Using telerehabilitation to support people with multiple sclerosis: A qualitative analysis of interactions, processes, and issues across three interventions

Introduction

It is important to understand the interactions, processes, and issues that occur within telerehabilitation interventions to inform research and practice. The aim of this study was to identify the difficulties reported and intervention features that were captured as helpful in the notes written by occupational therapists during a telerehabilitation trial.

Method

Administrative documentation in the form of 60 subjective, objective, assessment, and plan notes were collected. The trial examined the effectiveness of three teleconference-delivered interventions: physical activity alone, fatigue management with physical activity, and contact-control social support for people with multiple sclerosis.

Results

Five themes emerged: desiring change, taking action, experiencing difficulty, infrastructure support, and relief and appreciation. Desiring change captured therapists’ observations of clients’ desire to manage symptoms and improve participation; it was most apparent at the beginning and supported clients’ taking action as the interventions progressed. Therapists identified their own difficulties with group facilitation and time management and clients’ difficulties with some intervention materials. Infrastructure support was reported to be helpful in minimizing some of these difficulties. In the end, the therapists expressed relief that the clients appeared to benefit from and appreciate the interventions.

Conclusion

This study highlights the need for and importance of providing resources and training to support teleconference-delivered interventions in clinical practice.

Therapeutic videoconferencing interventions for the treatment of long-term conditions

We conducted a systematic review of literature relating to videoconferencing in therapeutic interventions for chronic conditions. Two hundred articles were reviewed in detail, 35 of which were relevant to the study. Of these, eight were randomized controlled trials (RCTs) and the remainder were service evaluations, pilot studies and case studies. Two major themes emerged, relating specifically to videoconferencing: clinical outcomes and patient satisfaction. There were 14 studies which measured clinical outcomes of interventions for chronic conditions delivered by videoconferencing. A range of evidence, including four RCTs of high quality, indicates that interventions for a variety of conditions, including psychological and physical, delivered by videoconferencing produce similar outcomes to treatment delivered in-person. Evidence suggests that levels of patient satisfaction with telerehabilitation are high and that the formation of a good therapeutic alliance is possible. Several papers reported that clinical staff showed lower levels of satisfaction in using telerehabilitation than patients. It is feasible to use videoconferencing as a means of delivering therapeutic interventions for people with chronic conditions in rural communities.