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Rangra P, Dickson L, Jagadamma KC. Service evaluation: Three subjective questions that aid in identifying frozen shoulder-Within a multi-centre musculoskeletal physiotherapy department in primary care. Musculoskeletal Care 2024; 22:e1886. [PMID: 38643407 DOI: 10.1002/msc.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
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Bramble LA, Tracy B, Siverling S, Mizuta J, Juliano K, Plack M. Patient, Provider, and Organizational Considerations for Implementing Rehabilitation Telehealth. Telemed J E Health 2024; 30:173-186. [PMID: 37318832 DOI: 10.1089/tmj.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Introduction: While telehealth services (THS) have been around for some time, for many in the rehabilitation services, it is a new mode of service delivery. THS can be as effective as face-to-face care and are valued by patients and clinicians. However, THS present considerable challenges and may not be appropriate for everyone. Clinicians and organizations must be prepared to triage and manage patients in this environment. Aims of this study were to capture clinician perceptions of the implementation of THS in rehabilitation and use the insights gained to provide strategies for overcoming implementation challenges. Methods: An electronic survey was emailed to 234 rehabilitation clinicians in a large urban hospital. Completion was voluntary and anonymous. Qualitative analysis of the open-ended responses consisted of an iterative consensus-driven interpretivist approach. Multiple strategies were used to minimize bias and optimize trustworthiness. Results: From the 48 responses received, four themes were identified: (1) THS provide unique benefits for patients, providers, and organizations; (2) challenges arose in multiple domains (clinical, technological, environmental, and regulatory); (3) clinicians require specific personal, clinical, and technological knowledge, skills, and attributes to be effective; and (4) individual characteristics, session type, home environment, and needs must be considered in patient selection. Discussion and Conclusion: From the themes identified, a conceptual framework illustrating the keys to effective implementation of THS was developed. Recommendations addressing challenges across multiple domains (clinical, technological, environmental, and regulatory), and at all levels of care delivery (patient, provider, and organization) are provided. Insights gained from this study can be used by clinicians in advocating for and designing effective THS programs. Educators would also gain from using these recommendations to train students and clinicians to recognize and address the challenges they may encounter in providing THS in rehabilitation.
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Affiliation(s)
| | - Brad Tracy
- Evidence in Motion, Sugar Grove, Illinois, USA
| | | | - Jay Mizuta
- Hospital for Special Surgery, New York, New York, USA
| | - Karen Juliano
- Hospital for Special Surgery, New York, New York, USA
| | - Margaret Plack
- The George Washington University, Washington, District of Columbia, USA
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Özel Aslıyüce Y, Fanuscu A, Aslıyüce A, Ülger Ö. Tele-Assessment of Functional Capacity: Validity, Intra- and Inter-rater Reliability. Workplace Health Saf 2023; 71:476-483. [PMID: 37387527 DOI: 10.1177/21650799231180780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Functional capacity evaluation is a standardized tool that assesses work-related skills. Although there are different test batteries, the most frequently used one is Work Well Systems. This study aims to determine the validity and inter- and intra-rater reliability of remote implementation of functional capacity tests (repetitive reaching, lifting object overhead, and working overhead) in asymptomatic individuals. METHODS A total of 51 asymptomatic individuals were included in the study. Participants completed all tests both face-to-face and remotely. Remote assessment videos were rewatched by the same researcher and different researchers for intra- and inter-rater reliability. All processes were scored by two independent researchers. RESULTS Remotely performing repetitive reaching (intraclass correlation coefficient [ICC]: 0.85-0.92, p < .001), lifting object overhead (ICC: 0.98, p < .001), and working overhead (ICC: 0.88 p < .001) tests are valid and reliable. DISCUSSION Repetitive reaching, lifting an object overhead, and sustained overhead work tests in the Work Well Systems-Functional Capacity Evaluation test battery can be performed remotely through videoconferencing. Remotely evaluating these tests, which are especially important in work-related situations, may be important in pandemic conditions and hybrid working conitions.
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Affiliation(s)
| | - Aybüke Fanuscu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation
| | | | - Özlem Ülger
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation
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Liao WJ, Lee KT, Chiang LY, Liang CH, Chen CP. Postoperative Rehabilitation after Anterior Cruciate Ligament Reconstruction through Telerehabilitation with Artificial Intelligence Brace during COVID-19 Pandemic. J Clin Med 2023; 12:4865. [PMID: 37510980 PMCID: PMC10381141 DOI: 10.3390/jcm12144865] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Due to the rapid spread of the coronavirus disease-19 (COVID-19), most of the patients expressed a reluctance to undergo postoperative rehabilitation at a rehabilitation clinic. Therefore, in this scenario it was necessary to reshape the crucial role of postoperative rehabilitation of these patients. We conducted a telerehabilitation program based on an artificial intelligence brace (AI brace) which can monitor the progress of rehabilitation through an app and an internet server. Our hypothesis was that home-based telerehabilitation might provide clinical outcomes comparable to face-to-face, hospital-based rehabilitation programs in terms of effectiveness. METHODS A retrospective cohort study enrolled patients who received anterior cruciate ligament reconstruction (ACLR) between January and September 2020. Patients were divided into two groups: the tele-AI group received telerehabilitation with an AI brace while the FTF group had face-to-face, hospital-based rehabilitation. Clinical knee functional scores and Tegner Activity Scale (TAS) were assessed and analyzed until 12 months after the operation. RESULTS The tele-AI group had higher IKDC scores at 3 months (p = 0.0443) and 6 months (p = 0.0052) after surgery and higher KOOS scores at 1 month (p = 0.0365) and 6 months (p = 0.0375) after surgery. However, no significant difference between the two groups was detected at the end of the follow-up. The tele-AI group had higher TAS than FTF group after 1 year. CONCLUSIONS Telerehabilitation after ACLR seems to provide a superior short-term outcome compared to hospital-based rehabilitation during the COVID-19 pandemic.
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Affiliation(s)
- Wei-Jen Liao
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Kun-Tsan Lee
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung 402202, Taiwan
| | - Liang-Yu Chiang
- Department of Orthopaedic Surgery, Taichung Armed Forces General Hospital, Taichung 41152, Taiwan
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Che-Han Liang
- Department of Orthopaedics, Tungs' Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
| | - Chao-Ping Chen
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
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Wu YQ, Long Y, Peng WJ, Gong C, Liu YQ, Peng XM, Zhong YB, Luo Y, Wang MY. The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e42090. [PMID: 37097721 PMCID: PMC10170363 DOI: 10.2196/42090] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/21/2022] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Fibromyalgia is a chronic pain syndrome characterized by persistent and widespread musculoskeletal pain. Telerehabilitation is a promising treatment for patients with fibromyalgia through long-term monitoring, intervention, supervision, consultation, and education. OBJECTIVE This study aimed to perform a comprehensive systematic review and meta-analysis of the efficacy and safety of telerehabilitation in patients with fibromyalgia. METHODS Randomized controlled trials (RCTs) related to fibromyalgia and telerehabilitation were systematically searched in the PubMed, PEDro, Cochrane Library, ScienceDirect, Ovid MEDLINE, Embase, and Web of Science databases from inception to November 13, 2022. Two independent researchers screened the literatures and evaluated the methodological quality using the Cochrane Risk of Bias Tool. The outcome measures included the Fibromyalgia Impact Questionnaire scale, pain intensity, depression, pain catastrophizing, quality of life (QoL), and adverse events. Pooled effect sizes were calculated by Stata SE 15.1; a fixed effects model was used when I2<50%, whereas a random effects model was used when I2≥50%. RESULTS A total of 14 RCTs with 1242 participants were included in this meta-analysis. The pooled results indicated that the telerehabilitation improved the Fibromyalgia Impact Questionnaire score (weighted mean difference -8.32, 95% CI -11.72 to -4.91; P<.001), pain intensity (standardized mean difference [SMD] -0.62, 95% CI -0.76 to -0.47; P<.001), depression levels (SMD -0.42, 95% CI -0.62 to -0.22; P<.001), pain catastrophizing (weighted mean difference -5.81, 95% CI -9.40 to -2.23; P=.001), and QoL (SMD 0.32, 95% CI 0.18 to 0.47; P<.001) in patients with fibromyalgia compared to control interventions. Only 1 RCT reported a mild adverse event of telerehabilitation; the other 13 RCTs did not mention this. CONCLUSIONS Telerehabilitation can improve the symptoms and QoL of fibromyalgia. However, the safety of telerehabilitation remains uncertain due to the lack of sufficient evidence for the management of fibromyalgia. More rigorously designed trials are needed in the future to verify the safety and efficacy of telerehabilitation in fibromyalgia. TRIAL REGISTRATION PROSPERO CRD42022338200; https://tinyurl.com/322keukv.
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Affiliation(s)
| | - Yi Long
- Gannan Medical University, GanZhou, China
| | | | - Cheng Gong
- Gannan Medical University, GanZhou, China
| | - Yue-Quan Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
| | | | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
| | - Yun Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
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Vomer RP, York E, Rayghan LS, Jethwa T, Montero DP, Nguyen CQ, Pujalte GGA. Telemedicine Examination of the Knee. Cureus 2023; 15:e37009. [PMID: 37139029 PMCID: PMC10150838 DOI: 10.7759/cureus.37009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid healthcare system adaptations, including the acceptance of telemedicine in primary care. In the case of knee ailments, among the most common problems encountered in primary care, telemedicine provides a literal window to observe the patient performing functional activities. Despite its potential, there is a lack of standardized protocols for data collection. The purpose of this article is to provide a step-by-step protocol to aid in performing a telemedicine examination of the knee. Methods This article provides a step-by-step guide for a telehealth examination of the knee. Results A step-by-step examination of how to structure a telemedicine evaluation of the knee. A glossary of images of each maneuver has been included to demonstrate the components of the examination. Additionally, a table of questions and possible answers were included to help guide the provider through a knee examination. Conclusion This article provides a structured and efficient means of extracting clinically relevant information during telemedicine examinations of the knee.
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Goldman JG, Merkitch D, Brewington D, Peirce H, Rho M, Jayabalan P, Curran J, Brennan K. Patient experiences receiving rehabilitation care via telehealth: Identifying opportunities for remote care. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1049554. [PMID: 36817717 PMCID: PMC9932031 DOI: 10.3389/fresc.2023.1049554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Use of telehealth has grown substantially in recent times due to the COVID-19 pandemic. Remote care services may greatly benefit patients with disabilities; chronic conditions; and neurological, musculoskeletal, and pain disorders, thereby allowing continuity of rehabilitation care, reducing barriers such as transportation, and minimizing COVID-19 exposure. In March 2020, our rehabilitation hospital, Shirley Ryan AbilityLab, launched a HIPAA-compliant telemedicine program for outpatient and day rehabilitation clinics and telerehabilitation therapy programs. The objective of this study was to examine patients' experiences and satisfaction with telemedicine in the rehabilitation physician practice, including novel virtual multidisciplinary evaluations. The present study examines survey data collected from 157 patients receiving telemedicine services at Shirley Ryan AbilityLab from December 2020-August 2021. Respondents were 61.8% female, predominantly White (82.2%) with ages ranging across the lifespan (69.4% over age 50 years). Diagnostic categories of the respondents included: musculoskeletal conditions 28%, chronic pain 22.3%, localized pain 10.2%, neurological conditions 26.8%, and Parkinson's and movement disorders 12.7%. Survey responses indicate that the telemedicine experiences were positive and well received. The majority of participants found these services easy to use, effective, and safe, and were overall satisfied with the attention and care they received from the providers-even for those who had not previously used telehealth. Respondents identified a variety of benefits, including alleviating financial and travel-related burdens. There were no significant differences in telehealth experiences or satisfaction across the different clinical diagnostic groups. Respondents viewed the integrated physician and rehabilitation therapist telehealth multidisciplinary model favorably, citing positive feedback regarding receiving multiple perspectives and recommendations, feeling like an integrated member of their healthcare team, and having a comprehensive, holistic team approach along with effective communication. These findings support that telemedicine can provide an effective care model in physiatry (physical medicine and rehabilitation) clinics, across different neurological, musculoskeletal, and pain conditions and in multidisciplinary team care settings. The insights provided by the present study expand our understanding of patient experiences with remote care frameworks for rehabilitation care, while controlling for institutional variation, and ultimately will help provide guidance regarding longer term integration of telemedicine in physiatry and multidisciplinary care models.
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Affiliation(s)
- Jennifer G. Goldman
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Correspondence: Jennifer G. Goldman
| | - Douglas Merkitch
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David Brewington
- Information Systems, Enterprise Data Warehouse, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Hannah Peirce
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Monica Rho
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jessica Curran
- Outpatient Physical Therapy, Shirley Ryan AbilityLab, Chicago, IL, United States
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Duruflé A, Le Meur C, Piette P, Fraudet B, Leblong E, Gallien P. Cost effectiveness of a telerehabilitation intervention vs home based care for adults with severe neurologic disability: A randomized clinical trial. Digit Health 2023; 9:20552076231191001. [PMID: 37545632 PMCID: PMC10403989 DOI: 10.1177/20552076231191001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023] Open
Abstract
Context Several options are available for the care of neurological conditions including care delivered in rehabilitation centres, at home or remotely. While economic studies are available comparing centres and homes, very little economic data relates to mobile teams comparing face-to-face and remote care. Objective To conduct an economic study comparing face-to-face care at home and care delivered remotely (tele-rehabilitation). Method A randomised clinical study with two groups; a control group receiving home care and an experimental group receiving tele-rehabilitation. The primary outcome measure was the ICER (Incremental Cost Effectiveness Ratio). Participants Patients with severe neurological disabilities. Results 80 patients were enrolled in the study; 77 were analysed to calculate the ICER, which was positive and located in the SW quadrant. A bootstrap with 1000 replications was positioned at 72.8% in the SW quadrant. Conclusion Tele-rehabilitation is an acceptable alternative to the management of neurological patients at home. In the mildest cases, remote-rehabilitation may even be dominant. More extensive studies are needed to specify the indications.
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Affiliation(s)
| | - Claire Le Meur
- Rehabilitation Center, Pôle Saint Helier, Rennes, France
| | - Patrice Piette
- Rehabilitation Center, Pôle Saint Helier, Rennes, France
| | | | - Emilie Leblong
- Rehabilitation Center, Pôle Saint Helier, Rennes, France
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Therapeutic Exercise Interventions through Telerehabilitation in Patients with Post COVID-19 Symptoms: A Systematic Review. J Clin Med 2022; 11:jcm11247521. [PMID: 36556137 PMCID: PMC9785416 DOI: 10.3390/jcm11247521] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
The worldwide incidence of COVID-19 has generated a pandemic of sequelae. These sequelae require multidisciplinary rehabilitative work to address the multisystemic symptoms that patients will present with now and in the future. The aim of the present systematic review is to analyze the current situation of telerehabilitation in patients with COVID-19 sequelae and its effectiveness. Searches were conducted on the following databases: PubMed, Scopus, PEDro, and Web of Science (WOS). There was no complete homogeneity among the five selected articles, so we differentiated two clinical subgroups for the clustering of outcome measures: (group one) patients with post-discharge symptoms and (group two) patients with permanent symptoms or “long COVID-19” defined as persistent symptoms > 2 months. For group one, post-discharge sequelae, improvements were obtained in cardiovascular parameters, and physical test studies in group two presented very favorable results in all the cardiorespiratory measures and physical tests evaluated. Telerehabilitation through therapeutic exercise based on mixed protocols of aerobic, respiratory, and low-load strength exercises appear to be an effective and safe strategy for the recovery of short- and long-term post-COVID-19 sequelae.
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Saragiotto BT, Sandal LF, Hartvigsen J. Can you be a manual therapist without using your hands? Chiropr Man Therap 2022; 30:48. [PMID: 36376968 PMCID: PMC9664669 DOI: 10.1186/s12998-022-00457-x] [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: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To align with current best practices, manual therapists have refined their treatment options to include exercise and pain education for people with chronic musculoskeletal pain. In this commentary, we suggest that manual therapists should also add telehealth to their toolbox. Thus, we aim to discuss the use of telehealth by manual therapists caring for patients with musculoskeletal disorders. MAIN BODY Telehealth can be delivered to the patient in different modes, such as real-time clinical contact or asynchronously. Platforms vary from websites and smartphone apps to virtual reality systems. Telehealth may be an effective approach, especially for improving pain and function in people with musculoskeletal pain, and it has the potential to reduce the individual and socioeconomic burden of musculoskeletal conditions. However, the certainty of evidence reported in systematic reviews is often low. Factors such as convenience, flexibility, undivided attention from the clinician, user-friendly platforms, goal setting, and use of evidence-based information are all enablers for telehealth use and improving patients' knowledge, self-efficacy, and self-management. Barriers to widening the use of telehealth in musculoskeletal care include the reliability of technology, data privacy issues, difficult to build therapeutic alliance, one-size-fits-all approaches, digital health literacy, and payment models. CONCLUSION We suggest that practitioners of manual medicine make telehealth part of their clinical toolbox where it makes sense and where there is evidence that it is beneficial for people who seek their care.
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Affiliation(s)
- Bruno T. Saragiotto
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, R. Cesário Galero, 448/475 - Tatuapé, São Paulo, SP 03071-000 Brazil ,grid.117476.20000 0004 1936 7611Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Louise F. Sandal
- grid.10825.3e0000 0001 0728 0170Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Jan Hartvigsen
- grid.10825.3e0000 0001 0728 0170Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark ,Chiropractic Knowledge Hub, Odense M, Denmark
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