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Hernandez-Sanchez S, Roses-Conde J, Martinez-Llorens N, Ruiz D, Espejo-Antúnez L, Tomás-Rodríguez I, Toledo-Marhuenda JV, Albornoz-Cabello M. EFisioTrack System for Monitoring Therapeutic Exercises in Patients with Shoulder Orthopedic Injuries in a Hospital Setting: A Pilot Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4898. [PMID: 39123945 PMCID: PMC11314742 DOI: 10.3390/s24154898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
To assess the effects of the eFisioTrack monitoring system on clinical variables in patients with prescribed physiotherapy for shoulder injuries, twenty-four adult patients with shoulder orthopaedic injuries who underwent physical therapy treatment in a hospital setting participated in the study (twelve in the experimental group and twelve as controls). Clinical outcome measures were shoulder function and pain (Constant-Murley Score and Disabilities of the Arm, Shoulder, and Hand or DASH score). Each variable was measured by a blinded physiotherapist at baseline and at one month follow-up. Patients performed the prescribed exercises either supervised by the physiotherapist (control group) or in a separate room without therapist supervision (experimental group). There were no statistically significant differences between groups before treatment or at follow-up for any outcomes (p ≥ 0.05). There was a statistically significant decrease (p ≤ 0.05) of at least 10 points in both groups for the DASH score at follow-up. Differences in the total score and subjective components of the Constant-Murley were also evidenced within groups. The use of the eFisioTrack system showed similar results in clinical measures compared to those performed under the direct supervision of the physiotherapist. This approach might be suitable for providing an effective shoulder exercise program at home.
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Affiliation(s)
- Sergio Hernandez-Sanchez
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Jorge Roses-Conde
- Rehabilitation Service, General University Hospital of Elche, Carrer Almazara, 11, 03203 Alicante, Spain; (J.R.-C.); (N.M.-L.)
| | - Neus Martinez-Llorens
- Rehabilitation Service, General University Hospital of Elche, Carrer Almazara, 11, 03203 Alicante, Spain; (J.R.-C.); (N.M.-L.)
| | - Daniel Ruiz
- Department of Computer Technology, University of Alicante, Carrer de Sant Vincent S/N, 03690 Alicante, Spain;
| | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06071 Badajoz, Spain;
| | - Isabel Tomás-Rodríguez
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Jose-Vicente Toledo-Marhuenda
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, San Fernando, 4, 41009 Sevilla, Spain;
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Vaksvik T, Støme LN, Føllesdal J, Tvedte KA, Melum L, Wilhelmsen CR, Kværner KJ. Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness. J Hand Ther 2024; 37:3-11. [PMID: 37778875 DOI: 10.1016/j.jht.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Video consultation was implemented as a new service in a hospital hand therapy setting. PURPOSE To describe the first year's practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. STUDY DESIGN Iterative design including economic evaluation. METHODS Using the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients' municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. RESULTS Of 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. CONCLUSIONS The results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.
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Affiliation(s)
- Tone Vaksvik
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | | | - Jorunn Føllesdal
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Linn Melum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kari J Kværner
- Centre for Connected Care (C3), Oslo University Hospital, Oslo, Norway; BI Norwegian Business School, Oslo, Norway
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Maltby A, Underhill A, Woodbridge S. The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review. HAND THERAPY 2023; 28:89-102. [PMID: 37904901 PMCID: PMC10581535 DOI: 10.1177/17589983231191867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 11/01/2023]
Abstract
Introduction In 2020, the COVID-19 pandemic caused a rapid uptake of virtual consultations (VCs) to minimise disease transmission and for this reason, research into telerehabilitation has been expanding. This review aimed to map and synthesize evidence on the use of VCs in upper limb musculoskeletal rehabilitation, describe key characteristics, and identify gaps in the research. Methods This scoping review investigated synchronous rehabilitation consultations performed over VC. All asynchronous, wearable or pre-recorded technology was excluded. CINAHL Complete, Medline, PEDro, Google Scholar and grey literature sources were searched. Screening and data extraction were done by a single researcher. Frequency counts were used to analyse the data. Results Nineteen studies were identified, with patients with shoulder injury/pain most frequently studied. Most sources (n = 9) used bespoke video programmes. Range of motion (ROM) was the most common assessment (n = 10) and exercise prescription (n = 7) was the most common treatment. Benefits included time and cost savings, maintaining therapeutic relationships and increasing patient independence. Most diagnostic assessments, except joint and nerve tension tests, were found to be reliable and valid. Studies noted increased function in activities, decreased pain and increased ROM after VCs. Limitations included restricted 'hands-on' treatment, resource and training concerns and limiting patient factors. Conclusions This review mapped available evidence and identified several gaps in the literature. Further robust research into VCs for hand/wrist disorders, ROM assessment and cost-effectiveness is needed.
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Affiliation(s)
- Amy Maltby
- School of Allied Health and Social Care, University of Derby, Derby, UK
- Hand Therapy Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Ann Underhill
- School of Allied Health and Social Care, University of Derby, Derby, UK
| | - Sarah Woodbridge
- School of Allied Health and Social Care, University of Derby, Derby, UK
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Paris Ferrer T, Masaracchio M, Kirker K, Madi Dewan B, Manthripragada M, Ojha H. Outcomes of direct access telehealth physical therapy for patients with musculoskeletal pain: a single cohort observational retrospective study. Physiother Theory Pract 2023:1-8. [PMID: 37585711 DOI: 10.1080/09593985.2023.2245032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Telehealth direct access physical therapy is becoming more prevalent in the management of outpatient musculoskeletal pain. This innovative model affords more opportunity to reach potential patients who otherwise would not be able to access services due to geographical isolation, travel barriers, and timely access to quality care. OBJECTIVE The purpose of the study was to investigate if pain, function, and ability to perform jobs improved after direct access telehealth physical therapy in patients with musculoskeletal pain. METHODS A single cohort retrospective design was implemented to offer telehealth physical therapy to patients with musculoskeletal pain from March to November 2021. Eligible patients were at least 18 years old, located in California, and had a history of peripartum pelvic dysfunction, muscle pain, joint pain, or neural symptoms. Paired-samples t-tests and the Wilcoxon signed-rank test were used to analyze normally distributed and non-parametric data (α = 0.05), respectively, to compare pretest and post scores. RESULTS Based on 89 participants, paired-samples t-tests showed statistically significant differences in function [t(87) = 20.71, p < .0001] and pain [t(82) = -8.15, p < .0001]. Wilcoxon's signed-rank test showed statistically significant differences in ability to perform job (Z = -7.345, p < .0001). CONCLUSION This study demonstrated that in a cohort of individuals with multiregional musculoskeletal pain, there was a decrease in pain and improvements in function and ability to perform job after direct access telehealth physical therapy.
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Affiliation(s)
- Tiffany Paris Ferrer
- Department of Physical Therapy, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | | | - Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | | | - Heidi Ojha
- Department of Physical Therapy, Aware Health, Lafayette, CA, USA
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Shim GY, Kim EH, Baek YJ, Chang WK, Kim BR, Oh JH, Lee JI, Hwang JH, Lim JY. A randomized controlled trial of postoperative rehabilitation using digital healthcare system after rotator cuff repair. NPJ Digit Med 2023; 6:95. [PMID: 37221303 DOI: 10.1038/s41746-023-00842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
A digital healthcare system based on augmented reality (AR) has promising uses for postoperative rehabilitation. We compare effectiveness of AR-based and conventional rehabilitation in patients after rotator cuff repair (RCR). This study randomly allocates 115 participants who underwent RCR to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). The DR group performs AR-based home exercises using UINCARE Home+, whereas the CR group performs brochure-based home exercises. The primary outcome is a change in the Simple Shoulder Test (SST) score between baseline and 12 weeks postoperatively. The secondary outcomes are the Disabilities of the Arm, Shoulder and Hand (DASH) score; Shoulder Pain And Disability Index (SPADI) score; EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire score; pain; range of motion (ROM); muscle strength; and handgrip strength. The outcomes are measured at baseline, and at 6, 12, and 24 weeks postoperatively. The change in SST score between baseline and 12 weeks postoperatively is significantly greater in the DR group than in the CR group (p = 0.025). The SPADI, DASH, and EQ5D5L scores demonstrate group×time interactions (p = 0.001, = 0.04, and = 0.016, respectively). However, no significant differences over time are observed between the groups in terms of pain, ROM, muscle strength, and handgrip strength. The outcomes show significant improvement in both groups (all p < 0.001). No adverse events are reported during the interventions. AR-based rehabilitation shows better improvement in terms of shoulder function after RCR compared to conventional rehabilitation. Therefore, as an alternative to the conventional rehabilitation, the digital healthcare system is effective for postoperative rehabilitation.
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Affiliation(s)
- Ga Yang Shim
- Department of Physical and Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eun Hye Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Yun Jeong Baek
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Bo Ram Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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de Rezende DRB, Neto IA, Iunes DH, Carvalho LC. Analysis of the effectiveness of remote intervention of patients affected by chronic diseases: A systematic review and meta-analysis. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231197316. [PMID: 37781504 PMCID: PMC10540568 DOI: 10.1177/27550834231197316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
Objectives The aim of the study was to verify the effectiveness of telemedicine in randomized controlled trials (RCTs) in terms of its influence on physical conditioning, quality of life, and health conditions in adults/elderly people affected by chronic diseases. Design This was a systematic review and meta-analysis. Methods The search covered RCTs published from 2011 to 2021 and was conducted using the PubMed, Embase, PEDro, Lilacs, and Cochrane Library databases, on volunteers of both sexes, that were rehabilitated, and/or monitored, and/or evaluated, specifically, via remote care. The extraction, quality of studies, and risk of bias were assessed using the RoB2 (risk of bias) tool, for analysis of the strength of evidence, the GRADE (Grading of Recommendations Assessment, Developing, and Evaluation) method was used, and for the preparation of meta-analysis was used at RevMan 5.4 (Review Manager) was used. Results The database search identified 3949 potential articles for screening, 13 of which were eligible for the present systematic review, involving 1469 participants with chronic diseases (chronic obstructive pulmonary disease (COPD), asthma, heart failure, diabetes mellitus, and fibromyalgia). Through the meta-analysis, an advantage was identified for the remote intervention on physical conditioning (p = 0.001), with an estimated effect of 0.29 (0.11, 0.46) and on health conditions (p = 0.0004), -0.30 (-0.47, -0.14), while for quality of life, no significant difference was identified (p = 0.90), 0.01 (-0.13, 0.14). Conclusion Telemedicine has clinical effectiveness for the outcome of physical conditioning and general health conditions in adults with chronic diseases when compared to usual care without face-to-face intervention.
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Affiliation(s)
| | | | - Denise Hollanda Iunes
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Leonardo César Carvalho
- Department of Postgraduate Program in Applied Health Biosciences, Federal University of Alfenas, Alfenas, Brazil
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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Marks D, Kitcher S, Attrazic E, Hing W, Cottrell M. The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review. Int J Telerehabil 2022. [DOI: 10.5195/ijt.2022.6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods: Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting; intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy; and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results: Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion: Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
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Grigorovich A, Xi M, Lam N, Pakosh M, Chan BCF. A systematic review of economic analyses of home-based telerehabilitation. Disabil Rehabil 2022; 44:8188-8200. [PMID: 34965827 DOI: 10.1080/09638288.2021.2019327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions. MATERIALS AND METHODS Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist. RESULTS Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear. CONCLUSIONS More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.
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Affiliation(s)
- Alisa Grigorovich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Min Xi
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Natascha Lam
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Brian C F Chan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Unlocking Opportunities for Innovation and Digitization of Musculoskeletal Care Delivery. J Am Acad Orthop Surg 2022; 30:965-970. [PMID: 35839488 DOI: 10.5435/jaaos-d-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is an established method of providing health care through digital mediums and has recently gained much attention within the field of orthopaedic surgery because of the social and biologic pressures imposed by COVID-19. However, a more diverse and all-encompassing concept of healthcare digitalization, deemed Telehealth , has emerged simultaneously because both healthcare providers and industries have recognized the potential efficacy and breath of applications possible with the digitalization of health care. Telehealth is a distinct concept compared with telemedicine and can be conceptualized as an umbrella term which not only encompasses telemedicine, but several digital means of healthcare services, including remote patient monitoring and physical therapy. The purpose of the current work was to comprehensively introduce the various applications of Telehealth, their relevance in the current healthcare infrastructure, and future implications for orthopaedic surgery through an evidence-based discussion and commentary.
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Nizeyimana E, Joseph C, Plastow N, Dawood G, Louw QA. A scoping review of feasibility, cost, access to rehabilitation services and implementation of telerehabilitation: Implications for low- and middle-income countries. Digit Health 2022; 8:20552076221131670. [PMID: 36249480 PMCID: PMC9557862 DOI: 10.1177/20552076221131670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Objective To scope all published information reporting on the feasibility, cost, access
to rehabilitation services, implementation processes including barriers and
facilitators of telerehabilitation (TR) in low- and middle-income countries
(LMICs) and high-income countries (HICs). Methods A comprehensive electronic search of PubMed, Scopus, PEDro, Cochrane library,
EBSCOhost (Academic search premier, Africa-wide information, CINAHL, Eric,
MEDLINE, Health sources - Nursing/Academic edition), Africa online, as well
as ProQuest databases were conducted. To maximise the coverage of the
literature, the reference lists of included articles identified through the
search were also screened. The analysis included both descriptive summary
and inductive thematic analysis. Results Twenty-nine studies were included. TR was reported to be feasible,
cost-saving and improved access to rehabilitation services in both HICs and
LMICs settings. Asynchronous methods using different mobile apps (Skype,
WhatsApp, Google meet, Facebook messenger, Viber, Face time and Emails) were
the most common mode of TR delivery. Barriers to the implementation were
identified and categorised in terms of human, organisational, technical and
clinical practice related factors. Facilitators for health professionals and
patients/caregivers’ dyads were also identified. Conclusion TR could be considered a feasible service delivery mode in both HICs and
LMICs. However, the mitigation of barriers such as lack of knowledge and
technical skills among TR providers and service users, lack of secure
platform dedicated for TR, lack of resources and connectivity issues which
are particularly prevalent in LMICs will be important to optimise the
benefits of TR.
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Affiliation(s)
- Eugene Nizeyimana
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa,Eugene Nizeyimana, Division of
Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch
University, Francie Van Zijl Dr, Parow, 7505, Cape Town, South Africa.
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Nicola Plastow
- Division of Occupational Therapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Gouwa Dawood
- Division of Speech, Language and Hearing Therapy, Department of
Health and Rehabilitation Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
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Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study. Pain Rep 2022; 7:e1026. [PMID: 36003064 PMCID: PMC9394689 DOI: 10.1097/pr9.0000000000001026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/10/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This study supports that a fully remote digital care program is feasible and able to promote high patient engagement in the telerehabilitation of patients with wrist and hand pain. Introduction: Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care–related costs. Objective: Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP). Methods: A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), analgesic intake, surgery intention, mental health (patient health questionnaire [PHQ-9] and generalized anxiety disorder [GAD-7]), fear-avoidance beliefs (FABQ-PA), work productivity and activity impairment, and engagement. Results: From 189 individuals starting the DCP, 149 (78.8%) completed the intervention. A significant pain improvement was observed (51.3% reduction (2.26, 95% CI 1.73; 2.78)) and 70.4% of participants surpassing minimum clinically important change. This change correlated with improvements in disability (52.1%), FABQ-PA (32.2%), and activities impairment recovery (65.4%). Improvements were also observed in other domains: surgery intent (76.1%), mental health (67.0% in anxiety and 72.7% in depression), and overall productivity losses (68.2%). Analgesic intake decreased from 22.5% to 7.1%. Mean patient satisfaction score was 8.5/10.0 (SD 1.8). Conclusions: These findings support the feasibility and utility of a fully remote DCP for patients with WP. Clinically significant improvements were observed in all health-related and productivity-related outcomes, alongside very high patient adherence rates and satisfaction. This study strengthens that management of WP is possible through a remote DCP, decreasing access barriers and potentially easing health care expenditure.
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Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159198. [PMID: 35954555 PMCID: PMC9367806 DOI: 10.3390/ijerph19159198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
Elbow musculoskeletal pain (EP) is a major cause of disability. Telerehabilitation has shown great potential in mitigating musculoskeletal pain conditions, but EP is less explored. This single-arm interventional study investigates clinical outcomes and engagement levels of a completely remote multimodal digital care program (DCP) in patients with EP. The DCP consisted of exercise, education, and cognitive-behavioral therapy for 8 weeks. Primary outcome: disability change (through the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), treatment response cut-offs: 12.0-point reduction and 30% change). Secondary outcomes: pain, analgesic intake, surgery intent, mental health, fear–avoidance beliefs, work productivity, and patient engagement. Of the 132 individuals that started the DCP, 112 (84.8%) completed the intervention. Significant improvements were observed in QuickDASH with an average reduction of 48.7% (11.9, 95% CI 9.8; 14.0), with 75.3% of participants reporting ≥30% change and 47.7% reporting ≥12.0 points. Disability change was accompanied by reductions in pain (53.1%), surgery intent (57.5%), anxiety (59.8%), depression (68.9%), fear–avoidance beliefs (34.2%), and productivity impairment (72.3%). Engagement (3.5 (SD 1.4) sessions per week) and satisfaction 8.5/10 (SD 1.6) were high. The significant improvement observed in clinical outcomes, alongside high engagement, and satisfaction suggests patient acceptance of this care delivery mode.
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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14
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Gava V, Ribeiro LP, Barreto RPG, Camargo PR. Effectiveness of physical therapy given by telerehabilitation on pain and disability of individuals with shoulder pain: A systematic review. Clin Rehabil 2022; 36:715-725. [PMID: 35230167 DOI: 10.1177/02692155221083496] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To systematically review the effects of physical therapy given by telerehabilitation on pain and disability in individuals with shoulder pain. DATA SOURCES PubMed, Embase, CINAHL, LILACS, Cochrane, Web of Science, SCOPUS, SciELO and Ibecs were searched in January/2022. METHODS This systematic review followed PRISMA guidelines. Randomized controlled trials investigating the effects of physical therapy given by telerehabilitation on pain and disability in patients with shoulder pain were included. The quality and level of the evidence were assessed with the Cochrane Risk of Bias tool and GRADE, respectively. The effect sizes of the main outcomes were also calculated. RESULTS Six randomized controlled trials were included with a total sample of 368 patients with shoulder pain. Four and two randomized controlled trials were assessed as low and high risk of bias, respectively. Three randomized controlled trials assessed shoulder post-operative care, two assessed chronic shoulder pain, and one assessed frozen shoulder. Very low to low evidence suggests that there is no difference between telerehabilitation and in-person physical therapy or home-based exercises programs to improve pain and disability in patients with shoulder pain. Low evidence suggests that telerehabilitation is superior to advice only to improve shoulder pain (effect size: 2.42; 95% Confidence Interval: 1.72, 3.06) and disability (effect size: 1.61; 95% Confidence Interval: 1.01, 2.18). CONCLUSIONS Although telerehabilitation may be a promising tool to treat patients with shoulder pain and disability, the very low to low quality of evidence does not support a definite recommendation of its use in this population.
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Affiliation(s)
- Vander Gava
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, 67828Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Larissa Pechincha Ribeiro
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, 67828Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | - Paula Rezende Camargo
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, 67828Universidade Federal de São Carlos, São Carlos, SP, Brazil
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15
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Janela D, Costa F, Molinos M, Moulder RG, Lains J, Francisco GE, Bento V, Cohen SP, Correia FD. Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:53-66. [PMID: 35035234 PMCID: PMC8755939 DOI: 10.2147/jpr.s343308] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.
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Affiliation(s)
- Dora Janela
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Fabíola Costa
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Maria Molinos
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | - Virgílio Bento
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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16
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Implementation of telerehabilitation in Austrian outpatient physiotherapy – A qualitative study / Implementierung von Telerehabilitation in der ambulanten Physiotherapie in Österreich – Eine qualitative Studie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2022. [DOI: 10.2478/ijhp-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
New technologies, for example, telerehabilitation (TR) tools, can support physiotherapists’ work. Even though studies have demonstrated their potential, TR is not yet fully implemented in Austrian outpatient physiotherapy. As a result of the Coronavirus pandemic and the associated lockdowns, physiotherapists in Austria were confronted with the challenge of offering therapies without physical contact. This study aims to investigate opinions and experiences of physiotherapists in Austria regarding TR and its implementation in different clinical fields.
Methods
A qualitative research design with expert interviews and a focus group discussion were conducted. Data were analysed using content analysis. The categories were formed following a deductive-inductive approach.
Results
The interview partners considered opportunities for using synchronous TR in internal medicine as well as orthopaedics and traumatology, especially in later, exercise-dominated stages. In addition, using TR can be supportive for patient education. In the field of neurology, synchronous TR is viewed with some criticism, especially when used for people with severe neuropsychological disorders. Asynchronous TR is considered useful across all disciplines and could support physical therapy from the first therapy session and throughout the treatment. Important questions regarding liability, billing, or data protection still need to be clarified. Interdisciplinary approaches in TR should also be pursued to improve care.
Conclusion
The use of asynchronous TR in addition to regular physiotherapy is seen as promising in all clinical fields. In general, when implementing TR, the needs and requirements of different fields should be considered. Moreover, various framework conditions still need to be clarified for further implementation of TR.
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17
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Fahey E, Elsheikh MFH, Davey MS, Rowan F, Cassidy JT, Cleary MS. Telemedicine in Orthopedic Surgery: A Systematic Review of Current Evidence. Telemed J E Health 2021; 28:613-635. [PMID: 34375150 DOI: 10.1089/tmj.2021.0221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has triggered transformative changes in how clinicians interact with patients. There has been a shift toward virtual consultations. The evidence to support this change in practice is unclear. The aim of this study was to systematically review the evidence base for virtual consultations for orthopedics. Materials and Methods: Two independent reviewers performed a literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the MEDLINE, EMBASE, and Scopus databases. Only studies reporting outcomes following the use of telemedicine for diagnosis, consultation, rehabilitation, and follow-up were included. Outcomes analyzed were: (1) patient and clinician satisfaction, (2) clinical outcome measures, and (3) cost analysis of traditional versus teleconsultation. Results: A total of 41 studies were included. Fifteen studies compared clinical outcomes of telemedicine against a matched traditional cohort. Of these 15 studies, 2 demonstrated noninferiority, 9 showed no statistically significant difference, and 4 found telemedicine to be superior. Eleven studies recorded patient reported outcomes, which demonstrated high patient satisfaction. Nine studies reported decreased costs when telemedicine was compared to traditional care. The remaining six studies had varied aims and methodologies that didn't fit well with any of these subheadings. Discussion: While the available evidence is limited, the studies assessed here show that telemedicine can deliver high quality health care with good clinical outcomes and high patient satisfaction in a cost-effective manner. Our team thinks what this has highlighted is that communication technology is advancing rapidly and that we as a community of surgeons need to be able to adapt rapidly and adopt innovative technology to continue to improve patient experience and outcomes.
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Affiliation(s)
- Eoin Fahey
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mohamed F H Elsheikh
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martin S Davey
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiachra Rowan
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Tristan Cassidy
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - May S Cleary
- Department of Orthopaedics, University Hospital Waterford, Waterford, Ireland.,Higher Surgical Training Scheme (HST), Royal College of Surgeons in Ireland, Dublin, Ireland.,College of Medicine, University College Cork, Cork, Ireland
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18
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Filippo M, Mourad F. The Flat Earth Theory: is Evidence-Based Physiotherapy a Sphere? J Man Manip Ther 2021; 29:67-70. [PMID: 33797340 DOI: 10.1080/10669817.2021.1890902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maselli Filippo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa - Campus of Savona, Savona, Italy
| | - Firas Mourad
- Department of Musculoskeletal Physical Therapy and Rehabilitation Science, Poliambulatorio Physio Power, Brescia, Italy
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19
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Phuphanich ME, Sinha KR, Truong M, Pham QG. Telemedicine for Musculoskeletal Rehabilitation and Orthopedic Postoperative Rehabilitation. Phys Med Rehabil Clin N Am 2021; 32:319-353. [PMID: 33814061 DOI: 10.1016/j.pmr.2020.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Melissa E Phuphanich
- Department of Physical Medicine and Rehabilitation, Greater Los Angeles VA Healthcare System, (117), 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Kunal R Sinha
- Department of Physical Medicine and Rehabilitation, Greater Los Angeles VA Healthcare System, (117), 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Michael Truong
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Quynh Giao Pham
- Pain Medicine Fellowship Training Program, Department of Medicine, Division of Physical Medicine and Rehabilitation, Greater Los Angeles VA Healthcare System, David Geffen School of Medicine at UCLA, (117), 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.
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20
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Elgert L, Steiner B, Saalfeld B, Marschollek M, Wolf KH. Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e21107. [PMID: 33538701 PMCID: PMC8294637 DOI: 10.2196/21107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/04/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. Objective This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. Methods The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. Results Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient’s range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients’ evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. Conclusions There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects.
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Affiliation(s)
- Lena Elgert
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Bianca Steiner
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Birgit Saalfeld
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Klaus-Hendrik Wolf
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
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21
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Computer- and Telephone-Delivered Interventions on Patient Outcomes and Resource Utilization in Patients With Orthopaedic Conditions: A Systematic Review and Narrative Synthesis. Orthop Nurs 2020; 39:340-352. [PMID: 32956277 DOI: 10.1097/nor.0000000000000699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend. PURPOSE The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions. METHODS The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice. RESULTS A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs. CONCLUSION Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.
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22
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Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract 2020; 48:102193. [PMID: 32560876 PMCID: PMC7261082 DOI: 10.1016/j.msksp.2020.102193] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Musculoskeletal conditions are a leading cause of global morbidity. Access to traditional in-person healthcare can be difficult for some under usual conditions and has become a ubiquitous barrier throughout the COVID-19 pandemic. Telehealth, defined as the 'delivery of healthcare at a distance using information and communication technology' is a solution to many access barriers and has been rapidly adopted by many healthcare professions throughout the crisis. While significant advancements in technology has made the widespread adoption of telehealth feasible, there are many factors to be considered when implementing a telehealth service. PURPOSE The aims of this masterclass are to (i) introduce telehealth and outline the current research within the context of musculoskeletal physiotherapy; (ii) provide insights into some of the broader challenges in the wide-scale adoption of telehealth; and (iii) to describe a systematic approach to implementing telehealth into existing healthcare settings, along with some practical considerations. IMPLICATIONS Telehealth is a broad concept and should be implemented to meet the specific needs of a healthcare service. This masterclass offers a structured approach to the implementation of a musculoskeletal physiotherapy telehealth service, and highlights practical considerations required by both clinicians and healthcare organisations throughout all stages of the implementation process.
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Affiliation(s)
- Michelle A. Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, 4029, Australia,Corresponding author. Physiotherapy Department, Royal Brisbane and Women's Hospital, Physiotherapy Department, Level 2 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
| | - Trevor G. Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, 4072, Australia,School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia
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23
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Jansson MM, Harjumaa M, Puhto AP, Pikkarainen M. Healthcare professionals' perceived problems in fast-track hip and knee arthroplasty: results of a qualitative interview study. J Orthop Surg Res 2019; 14:294. [PMID: 31484536 PMCID: PMC6727416 DOI: 10.1186/s13018-019-1334-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. Methods Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. Results Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. Conclusions The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations.
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Affiliation(s)
- Miia Marika Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland, P.O.Box 1100, FI-90571, Oulu, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, P.O.Box 21, FI-90029, Oulu, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, P.O.Box 1100, FI-90571, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, P.O.Box 8000, FI-90014, Oulo, Finland
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24
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Seo NJ, Crocher V, Spaho E, Ewert CR, Fathi MF, Hur P, Lum SA, Humanitzki EM, Kelly AL, Ramakrishnan V, Woodbury ML. Capturing Upper Limb Gross Motor Categories Using the Kinect® Sensor. Am J Occup Ther 2019; 73:7304205090p1-7304205090p10. [PMID: 31318673 DOI: 10.5014/ajot.2019.031682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Along with growth in telerehabilitation, a concurrent need has arisen for standardized methods of tele-evaluation. OBJECTIVE To examine the feasibility of using the Kinect sensor in an objective, computerized clinical assessment of upper limb motor categories. DESIGN We developed a computerized Mallet classification using the Kinect sensor. Accuracy of computer scoring was assessed on the basis of reference scores determined collaboratively by multiple evaluators from reviewing video recording of movements. In addition, using the reference score, we assessed the accuracy of the typical clinical procedure in which scores were determined immediately on the basis of visual observation. The accuracy of the computer scores was compared with that of the typical clinical procedure. SETTING Research laboratory. PARTICIPANTS Seven patients with stroke and 10 healthy adult participants. Healthy participants intentionally achieved predetermined scores. OUTCOMES AND MEASURES Accuracy of the computer scores in comparison with accuracy of the typical clinical procedure (immediate visual assessment). RESULTS The computerized assessment placed participants' upper limb movements in motor categories as accurately as did typical clinical procedures. CONCLUSIONS AND RELEVANCE Computerized clinical assessment using the Kinect sensor promises to facilitate tele-evaluation and complement telehealth applications. WHAT THIS ARTICLE ADDS Computerized clinical assessment can enable patients to conduct evaluations remotely in their homes without therapists present.
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Affiliation(s)
- Na Jin Seo
- Na Jin Seo, PhD, is Associate Professor, Division of Occupational Therapy, Department of Health Professions, and Associate Professor, Department of Health Science and Research, Medical University of South Carolina, Charleston;
| | - Vincent Crocher
- Vincent Crocher, PhD, is Research Associate, School of Engineering, University of Melbourne, Parkville, Victoria, Australia. At the time of the study, he was Postdoctoral Researcher, Department of Industrial and Manufacturing Engineering, University of Wisconsin-Milwaukee
| | - Egli Spaho
- Egli Spaho, DPT, is Physical Therapist, Ascension All Saints Hospital, Racine, Wisconsin. At the time of the study, he was Research Assistant, Department of Kinesiology, University of Wisconsin-Milwaukee
| | - Charles R Ewert
- Charles R. Ewert, BS, is Associate Software Engineer, Northwestern Mutual, Milwaukee, Wisconsin. At the time of the study, he was Research Assistant, Department of Computer Science, University of Wisconsin-Milwaukee
| | - Mojtaba F Fathi
- Mojtaba F. Fathi, PhD, is Research Associate, Department of Mechanical Engineering, University of Wisconsin-Milwaukee
| | - Pilwon Hur
- Pilwon Hur, PhD, is Assistant Professor, Department of Mechanical Engineering, Texas A&M University, College Station
| | - Sara A Lum
- Sara A. Lum, MS, OTR/L, is Occupational Therapist, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. At the time of the study, she was Student, Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston
| | - Elizabeth M Humanitzki
- Elizabeth M. Humanitzki, MS, OTR/L, is Occupational Therapist, Coastal Therapy Services Inc., Charleston, South Carolina. At the time of the study, she was Student, Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston
| | - Abigail L Kelly
- Abigail L. Kelly, MS, is Instructor, Department of Stomatology, Medical University of South Carolina, Charleston. At the time of the study, she was Research Associate, Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Viswanathan Ramakrishnan
- Viswanathan Ramakrishnan, PhD, is Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Michelle L Woodbury
- Michelle L. Woodbury, PhD, OTR/L, is Associate Professor, Division of Occupational Therapy, Department of Health Professions, and Associate Professor, Department of Health Science and Research, Medical University of South Carolina, Charleston
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