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Moecke DP, Holyk T, Beckett M, Chopra S, Petlitsyna P, Girt M, Kirkham A, Kamurasi I, Turner J, Sneddon D, Friesen M, McDonald I, Denson-Camp N, Crosbie S, Camp PG. Scoping review of telehealth use by Indigenous populations from Australia, Canada, New Zealand, and the United States. J Telemed Telecare 2024; 30:1398-1416. [PMID: 36911983 PMCID: PMC11411853 DOI: 10.1177/1357633x231158835] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Telehealth has the potential to address health disparities experienced by Indigenous people, especially in remote areas. This scoping review aims to map and characterize the existing evidence on telehealth use by Indigenous people and explore the key concepts for effective use, cultural safety, and building therapeutic relationships. METHODS A search for published and gray literature, written in English, and published between 2000 and 2022 was completed in 17 electronic databases. Two reviewers independently screened retrieved records for eligibility. For included articles, data were extracted, categorized, and analyzed. Synthesis of findings was performed narratively. RESULTS A total of 321 studies were included. The most popular type of telehealth used was mHealth (44%), and the most common health focuses of the telehealth interventions were mental health (26%) and diabetes/diabetic retinopathy (13%). Frequently described barriers to effective telehealth use included concerns about privacy/confidentiality and limited internet availability; meanwhile, telehealth-usage facilitators included cultural relevance and community engagement. Although working in collaboration with Indigenous communities was the most frequently reported way to achieve cultural safety, 40% of the studies did not report Indigenous involvement. Finally, difficulty to establish trusting therapeutic relationships was a major concern raised about telehealth, and evidence suggests that having the first visit-in-person is a potential way to address this issue. CONCLUSION This comprehensive review identified critical factors to guide the development of culturally-informed telehealth services to meet the needs of Indigenous people and to achieve equitable access and positive health outcomes.
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Affiliation(s)
- Débora Petry Moecke
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Travis Holyk
- Carrier Sekani Family Services, Prince George, Canada
| | - Madelaine Beckett
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sunaina Chopra
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Mirha Girt
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Ivan Kamurasi
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Justin Turner
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Donovan Sneddon
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Ian McDonald
- University of British Columbia (UBC), Vancouver, Canada
| | | | | | - Pat G Camp
- University of British Columbia (UBC), Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Lovo S, Harrison L, O’Connell ME, Rotter T, Bath B. A physical therapist and nurse practitioner model of care for chronic back pain using telehealth: Diagnostic and management concordance. J Telemed Telecare 2024; 30:842-850. [PMID: 35546114 PMCID: PMC11331670 DOI: 10.1177/1357633x221098904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/18/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models. METHODS In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PTteam); 2) in-person PT (PTalone); and 3) in-person NP (NPalone). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa. RESULTS Overall diagnostic categorization was compared for PTalone versus NPalone and NP/PTteam: percent agreement was 77.8% (k = 0.474, p = 0.001) and 74.1% (k = 0.359, p = 0.004), respectively. In terms of management recommendations, the PTalone and NPalone demonstrated strong agreement on "need for urgent surgical referral" (92.6%, k = 0.649 (p < 0.00) and slight agreement for "refer to primary physician for pharmacology, lab or imaging" (81.5%, k = 0.372 (p = 0.013). The PTalone and NP/PTteam demonstrated strong agreement on "need for urgent surgical referral" (96.3%, k = 0.649, p = 0.000) and "recommendation for PT follow up" (88.9%, k = 0.664, p = 0.000). DISCUSSION The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.
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Affiliation(s)
- Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Liz Harrison
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Megan E O’Connell
- College of Arts and Science, University of Saskatchewan, Saskatoon, Canada
| | - Thomas Rotter
- School of Nursing Health Quality Program, Queen’s University, Kingston, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
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Crockett K, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Martinez-Rueda R, Aiyer H, Carnegie B, Custer M, McIntosh S, Bath B. "Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain. Can J Pain 2024; 8:2318706. [PMID: 38616950 PMCID: PMC11008541 DOI: 10.1080/24740527.2024.2318706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
Background Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.
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Affiliation(s)
- Katie Crockett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology, & Health, Royal Institute of Technology, Stockholm, Sweden
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terrence McDonald
- Department of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Calgary, Alberta, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rosmary Martinez-Rueda
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harini Aiyer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Lovo S, Imeah B, Sari N, O’Connell ME, Milosavljevic S, Angarita-Fonseca A, Bath B. Effectiveness of an interprofessional assessment and management approach for people with chronic low back disorders delivered via virtual care: A randomized controlled trial pilot intervention. Digit Health 2024; 10:20552076241260569. [PMID: 38846367 PMCID: PMC11155314 DOI: 10.1177/20552076241260569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Virtual care for chronic conditions has seen uptake due to COVID-19. Evaluation of virtual models is important to ensure evidence-based practice. There is a paucity of research in the use of virtual care for management of chronic back disorders. The objective of this study was to evaluate effectiveness of a team-based virtual care model for back disorder assessment where a physical therapist uses virtual care to join a nurse practitioner and patient in a rural Saskatchewan, Canada community. Methods Sixty-four rural adults with chronic back disorders were randomly allocated to receive either: (1) team-based virtual care (n = 24); (2) care from an urban physical therapist travelling to community (n = 20); or (3) care from a rural nurse practitioner (n = 20). The team-based care group involved a nurse practitioner located with a rural patient, and a physical therapist joining using virtual care. The physical therapist alone and the nurse practitioner alone groups received in-person assessments. Groups with a physical therapist involved had follow-up treatments by in-person physical therapy. Outcomes over six months included pain, disability, back beliefs, satisfaction, quality-adjusted health status and management-related costs. Results There were no significant differences for pain, disability, back beliefs and satisfaction between groups. The average cost per patient for implementing in-person physical therapist assessment ($135) was higher compared with the team over virtual care ($118) and NP care ($59). Conclusion Primary outcomes were not different by group. Physical therapist alone was more costly than other groups. Future research should include more participants, longer follow-up time and refined cost parameters. Trial Registration ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7).
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Affiliation(s)
- Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Biaka Imeah
- Ministry of Social Services, Government of Saskatchewan, Regina, Saskatchewan, Canada
| | - Nazmi Sari
- Department of Economics, College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Megan E O’Connell
- Department of Economics, College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Steve Milosavljevic
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adriana Angarita-Fonseca
- College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Universidad de Santander, Bucaramanga, Colombia
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Center for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Canada
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Crockett K, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Carnegie B, Custer M, McIntosh S, Bath B. Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey. Health Serv Insights 2023; 16:11786329231193794. [PMID: 37641592 PMCID: PMC10460467 DOI: 10.1177/11786329231193794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
Background Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽ .001). Not knowing where to go to access care or what would help their low back pain (P = .03), lack of cultural sensitivity (P = .007), and comfort discussing problems with health care professionals (P = .26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P = .013) and having healthcare options nearby in their community (P = .045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.
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Affiliation(s)
- Katie Crockett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology, & Health, Royal Institute of Technology, Stockholm, Sweden
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Terrence McDonald
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK, Canada
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Velez M, Lugo-Agudelo LH, Patiño Lugo DF, Glenton C, Posada AM, Mesa Franco LF, Negrini S, Kiekens C, Spir Brunal MA, Roberg ASB, Cruz Sarmiento KM. Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 2:CD014823. [PMID: 36780267 PMCID: PMC9918343 DOI: 10.1002/14651858.cd014823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. OBJECTIVES To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. SEARCH METHODS We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. AUTHORS' CONCLUSIONS This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.
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Affiliation(s)
- Marcela Velez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | | | - Claire Glenton
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ana M Posada
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University La Statale , Milano, Italy
- Laboratory of Evidence Based Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Raymond L, Castonguay A, Doyon O, Paré G. Nurse practitioners' involvement and experience with AI-based health technologies: A systematic review. Appl Nurs Res 2022; 66:151604. [DOI: 10.1016/j.apnr.2022.151604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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Zischke C, Simas V, Hing W, Milne N, Spittle A, Pope R. The utility of physiotherapy assessments delivered by telehealth: A systematic review. J Glob Health 2021; 11:04072. [PMID: 34956637 PMCID: PMC8684795 DOI: 10.7189/jogh.11.04072] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Telehealth use is increasing due to its ability to overcome service access barriers and provide continued care when disease transmission is of concern. However, little is known of the validity, reliability and utility of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. The aim of this systematic review was to determine the current clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all areas of physiotherapy practice. METHODS A comprehensive search of databases (PubMed/MEDLINE, The Cochrane Library, Embase and EBSCO) was undertaken to identify studies investigating the clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. Following selection, a quality appraisal was conducted using the Brink and Louw or Mixed Methods Appraisal Tool. Evidence regarding validity, reliability and utility of synchronous telehealth physiotherapy assessments was extracted and synthesised using a critical narrative approach. RESULTS Thirty-nine studies conducted in a variety of simulated (n = 15) or real-world telehealth environments (n = 24), were included. The quality of the validity, reliability and utility studies varied. Assessments including range of movement, muscle strength, endurance, pain, special orthopaedic tests (shoulder/elbow), Berg Balance Scale, timed up and go, timed stance test, six-minute walk test, steps in 360-degree turn, Movement Assessment Battery for Children (2nd Edition), step test, ABILHAND assessment, active straight leg raise, and circumferential measures of the upper limb were reported as valid/reliable in limited populations and settings (many with small sample sizes). Participants appeared to embrace telehealth technology use, with most studies reporting high levels of participant satisfaction. If given a choice, many reported a preference for in-person physiotherapy assessments. Some inconsistencies in visual/auditory quality and challenges with verbal/non-verbal communication methods were reported. Telehealth was considered relatively cost-effective once services were established. CONCLUSIONS Performing physiotherapy assessments using synchronous forms of telehealth appears valid and reliable for specific assessment types in limited populations. Further research is needed in all areas of physiotherapy practice, to strengthen the evidence surrounding its clinometric value. Clinicians contemplating using this assessment mode should consider the client/family preferences, assessment requirements, cultural needs, environment, cost considerations, access and confidence using technology. PROTOCOL REGISTRATION PROSPERO: CRD42018108166.
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Affiliation(s)
- Cherie Zischke
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Vinicius Simas
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Alicia Spittle
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
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Tanner K, Bican R, Boster J, Christensen C, Coffman C, Fallieras K, Long R, Mansfield C, O'Rourke S, Pauline L, Sagester G, Marrie J. Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services. Int J Telerehabil 2020; 12:43-52. [PMID: 33520094 PMCID: PMC7757654 DOI: 10.5195/ijt.2020.6336] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Telerehabilitation has long been recognized as a promising means of providing pediatric services; however, significant barriers such as cost, payor reimbursement, and access prevented widespread use. The advent of the COVID-19 pandemic necessitated rapid adoption of telerehabilitation into clinical practice to provide access to care while maintaining social distancing. The purpose of this study is to present clinical data on the feasibility and acceptability of speech-language pathology, developmental occupational and physical therapies, and sports and orthopedic therapies telerehabilitation delivered in a pediatric hospital setting. Methods Telerehabilitation services were rapidly implemented in three stages: building the foundation, implementing, and refining this service delivery model. Paper patient satisfaction surveys were administered as part of ongoing quality improvement efforts throughout 2019 and were adapted for online administration in 2020 for telerehabilitation patients. Outpatient visit counts by type (in-person, phone, and video) were extracted from the electronic medical record using data warehousing techniques. Results Historical patient satisfaction rates from 2019 indicated high patient satisfaction (98.97% positive responses); these results were maintained for telerehabilitation visits (97.73%), indicating that families found telerehabilitation services acceptable. Patient volume returned to 73.5% of pre-pandemic volume after the implementation of telerehabilitation services. Conclusions Pediatric telerehabilitation is feasible to provide in clinical settings, and the services are acceptable to patient families. Future work is needed to evaluate the impact of telerehabilitation services on patient care and applications for ongoing use of this delivery model.
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Affiliation(s)
- Kelly Tanner
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rachel Bican
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jamie Boster
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Catie Christensen
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Candace Coffman
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kristin Fallieras
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rene Long
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christine Mansfield
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sara O'Rourke
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lindsey Pauline
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Grace Sagester
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - James Marrie
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
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Lovo S, Harrison L, O'Connell ME, Trask C, Bath B. Experience of patients and practitioners with a team and technology approach to chronic back disorder management. J Multidiscip Healthc 2019; 12:855-869. [PMID: 31695402 PMCID: PMC6811366 DOI: 10.2147/jmdh.s208888] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/01/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Although rural and remote residents face general challenges accessing health care in comparison to urban dwellers, care for musculoskeletal conditions like chronic back disorders (CBD) is particularly challenging for rural and remote residents due to lack of access to physical yherapists. Telerehabilitation such as secure videoconferencing offers one solution to this disparity in rural care delivery, but incorporating the perspectives of health practitioners and patients is important when developing new sustainable care models. Patients and methods This study investigated the experiences of practitioners and patients during a novel interprofessional model of assessment where an urban-based physical therapist used videoconferencing to virtually join a rural nurse practitioner and a rural patient with CBD. Patient surveys and semi-structured interviews of practitioners and patients were analyzed quantitatively and qualitatively. Results Most patients were “very satisfied” (62.1%) or “satisfied” (31.6%) with the overall experience, and “very” (63.1%) or “somewhat (36.9%) confident” with the assessment. Thematic analysis of interviews revealed that this novel assessment method identified: access to care for CBD, effective interprofessional practice, enhanced clinical care for CBD, and technology considerations. Conclusion Patient satisfaction with the telerehabilitation model of care was high. Patients and practitioners reported their experiences were impacted by access to care, interprofessional practice, enhanced care for CBD and technology. These findings will be useful in the development of patient-centered models of care utilizing telehealth strategies.
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Affiliation(s)
- Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - L Harrison
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - M E O'Connell
- College of Arts and Science, University of Saskatchewan, Saskatoon, SK S7N 5A5, Canada
| | - C Trask
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - B Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada.,Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
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Shah TI, Milosavljevic S, Trask C, Bath B. Mapping Physiotherapy Use in Canada in Relation to Physiotherapist Distribution. Physiother Can 2019; 71:213-219. [PMID: 31719717 PMCID: PMC6830420 DOI: 10.3138/ptc-2018-0023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: In this cross-sectional study, we examined the distribution of physiotherapists at the health region level across Canada in relation to self-reported physiotherapy use across the provinces and territories. Method: We drew on two data sources: the physiotherapy use question from the 2014 Canadian Community Health Survey and physiotherapists' primary employment information, obtained from the Canadian Institute of Health Information's 2015 Physiotherapist Database. We then applied geospatial mapping and Pearson's correlation analysis to the resulting variables. Results: Physiotherapy use is moderately associated with the distribution of physiotherapists (Pearson's r 92 = 0.581, p < 0.001). The use and distribution variables were converted into three categories using SDs of 0.5 from national means as cut-off values. Cross-classification between the variables revealed that 15.2% of health regions have a high use-high distribution ratio; 18.5% have a low use-low distribution ratio; 4.3% have a high use-low distribution ratio; 2.2% have a low use-high distribution ratio; and 60.0% have medium use-medium distribution ratio. Conclusions: The distribution of physiotherapists and self-reported physiotherapy use varies across health regions, indicating a potential inequality in geographical access. Given that most provinces have a regionalized approach to health human resources and health service delivery, these findings may be helpful to managers and policy-makers and may allow them to make a more granular comparison of intra- and inter-provincial differences and potential gaps.
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Affiliation(s)
| | | | - Catherine Trask
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Sask
| | - Brenna Bath
- School of Rehabilitation Science
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Sask
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Sherry J. The robot nurses are coming to a workplace near you. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:765-767. [PMID: 29995519 DOI: 10.12968/bjon.2018.27.13.765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As robot technology rapidly encroaches into most areas of our lives, second-year Kingston and St George's universities nursing student Jack Sherry remains optimistic that he will still have a job, jsherry38@gmail.com.
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The use of technology to improve health care to Saskatchewan's First Nations communities. ACTA ACUST UNITED AC 2017; 43:120-124. [PMID: 29770076 DOI: 10.14745/ccdr.v43i06a01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Saskatchewan is a province of over one million people and over 13% are Indigenous peoples, many of whom live on reserve lands. Despite continued efforts, access to health care remains a significant challenge for these Indigenous people, especially those in the North. Objective To address this challenge, Saskatchewan's health care providers have been incorporating the use of technology for various health services. This paper describes various ways technology has been used in First Nations communities in Saskatchewan. Methods Several pilot projects between First Nations leaders and health care providers, in the communities as well as in the urban setting, have taken place over the past 10 years. Information on these pilots was supplemented with literature reviews and consultations with colleagues at the Northern Inter-Tribal Health Authority, the First Nations and Inuit Health Branch (FNIHB), Health Canada and lead physicians for services to the North. Results Numerous technologies have shown promise in aiding the timely delivery of high quality health care. Remote Presence Robotic Technology (RPRT) is a form of telemedicine that creates the sense that a clinician is at the patient's side; enabling clinical services to be provided remotely and in real time. Increasing access to internet services and providing computer tablets to community health nurses have improved patients' access to clinical care and to vital health care information. Robotic ultrasonography has been used to provide onsite care for pre-natal patients. The provision of cell phones to HIV-positive patients has improved compliance with anti-retroviral therapy and has resulted in better clinical outcomes. The Xpert MTB/RIF (Mycobacerium tuberculosis complex / resistance to rifampicin) is an automated device that, through analysis of raw sputum samples, can identify the presence of M. tuberculosis with greater speed, sensitivity and specificity than the conventional acid-fast bacilli (AFB) smear. Similarly, telemedicine remote communications equipment is being used for patient care across communities. Panorama is a comprehensive, integrated public health information system designed for public health professionals and is currently being introduced in 21 communities in Saskatchewan. Conclusion Not only do these innovative technologies appear to improve access and enhance the quality of timely care in remote communities but they also bring comfort to patients, prevent unnecessary transportation and minimize time away from work and family. Although these technologies are not a panacea for some of the determinants of health that can affect the incidence and severity of infectious diseases in First Nations, they do appear to address some of the geographic challenges faced in providing health services in remote communities.
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