Barriers leading to increased disability in neurologically challenged populations during COVID-19 pandemic: a scoping review

Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study

PURPOSE

Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers.

METHODS

Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method.

RESULTS

Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified.

CONCLUSIONS

This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.

Gender Diversity, Disability, and Well-Being: Impact of Delayed and Foregone Care Because of COVID-19

Purpose: This study explored the impact of delayed and foregone care due to COVID-19 on well-being among disabled and gender diverse adults. Methods: Using data from the 2021 National Survey on Health and Disability and logistic regression modeling we assessed the impact of delayed or foregone care due to COVID-19 on well-being among disabled people (n = 1638), with comparisons between cisgender (n = 1538) and gender diverse (n = 100) people with disabilities. We report odds ratios (OR) and confidence intervals (CI). Results: Disabled people reported high rates of delayed (79.36%) and foregone (67.83%) care and subsequent negative effects on well-being (72.07%). Gender diverse disabled people were over four times more likely to have delayed any care (OR 4.45, 95% CI 1.86-10.77) and three times more likely to have foregone any care (OR 3.14, 95% CI 1.71-5.79) due to COVID-19 compared to cisgender disabled people. They were three times more likely to report any negative impact on their health and well-being because of delayed and foregone care (OR 2.78, 95% CI 1.43-5.39). Conclusion: The COVID-19 pandemic affected the health care utilization of disabled people, resulting in high rates of delayed care, foregone care, and negative impacts on well-being. These effects were intensified at the intersection of disability and marginalized gender identity, with gender diverse disabled people having higher odds of delayed and foregone care and negative effects on well-being, including physical health, mental health, pain levels, and overall level of functioning.

Feasibility of Telerehabilitation-Based Pelvic Floor Muscle Training for Urinary Incontinence in People With Multiple Sclerosis: A Randomized, Controlled, Assessor-Blinded Study

BACKGROUND AND PURPOSE

Urinary incontinence is a common symptom in people with multiple sclerosis. The primary aim was to investigate feasibility of telerehabilitation-based pelvic floor muscle training (Tele-PFMT) and compare its effects on leakage episodes and pad usage with home exercise-based pelvic floor muscle training (Home-PFMT) and control groups.

METHODS

Forty-five people with multiple sclerosis with urinary incontinence were randomized into 3 groups. Tele-PFMT and Home-PFMT groups followed the same protocol for 8 weeks, but Tele-PFMT performed exercises 2 sessions/week under a physiotherapist's supervision. The control group did not receive any specific treatment. Assessments were made at baseline, weeks 4, 8, and 12. Primary outcome measures were feasibility (compliance to exercise, patient satisfaction, and number of participants included in the study), number of leakage episodes, and pad usage. Secondary outcomes included severity of urinary incontinence and overactive bladder symptoms, sexual function, quality of life, anxiety, and depression.

RESULTS

Participant eligibility rate was 19%. Patient satisfaction and compliance to exercise were significantly higher in Tele-PFMT than in Home-PFMT ( P < 0.05). No significant differences in the change of leakage episodes and pad usage were found between Tele-PFMT and Home-PFMT. No significant differences in secondary outcomes were found between PFMT groups. Participants in both the Tele-PFMT and Home-PFMT groups had significantly better scores for some measures of urinary incontinence, and overactive bladder and quality of life in compared with the control group.

DISCUSSION AND CONCLUSIONS

Tele-PFMT was feasible and acceptable in people with multiple sclerosis, and this mode of delivery was associated with greater exercise compliance and satisfaction compared with Home-PFMT. However, Tele-PFMT did not exhibit superiority in terms of leakage episodes and pad usage compared with Home-PFMT. A large trial comparing Home-PFMT and Tele-PFMT is warranted.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A440 ).

Barriers to Video Call-Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process

BACKGROUND

Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses.

OBJECTIVE

This review aimed to identify and map the perceived barriers to the use of video call-based telehealth interventions among allied health professionals and nurses.

METHODS

A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call-based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups.

RESULTS

A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication.

CONCLUSIONS

This review identified key barriers to video call-based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers.

Gait-Adaptability Training in People With Hereditary Spastic Paraplegia: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

In people with hereditary spastic paraplegia (HSP), reduced gait adaptability is common and disabling. Gait impairments result from lower extremity spasticity, muscle weakness, and impaired proprioception. The aim of this study was to assess the efficacy of a 5-week gait-adaptability training in people with pure HSP.

METHOD

We conducted a randomized clinical trial with a cross-over design for the control group, and a 15-week follow-up period after training. Thirty-six people with pure HSP were randomized to 5 weeks of (i) gait-adaptability training (10 hours of C-Mill training-a treadmill equipped with augmented reality) or (ii) a waiting-list control period followed by 5 weeks gait-adaptability training. Both groups continued to receive usual care. The primary outcome was the obstacle subtask of the Emory Functional Ambulation Profile. Secondary outcome measures consisted of clinical balance and gait assessments, fall rates, and spatiotemporal gait parameters assessed via 3D motion analysis.

RESULTS

The gait-adaptability training group (n = 18) did not significantly decrease the time required to perform the obstacle subtask compared to the waiting-list control group (n = 18) after adjusting for baseline differences (mean: -0.33 seconds, 95% CI: -1.3, 0.6). Similar, non-significant results were found for most secondary outcomes. After merging both groups (n = 36), the required time to perform the obstacle subtask significantly decreased by 1.3 seconds (95% CI: -2.1, -0.4) directly following 5 weeks of gait-adaptability training, and this effect was retained at the 15-week follow-up.

CONCLUSIONS

We found insufficient evidence to conclude that 5 weeks of gait-adaptability training leads to greater improvement of gait adaptability in people with pure HSP.

Varieties of 'new normal': Employment experiences among youth with and without disabilities during the reopening stages of the COVID-19 pandemic

BACKGROUND

Working and volunteering in the reopening stages of the COVID-19 pandemic has looked different depending on the location, employment sector and nature of the job. Although researchers have begun exploring the impacts on adults, little is known about what the transition to a 'new normal' in the reopening stages has been like for youth, especially those with disabilities.

OBJECTIVE

To explore and compare the experiences and perspectives of youth with and without disabilities who were working, volunteering or seeking work during the re-opening stages of the COVID-19 pandemic in Canada.

METHODS

We used a qualitative design involving semi-structured interviews with 16 youth (seven with a disability, nine without), aged 15-29 (mean 22 years). Thematic analysis was used to analyze the data.

RESULTS

Five main themes were identified: (1) Mixed views on being onsite in the reopening stages; (2) Mixed views on remaining remote; (3) Hybrid model as the best of both worlds; (4) Mixed views on COVID-19 workplace safety in the reopening stages; and (5) Hopes, dreams and advice for the future. Apart from the first main theme, there were more similarities than differences between youth with and without disabilities.

CONCLUSION

Our study highlights that youth encountered various work and volunteer arrangements during the reopening stages of the pandemic, and the personal preferences for particular models depend largely on their employment sector. The areas of agreement among youth highlight some longer-term impacts of the pandemic shutdowns and point to the need for greater mental health and career supports.

Telerehabilitation: A Practical Remote Alternative for Coaching and Monitoring Physical Kinetic Therapy in Patients with Mild and Moderate Disabling Parkinson's Disease during the COVID-19 Pandemic

Background

The COVID-19 pandemic imposed social/physical distancing, lockdown measures, and forced reorientation of the rehabilitation programs for people with Parkinson's disease (PD). Epidemiologic safety measures boosted remote exercise-based treatment.

Objectives

Remote delivery of rehabilitation care services is not typically used in our department. Therefore, this study aimed to assess and implement a telehealth physical rehabilitation program tailored for outpatients with idiopathic PD and slight or medium functional limitations.

Methods

A prospective study was performed on a group of outpatients with idiopathic PD, selected from the database of the neurorehabilitation clinic of the Emergency Teaching Hospital "Bagdasar-Arseni." We studied 17 patients (5 women and 12 men), aged between 54-70 years (average 65.9 ± 4.87), with a disease history of 7.3 ± 3.6 (years), with mild or moderate disabling clinical forms, quantified by an average Hoehn and Yahr score of 2.3 ± 0.35 (limits 1.5-3). All patients underwent pharmacologic treatment with unchanged doses throughout the study. No patients had disabling osteoarticular problems (all could walk independently) and had no significant psycho-cognitive dysfunction. Patients were supervised and coached online in tandem by the therapist and physician. In addition, a family member assisted and supervised the patient's performance and coordinated the technical electronic procedures. Walking biodynamics was assessed by timing "6-meters walking" and "Get up and walk 3 meters" (TUG) tests. Each person attended ten sessions of motor telerehabilitation procedures (2 per week) lasting 50 minutes each during social distancing (October-December 2021).

Results

None of the patients was at increased risk of falling. They all improved their locomotor performance, reflected in a significant decrease in TUG duration (the initial average time improved from 13.50 seconds to 10.57). The telerehabilitation program also significantly improved the average walking speed (initially, 44.5 cm/sec and finally, it raised to 56.8 cm/sec). Discussion. The TUG and "6-meters walking" tests are helpful tools for a global biodynamic remote assessment of PD patients. Limitations of the study: a small group of selected patients, restrictive working conditions (due to epidemiological social/physical restrictions and no direct physiotherapist-patient contact), and need for supervision by an attendant to assist the subject and perform the audio-video transmission. Further studies are necessary to identify the optimal web-based model of care and boost the implementation of this modern neurorehabilitation concept.

Conclusions

Telemedicine turned the virtual space into a new reality and may compensate for the restrictions imposed on face-to-face meetings in pandemic conditions. Moreover, with modern telecommunication techniques, a regular and individualized physical kinetic rehabilitation program can be performed even in pandemic conditions. Remote delivery of kinetic motor programs was appropriate for selected groups of PD patients.

Think globally, act locally: Quality improvement as a catalyst for COVID-19 related care during the transitional years

The COVID-19 pandemic has posed distinctive challenges to adolescents and young adults living with spina bifida, especially those from ethic minority populations. With this public health challenge in mind, developing a customized electronic health record to leverage registry data to promote and quantify COVID-19 vaccination uptake among this population is feasible. We provide a brief description of our activities in customizing an electronic health record to track vaccination uptake among adolescents and young adults with spina bifida (AYASB); and the lessons learned, in hopeful support of those scaling-up vaccination delivery across the globe for AYASB as they transition to adult-centered care. Thus, as providers think globally and act locally, COVID-19 immunization efforts can be implemented while providing culturally appropriate transition policies and services for individuals with neurodevelopmental disabilities.