patients) engaged in musculoskeletal physical therapy telehealth e-mentoring across two universities (UK and Canada).

METHODS AND ANALYSIS

Using case study design, we will use sequential mixed methods involving qualitative and quantitative components based on existing evidence. To examine the influence of telehealth e-mentoring on health outcomes in patients with musculoskeletal complaints, we will use patient-reported outcomes for satisfaction, patient empowerment and change in musculoskeletal health. We will conduct semistructured interviews to explore the development of critical thinking, clinical reasoning, communication skills and confidence of students engaged in telehealth e-mentoring. To explore the mentor acceptability and appropriateness of telehealth e-mentoring, we will conduct a focus group in each site. Finally, we will include a focus group of participants from each site to allow a cross-cultural comparison of findings to inform international stakeholders. Quantitative data will be analysed using descriptive statistics (median and IQR) to describe changes in outcome data and qualitative data will be analysed following the Framework Method.

ETHICS AND DISSEMINATION

This study has ethical approval from both institutions: the University of Birmingham (ERN_20-0695) and Western University (2020-116233-47832). Findings will be published in a peer-reviewed journal and disseminated to key stakeholders in musculoskeletal physical therapy education and practice.

Telerehabilitation for Headache Management

Headache is one of the most disabling conditions in the world. Despite plentiful evidence supporting rehabilitation strategies, headache is significantly underassessed and undertreated. Obstacles to headache care include lack of available expertise in headache management, few available resources for effective assessment and treatment, and cost and disability that preclude treatment seeking in patients with headache. Telerehabilitation can allow providers to access expert consultation and gives patients easier access to assessment and treatment. This article covers existing telerehabilitation options for headache management and explores the strength of evidence supporting these approaches. Risks of telerehabilitation and recommendations for future development are discussed.

An Inertial Measurement Unit-Based Wireless System for Shoulder Motion Assessment in Patients with Cervical Spinal Cord Injury: A Validation Pilot Study in a Clinical Setting

Residual motion of upper limbs in individuals who experienced cervical spinal cord injury (CSCI) is vital to achieve functional independence. Several interventions were developed to restore shoulder range of motion (ROM) in CSCI patients. However, shoulder ROM assessment in clinical practice is commonly limited to use of a simple goniometer. Conventional goniometric measurements are operator-dependent and require significant time and effort. Therefore, innovative technology for supporting medical personnel in objectively and reliably measuring the efficacy of treatments for shoulder ROM in CSCI patients would be extremely desirable. This study evaluated the validity of a customized wireless wearable sensors (Inertial Measurement Units-IMUs) system for shoulder ROM assessment in CSCI patients in clinical setting. Eight CSCI patients and eight healthy controls performed four shoulder movements (forward flexion, abduction, and internal and external rotation) with dominant arm. Every movement was evaluated with a goniometer by different testers and with the IMU system at the same time. Validity was evaluated by comparing IMUs and goniometer measurements using Intraclass Correlation Coefficient (ICC) and Limits of Agreement (LOA). inter-tester reliability of IMUs and goniometer measurements was also investigated. Preliminary results provide essential information on the accuracy of the proposed wireless wearable sensors system in acquiring objective measurements of the shoulder movements in CSCI patients.

An Overview of Telehealth in Total Joint Arthroplasty

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians' ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.

The impact of COVID-19 on hand therapy practice

BACKGROUND

Hand therapists and health care providers across the spectrum have been profoundly impacted by COVID-19. Greater insight and information regarding how practitioners have been affected by this unparalleled pandemic is important.

PURPOSE

Survey research was performed to examine the impact of the COVID-19 pandemic on hand therapy practice.

STUDY DESIGN

Online survey research.

METHODS

Four constructs guided the development of the survey: psychosocial and financial impact; safety practice patterns; changes in current practice patterns; use of telehealth. The survey was distributed to members of the American Society of Hand Therapists from April 14, 2020 through May 4, 2020. Descriptive demographic data were obtained. Frequencies were examined using ChiSquare, correlations were examined using Spearman Correlation Coefficient, and means were compared via independent t-test.

RESULTS

A total of 719 members responded to the survey. Eighty-six percent of therapists reported feeling more stress than they did prior to the COVID-19 pandemic. This level of stress was similar across ages, practice settings, financial stability or instability, and geographical settings. Older therapists (r_s = 0.04) and those that practiced longer (r_s = 0.009) felt more comfortable with in-person treatment. Ninety-eight percent of therapists reported a decrease in caseload. Postoperative cases (P= .0001) and patients ages 19-49 were more likely to receive in-person treatment (P= .002). 46% of therapists reported providing telehealth services. Nontraumatic, nonoperative cases (P= .0001) and patients aged 65 or older were more likely to receive telehealth services (P= .0001). Younger therapists (r_s = 0.03) and therapists working in outpatient therapist owned, outpatient corporate owned, and outpatient academic medical centers (X² [4, N = 637] = 15.9463, P= .003) were more likely to utilize telehealth.

CONCLUSION

Stress was felt globally among hand therapy clinicians regardless of financial security or insecurity, age, practice area, or geographical setting. Therapists saw a drastic decrease in caseloads. In-person caseloads shifted primarily to postoperative cases.

STUDY DESIGN

Web based survey.

Patient and Provider-Reported Satisfaction of Cancer Rehabilitation Telemedicine Visits During the COVID-19 Pandemic

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has accelerated the growth of telemedicine services across the United States. In this study, we examined cancer rehabilitation patient and physician satisfaction with telemedicine visits. We also sought to evaluate the types of provider services that are given during telemedicine visits.

OBJECTIVE

To assess overall patient and provider satisfaction with telemedicine visits and explore whether satisfaction varied by contact method (phone or video) and encounter type (new problem, worsening problem, stable/improving problem).

DESIGN

Prospective survey study.

SETTING

Cancer rehabilitation program at an academic medical center.

PARTICIPANTS

Three cancer rehabilitation providers and 155 unique patients participated in the study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Provider and patient satisfaction measured by customized surveys.

RESULTS

One hundred eighty-four encounters with 169 unique patients were scheduled. Of these, 14 were new visits and 170 were follow-up visits. Eighteen encounters (9.8%) were either no shows or rescheduled, making for 166 encounters with 155 unique patients. Patient and provider responses comprised the following: 94.8% of patient responses reported "quite a bit" or "very much" for the telemedicine visit being a good experience; 63.1% of patient responses reported "quite a bit" or "very much" for interest in using telemedicine visits in the future; and 83.9% of provider responses reported "quite a bit" or "very much" for the patient's main problem being addressed by the visit. Providers were more likely to prefer an in-person visit for a new or worsening problem versus a stable/improving problem. The most common services provided were medication prescription/titration and education/counseling. The least common services provided were making of new diagnoses, ordering interventional procedures, and making referrals.

CONCLUSION

Telemedicine visits were well received by both patients and providers in a cancer rehabilitation medicine clinic setting. However, in the case of a new or worsening problem, satisfaction declined. These data support that telemedicine visits should be considered essential as part of comprehensive cancer rehabilitation care, especially during a public health crisis.

Changes in Interventional Pain Physician Decision-Making, Practice Patterns, and Mental Health During the Early Phase of the SARS-CoV-2 Global Pandemic

Background and Objectives

The novel coronavirus outbreak (SARS-CoV-2) began in late 2019 and dramatically impacted health care systems. This study aimed to describe the impact of the early phase of the pandemic on physician decision-making, practice patterns, and mental health.

Methods

An anonymous survey was distributed to physician members of the Spine Intervention Society (SIS) on March 24 and April 7, 2020. Respondents provided information regarding changes in clinical volume, treatment, and mental health (Patient Health Questionnaire [PHQ-4]) before April 10, 2020.

Results

Of the 1,430 individuals who opened the survey, 260 completed it (18.2%). Overall clinical and procedural volume decreased to 69.6% and 13.0% of prepandemic volume, respectively. Mean in-person clinic visits were reduced to 17.7% of total prepandemic clinic volume. Ongoing clinical visits were predominantly completed via telemedicine (video) or telephone (74.5%), rather than in-person (25.5%). Telemedicine and telephone visits represented 24.6% and 27.3% of prepandemic clinical volume, respectively. Respondents decreased in-person visits of select groups of high-risk patients by 85.8–94.6%. Significantly more providers reported increasing rather than decreasing prescriptions of the following medications: opioids (28.8% vs 6.2% of providers, P < 0.001), muscle relaxants (22.3% vs 5.4%, P < 0.001), neuropathic pain medications (29.6% vs 3.8%, P < 0.001), and acetaminophen (26.2% vs 4.2%, P < 0.001). Respondents’ mean PHQ-4 score was 3.1, with 19% reporting moderate or severe psychological distress. Several demographic factors were significantly associated with practice changes.

Conclusions

The novel coronavirus pandemic dramatically altered the practice and prescribing patterns of interventional pain physicians.

Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services

Objective

Telerehabilitation has long been recognized as a promising means of providing pediatric services; however, significant barriers such as cost, payor reimbursement, and access prevented widespread use. The advent of the COVID-19 pandemic necessitated rapid adoption of telerehabilitation into clinical practice to provide access to care while maintaining social distancing. The purpose of this study is to present clinical data on the feasibility and acceptability of speech-language pathology, developmental occupational and physical therapies, and sports and orthopedic therapies telerehabilitation delivered in a pediatric hospital setting.

Methods

Telerehabilitation services were rapidly implemented in three stages: building the foundation, implementing, and refining this service delivery model. Paper patient satisfaction surveys were administered as part of ongoing quality improvement efforts throughout 2019 and were adapted for online administration in 2020 for telerehabilitation patients. Outpatient visit counts by type (in-person, phone, and video) were extracted from the electronic medical record using data warehousing techniques.

Results

Historical patient satisfaction rates from 2019 indicated high patient satisfaction (98.97% positive responses); these results were maintained for telerehabilitation visits (97.73%), indicating that families found telerehabilitation services acceptable. Patient volume returned to 73.5% of pre-pandemic volume after the implementation of telerehabilitation services.

Conclusions

Pediatric telerehabilitation is feasible to provide in clinical settings, and the services are acceptable to patient families. Future work is needed to evaluate the impact of telerehabilitation services on patient care and applications for ongoing use of this delivery model.

Spasticity Outpatient Evaluation via Telemedicine: A Practical Framework

The COVID-19 global pandemic has resulted in significant changes to delivery of care in the field of physiatry. Most prominently, in-person visits have fast tracked to virtual visits. As we are forced to quickly adopt this new technology for our doctor-patient interactions, many questions remain with regard to structuring telemedicine visits for optimal outcomes. Little has been written on virtual evaluations of patients with spasticity. The intent of this article was to provide a framework for conducting a virtual spasticity assessment via telemedicine. We will provide tips on how to conduct a person-centered virtual examination assessment and how to document goals related to the virtual assessment.

Differences Between Neurosurgical Subspecialties in Telehealth Adoption

OBJECTIVE

The health care field has been faced with unprecedented challenges during the COVID 19 pandemic. One such challenge was the implementation of enhanced telehealth capabilities to ensure continuity of care. In this study, we aim to understand differences between subspecialties with regard to patient consent and satisfaction following telehealth implementation.

METHODS

A retrospective review of the electronic medical record was performed from March 2 to May 8, 2020 to evaluate surgical consents before and after telehealth implementation. Press Ganey survey results were also obtained both pre- and posttelehealth implementation and compared.

RESULTS

There was no significant difference in the percentage of new patients consented for surgery (after being seen via telehealth only) between the cranial and spine services. For procedures in which >10 patients were consented for surgery, the highest proportion of patients seen only via telehealth was for ventriculoperitoneal shunt placement/endoscopic third ventriculostomy for the cranial service, and lumbar laminectomy and microdiscectomy for the spine service. Additionally, the spine service experienced marked improvement in Press Ganey scores posttelehealth implementation with overall doctor ranking improving from the 29th to the 93rd percentile, and likelihood to recommend increasing from the 24th to the 94th percentile.

CONCLUSIONS

There were clear trends with regard to which pathologies and procedures were most amenable to telehealth visits, which suggests a potential roadmap for future clinic planning. Additionally, the notable improvement in spine patient satisfaction following the implementation of a telehealth program suggests the need for long-term process changes.

A 'new normal' following COVID-19 and the economic crisis: Using systems thinking to identify challenges and opportunities in disability, telework, and rehabilitation

BACKGROUND

The novel coronavirus (COVID-19) that emerged in late 2019, and later become a global pandemic, has unleashed an almost unprecedented global public health and economic crisis.

OBJECTIVE

In this perspective, we examine the effects of COVID-19 and identify a likely 'new normal' in terms of challenges and opportunities within the fields of disability, telework, and rehabilitation.

METHODS

We use a systems thinking lens informed by recent empirical evidence and peer-reviewed qualitative accounts regarding the pandemic to identify emerging challenges, and pinpoint opportunities related to health and changing employment infrastructure of people with disabilities and rehabilitation professionals.

RESULTS

From our interpretation, the key leverage points or opportunities include: (1) developing disability-inclusive public health responses and emergency preparedness; (2) enabling employment and telework opportunities for people with disabilities; (3) addressing the new requirements in rehabilitation service provision, including participating as essential team members in the care of people with infectious diseases such as COVID-19; (4) embracing the added emphasis on, and capacity for, telehealth; and (5) developing greater resilience, distance learning, and employability among the rehabilitation workforce.

CONCLUSIONS

The COVID-19 pandemic has become increasingly challenging to the lives of people with disabilities and rehabilitation professionals; however, key challenges can be minimized and opportunities can be capitalized upon in order to 'build back better' after COVID-19.

The Virtual Shoulder and Knee Physical Examination

The COVID-19 crisis has forced a sudden and dramatic shift in the way that clinicians interact with their patients, from outpatient encounters to telehealth visits utilizing a variety of internet-based videoconferencing applications. Although many aspects of pre–COVID-19 outpatient sports medicine care will ultimately resume, it is likely that telehealth will persist because of its practicality and because of patient demand for access to efficient and convenient health care. Physical examination is widely considered a critical obstacle to a thorough evaluation of sports medicine patients during telehealth visits. However, a closer reflection suggests that a majority of the examination maneuvers are possible virtually with limited, if any, modifications. Thus, we provide a comprehensive shoulder and knee physical examination for sports medicine telehealth visits, including (1) verbal instructions in layman’s terms that can be provided to the patient before or read verbatim during the visit, (2) multimedia options (narrated videos and annotated presentations) of the shoulder and knee examination that can be provided to patients via screen-share options, and (3) a corresponding checklist to aid in documentation.

Acceptance of Rehabilitation Technology in Adults With Moderate to Severe Traumatic Brain Injury, Their Caregivers, and Healthcare Professionals: A Systematic Review

BACKGROUND

Moderate to severe traumatic brain injuries (TBIs) commonly result in persistent physical, cognitive, and/or emotional deficits that require long-term rehabilitation. Technology-enabled rehabilitation provides an innovative alternative to traditional intervention models. End-user acceptance of these interventions, however, is a critical factor in determining the effective implementation and acceptance of these technologies.

OBJECTIVE

To systematically review the literature to identify methods and measures used to evaluate user acceptance relating to rehabilitation technologies for adults with moderate to severe TBI, their caregivers, and healthcare professionals.

METHODS

Six key databases including Medline, Embase, CINAHL, Cochrane, Scopus, and Web of Science were searched using the relevant search terms.

RESULTS

From a yield of 2059 studies, 13 studies met the eligibility criteria. The review revealed limited research that formally evaluated user acceptance in relation to rehabilitation technologies designed for adults with TBI. Furthermore, where such evaluations were conducted, comprehensive research designs incorporating theoretical frameworks of technology acceptance were sparse. Importantly, a range of technologies and recommendations that positively influenced user acceptance were identified. Future directions for research in this area include the use of theory-driven research designs to enhance our understanding of technology acceptance, to support the development of rehabilitation technologies that maximize functional outcomes for individuals with TBI.

[Rehabilitation during the lockdown]

The health system is facing a global pandemic due to coronavirus disease 2019. Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organization advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on coronavirus disease 2019 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions.

CaRE @ Home: Pilot Study of an Online Multidimensional Cancer Rehabilitation and Exercise Program for Cancer Survivors

BACKGROUND

Although facility-based cancer rehabilitation and exercise programs exist, patients are often unable to attend due to distance, cost, and other competing obligations. There is a need for scalable remote interventions that can reach and serve a larger population.

METHODS

We conducted a mixed methods pilot study to assess the feasibility, acceptability and impact of CaRE@Home: an 8-week online multidimensional cancer rehabilitation and exercise program. Feasibility and acceptability data were captured by attendance and adherence metrics and through qualitative interviews. Preliminary estimates of the effects of CaRE@Home on patient-reported and physically measured outcomes were calculated.

RESULTS

A total of n = 35 participated in the study. Recruitment (64%), retention (83%), and adherence (80%) rates, along with qualitative findings, support the feasibility of the CaRE@Home intervention. Acceptability was also high, and participants provided useful feedback for program improvements. Disability (WHODAS 2.0) scores significantly decreased from baseline (T1) to immediately post-intervention (T2) and three months post-intervention (T3) (p = 0.03 and p = 0.008). Physical activity (GSLTPAQ) levels significantly increased for both Total LSI (p = 0.007 and p = 0.0002) and moderate to strenuous LSI (p = 0.003 and p = 0.002) from baseline to T2 and T3. Work productivity (iPCQ) increased from T1 to T3 (p = 0.026). There was a significant increase in six minute walk distance from baseline to T2 and T3 (p < 0.001 and p = 0.010) and in grip strength from baseline to T2 and T3 (p = 0.003 and p < 0.001).

CONCLUSIONS

Results indicate that the CaRE@Home program is a feasible and acceptable cancer rehabilitation program that may help cancer survivors regain functional ability and decrease disability. In order to confirm these findings, a controlled trial is required.

Telerehabilitation: Development, Application, and Need for Increased Usage in the COVID-19 Era for Patients with Spinal Pathology

The coronavirus disease 2019 (COVID-19) pandemic has triggered governments worldwide to implement severe restrictions on physical therapy protocols in order to better control the spread of the virus. One of the mechanisms of providing physical therapy patient care during this era is via telemedicine. Telerehabilitation or telerehab is a technological visual-audio system that serves patients, including those with a spine injury, ailment, or postoperatively, with neurological deficits. In this scoping review, we discuss the development of telerehab, the technological advances in the field, and the usage of telerehab specifically pertaining to spine patients, and comment on the advancement of telerehab in the time of COVID-19. There is preliminary evidence that suggests that the adoption of telerehab in lieu of face-to-face interventions is beneficial for reducing pain and improving physical function in patients afflicted with chronic nonmalignant musculoskeletal pain from low back pain, lumbar stenosis, neck pain, and osteoarthritis. Availability is important, as the necessary technology should be accessible to all participants. Safety and security should be addressed, as the passage of patient data over the Internet requires secure confidentiality. Ease-of-use is crucial to promote practicality, user-friendly operation, and adherence to therapy. The combination of evidence-based methodologies with cost-effective services will serve as a basis for the further expansion of vital telerehab services and increases reimbursement by health insurance providers.

The Telemedicine Musculoskeletal Examination

Telemedicine uses modern telecommunication technology to exchange medical information and provide clinical care to individuals at a distance. Initially intended to improve health care for patients in remote settings, telemedicine now has a broad clinical scope with the general purpose of providing convenient, safe, and time- and cost-efficient care. The coronavirus disease 2019 pandemic has created marked nationwide changes in health care access and delivery. Elective appointments and procedures have been canceled or delayed, and multiple states still have some degree of shelter-in-place orders. Many institutions are now relying more heavily on telehealth services to continue to provide medical care to individuals while also preserving the safety of health care professionals and patients. Telemedicine can also help reduce the surge in health care needs and visits as restrictions are lifted. In recent weeks, there has been a significant amount of information and advice on how to best approach telemedicine visits. Given the frequent presentation of individuals with musculoskeletal complaints to the medical practitioner, it is important to have a framework for the virtual musculoskeletal physical examination. This will be of importance as telemedicine continues to evolve, even after coronavirus disease 2019 restrictions are lifted. This article will provide the medical practitioner performing a virtual musculoskeletal examination with a specific set of guidelines, both written and visual, to enhance the information obtained when evaluating the shoulder, hip, knee, ankle, and cervical and lumbar spine. In addition to photographs, accompanying videos are included to facilitate and demonstrate specific physical examination techniques that the patient can self-perform.

Telemedicine During COVID-19 for Outpatient Sports and Musculoskeletal Medicine Physicians

Introduction

The global pandemic due to SARS‐CoV‐2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described.

Objective

To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic.

Design

Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020‐17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey.

Primary Outcome Measures

Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine.

Results

Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow‐up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as “excellent” or “very good” across measures (91.6%‐95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no‐show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues.

Conclusions

In summary, rapid expansion of telemedicine during the COVID‐19 pandemic was well‐received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.

Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic

Background

The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services.

Aim

The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template.

Results

eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education.

Conclusion

teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.

Clinicians' Initial Experiences of Transition to Online Interdisciplinary Pain Rehabilitation During the Covid-19 Pandemic

Objective

Public health legislation during the CO-VID-19 pandemic has resulted in forced transitioning to the use of remote care in order to continue the provision of pain rehabilitation worldwide. The objective of this study was to gain insight into clinicians’ initial experiences with the provision of interdisciplinary pain rehabilitation via videoconferencing.

Design

Observational, cross-sectional design.

Participants

Twelve team members (specialists in rehabilitation medicine -MD-, psychologists, physiotherapists and occupational therapists) from a tertiary expertise centre in pain rehabilitation.

Methods

Quantitative and qualitative data were collected via a digital survey. Theme-based content analysis was performed for qualitative data.

Results

The themes that emerged were: the compulsory context; prerequisites for proper use of videoconferencing methods, which are strongly associated with the clinicians’ experiences; changes experienced in specific components of pain rehabilitation; and overarching changes experienced, including opportunities and limitations (sub-themes: therapeutic relationship, system involvement, efficiency, hands-on possibilities, interdisciplinary teamwork, and formalities). Overall, clinicians expressed moderate agreement with the statements that the quality of the pain rehabilitation programme can be maintained using videoconferencing, and that the COVID-19 pandemic offers opportunities for growth and innovation in telehealth.

Conclusion

It is feasible to provide valid and satisfactory pain rehabilitation via videoconferencing. This study identified facilitators and barriers to the use of videoconferencing, and great potential for integrating aspects of telehealth into standard care after the pandemic.

Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan

The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 (COVID-19). The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients' needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.

Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field

OBJECTIVE

The purpose of this paper is to describe the rapid deployment of telehealth, particularly real time video conference, for chiropractic services as a response to COVID-19.

METHODS

Two health centers at 2 campuses of a large California corporation have chiropractic care integrated into physical medicine services. Care was suspended beginning on March 17, 2020 to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among patients and staff. On March 19, the Governor of California issued a stay at home order. With musculoskeletal problems being common in the employee patient population, telehealth services were quickly developed to continue chiropractic care for patients. Using existing infrastructure, several members of the health center team developed chiropractic telehealth operations within 2 days.

RESULTS

Musculoskeletal telehealth services included examinations, risk assessment, advice, and rehabilitative exercises. These telehealth visits facilitated care that would have otherwise been unavailable to employees. Patients reported that the appointments were helpful, addressed their concerns, and provided a safe method to see their doctor. Regular interprofessional teamwork and relations between the clinic operator and client company were key contributors to operationalizing this service in our integrated healthcare environment.

CONCLUSION

We were able to quickly implement real time video conferencing and other forms of telehealth for chiropractic services at 2 worksite health centers. This paper includes information and insights to providers about setting up similar telehealth systems so they may also provide this benefit for patients in their communities during pandemics or disasters.

How to Conduct an Outpatient Telemedicine Rehabilitation or Prehabilitation Visit

The novel coronavirus pandemic is resulting in an accelerated conversion of in-person physician visits to virtual visits. As barriers to adoption of telemedicine are rapidly decreasing, it is important to recognize the need for practical and immediately deployable information that can improve doctor-patient interactions, facilitate accurate documentation, and increase confidence in the transition to virtual visits. In this article we aim to outline the components of an outpatient telemedicine visit for physiatrists, with a particular focus on an adapted virtual physical examination. Uses of telemedicine may include future large scale concerns such as natural disasters or climate change. We describe a general approach to the visit, review definitions of terms commonly used in telemedicine, and offer tips for optimizing the encounter.

Potentials of Digitalization in Sports Medicine: A Narrative Review

Digital transformation is becoming increasingly common in modern life and sports medicine, like many other medical disciplines, it is strongly influenced and impacted by this rapidly changing field. This review aims to give a brief overview of the potential that digital technologies can have for health care providers and patients in the clinical practice of sports medicine. We will focus on mobile applications, wearables, smart devices, intelligent machines, telemedicine, artificial intelligence, big data, system interoperability, virtual reality, augmented reality, exergaming, or social networks. While some technologies are already used in current medical practice, others still have undiscovered potential. Due to the diversity and ever changing nature of this field, we will briefly review multiple areas in an attempt to give readers some general exposure to the landscape instead of a thorough, deep review of one topic. Further research will be necessary to show how digitalization applications could best be used for patient treatments.

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

BACKGROUND

Prior studies of inpatient rehabilitation of patients with brain tumor demonstrate similar functional gains as compared to other rehabilitation populations. There are few studies specifically examining the rehabilitation of patients with glioblastoma.

OBJECTIVE

To compare functional outcomes between matched patients admitted to acute inpatient rehabilitation after initial diagnosis of glioblastoma (iGBM) and after diagnosis of recurrent glioblastoma (rGBM).

DESIGN

A retrospective, case-matched study using descriptive statistics compared demographic information and functional outcomes as designated by the Functional Independence Measure (FIM) score.

SETTING

A single, freestanding inpatient rehabilitation hospital.

PATIENTS

Over a 20-month period, 25 patients with iGBM were matched with 25 patients admitted to an inpatient rehabilitation facility with rGBM by the following criteria: (1) side of lesion (left/right hemisphere), (2) admission total FIM score within 10 points, (3) age within 10 years, and (4) gender. Nineteen of the 25 patients in each group were matched meeting all criteria, and 6 of the 25 patients were matched meeting three out of four criteria.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The primary outcome measures were differences in functional outcomes as measured by FIM scores.

RESULTS

There were no statistically significant differences (P < .05) between the groups in mean admission FIM scores, discharge FIM scores, FIM gains, and FIM efficiencies. There were no statistically significant differences in the development of complications during acute rehabilitation and transfer rate to acute care hospital. Sixty-four percent of patients in both groups were able to be discharged home.

CONCLUSIONS

This study demonstrated no statistically significant differences in functional outcomes between matched patients admitted with iGBM compared to rGBM. Further studies are indicated to examine the rehabilitation outcomes of patients with rGBM in inpatient rehabilitation.

The role of telehealth as a platform for postoperative visits following rotator cuff repair: a prospective, randomized controlled trial

BACKGROUND

The application of telehealth for surgical follow-up has gained recent exposure in orthopedic care. Although the results following joint arthroplasty are encouraging, the role of telemedicine for postoperative care following arthroscopic rotator cuff repair still needs to be defined. The goal of this study was to evaluate the safety, efficacy, and socioeconomic benefits of telehealth as a platform for postoperative follow-up.

METHODS

This was a prospective, randomized controlled trial that enrolled 66 patients who underwent follow-up in the office vs. via telemedicine for postoperative visits at 2, 6, and 12 weeks after surgery. Post-visit surveys were administered to patients and physicians via e-mail, and the Student t test and Fisher exact test were used to compare responses.

RESULTS

In total, 58 patients (88%) completed the study (28 telehealth vs. 30 control). Patients in each group demonstrated similar pain scores at each follow-up visit (P = .638, P = .124, and P = .951) and similar overall satisfaction scores (P = .304). Patients in the telehealth group expressed a stronger preference for telehealth than their control counterparts (P < .001). Telehealth visits were less time-consuming from both a patient (P < .001) and physician (P = .002) perspective. Telehealth visits also required less time off work for both patients (P = .001) and caregivers (P < .001).

CONCLUSION

Patients undergoing arthroscopic rotator cuff surgery were able to receive safe and effective early postoperative follow-up care using telemedicine. The preference for telehealth increased for both surgeons and patients following first-hand experience. The use of a telehealth platform is a reasonable follow-up model to consider for patients seeking convenient and efficient care following arthroscopic rotator cuff repair.

Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba

Pediatric concussion patients living in northern communities in Canada can face unique challenges accessing primary and specialized healthcare. In this study we report the clinical characteristics, healthcare utilization, outcomes and estimated cost avoidance associated with a pilot pediatric concussion telemedicine program established between a multi-disciplinary pediatric concussion program in Winnipeg, Manitoba and a hospital in Thompson, Manitoba. From October 1^st- July 1^st, 2018, 20 patients were evaluated; mean age 13.1 years, 15 (75%) males and 14 (70%) self-identified as Indigenous. Injury mechanisms included hockey (50%), falls (35%) and assaults (15%). Median time from referral to initial consultation was 2.0 days. After screening by the neurosurgeon, 90% of patients underwent initial consultation via real-time videoconferencing with 80% managed exclusively through telemedicine. At the end of the study, 90% met the criteria for clinical recovery, one remained in treatment and one was discharged to a headache neurologist. Sixty-six telemedicine encounters were completed including 57 videoconferencing appointments and 9 telephone follow-ups representing an estimated cost avoidance of $40,972.94. This study suggests telemedicine may be a useful approach to assist pediatric concussion programs with delivering timely, safe and cost-effective care to patients living in medically underserviced remote and northern communities in Canada.

Videoconferencing Psychotherapy in the Public Sector: Synthesis and Model for Implementation

BACKGROUND

Videoconferencing psychotherapy (VCP) is a growing practice among mental health professionals. Early adopters have predominantly been in private practice settings, and more recent adoption has occurred in larger organizations, such as the military. The implementation of VCP into larger health service providers in the public sector is an important step in reaching and helping vulnerable and at-risk individuals; however, several additional implementation challenges exist for public sector organizations.

OBJECTIVE

The aim of this study was to offer an implementation model for effectively introducing VCP into public sector organizations. This model will also provide practical guidelines for planning and executing an embedded service trial to assess the effectiveness of the VCP modality once implemented.

METHODS

An iterative search strategy was employed, drawing on multiple fields of research across mental health, information technology, and organizational psychology. Previous VCP implementation papers were considered in detail to provide a synthesis of the barriers, facilitators, and lessons learned from the implementation attempts in the military and other public sector settings.

RESULTS

A model was formulated, which draws on change management for technology integration and considers the specific needs for VCP integration in larger organizations. A total of 6 phases were formulated and were further broken down into practical and measurable steps. The model explicitly considers the barriers often encountered in large organizational settings and suggests steps to increase facilitating factors.

CONCLUSIONS

Although the model proposed is time and resource intensive, it draws on a comprehensive understanding of larger organizational needs and the unique challenge that the introduction of VCP presents to such organizations.

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review

BACKGROUND

Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI.

METHODS

Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001).

RESULTS

Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak.

CONCLUSIONS

The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.