We?ve seen the use of telecommunications in physical therapy become more prevalent with the changing climate in healthcare. Using telecommunications technology to provide health care, health information, and health education across a distance is referred to as telehealth.
When telehealth is used in rehabilitation practices it is referred to as telerehabilitation: the application of communication technology for supporting rehabilitation services. With all the buzz about telehealth and telerehabilitation we thought we would give an overview of how they are influencing healthcare.
Doctors and physical therapists can use telecommunications technology to correspond with their patients or other health professionals. The debate surrounding the use of telehealth is whether or not it provides the same quality care as face-to-face meetings with patients. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation was conducted by the Department of Health Administration at the University of Montreal to collect data to try to answer this question.
In this study, twenty-eight articles on telerehabilitation were analyzed. The articles dealt with neurological rehabilitation, cardiac rehabilitation, follow up of individuals with spinal cord injuries, rehabilitation for speech-language impairments and rehabilitation for varied clienteles (1).
The study found that clinical outcomes were generally improved following telerehabilitation, outcomes were at least similar or better than an alternative intervention, consultation time tended to be longer with telerehabilitation, and satisfaction with telerehabilitation was consistently high (1). The results showed telerehabilitation was valued by the majority of patients to be effective and efficient.
In order for telehealth to be implemented there needs to be informed consent, technical standards put in place, professional standards set, and provider and end user acceptance. Some people prefer face-to-face contact with their doctor and feel videoconferencing with their providers would be cumbersome and ineffective. In order for people to accept videoconferencing as a way of communicating with their doctors, thorough instructions of equipment use would need to be provided and the experience would need to replicate that of a face-to-face visit.
In the International Journal of Telerehabilitation the benefits of its use were listed as follows: 1) decreased travel between rural communities and specialized urban health centers; 2) better clinical support in local communities; 3) improved access to specialized services; 4) delivery of health care in rural communities; 5) indirect educational benefits for remote clinicians who participate in teleconsultations; 6) reduced feelings of isolation for rural clinicians; 7) improved service stability in regions with high staff turnover; and 8 ) multimedia communication. (3)
While many of these benefits refer to the benefits brought to rural communities, it is becoming apparent that telehealth benefits people everywhere:
In a study conducted by Hatzakis within the Veterans Health Administration it was determined that veterans with multiple sclerosis have significant barriers to care as a result of their disability. Twenty percent of patients surveyed reported that parking, distance, or transportation difficulties significantly interfered with their receiving treatment. Furthermore, for individuals with sensation issues (e.g., spinal cord injury) prolonged sitting during travel can carry the potential risk of worsening a sore or decubitus ulcer. For this reason, many individuals delay or avoid necessary treatment. While issues of access are clearly magnified in rural areas, mobility restrictions and accessibility problems also decrease the quality of healthcare for individuals located in urban areas. (4)
Telerehabilitation provides a way in which patients can receive treatment and communicate with their therapists without having to leave their homes. Telerehabilitation not only allows patients to hear their therapist give instructions but also allows patients to see their therapists as they demonstrate exercises and explain treatment instructions. Telerehabilition has become more popular in cases in which travel is difficult for the patient or the patient is experiencing pain or discomfort that prohibits them from making the trip to their provider. Patients can visit their therapists? practices but also have the option of checking in with their therapists through the use of telecommuications when a face-to-face visit is unnecessary or the trip is difficult for the patient to make.
As telerehabilitation services continue to grow as a complement to traditional face-to-face clinical services, there is an increasing need to standardize appropriate clinical uses, reimbursement, and health care policy regarding the use of telerehabilitation (2).
Licensure and practice across state lines prohibits health professionals from treating patients who are located out of state and one of the many benefits of telecommunications is that health professionals can communicate with their patients regardless of their location. The professional liability and training that needs to be conducted is extensive and quality standards need to be set in place for the devices that will be used in order to replicate a face-to-face meeting.
While the debate surrounding the use of telehealth continues and many feel the replacement of face-to-face meetings with telecommunications hinders quality of care, advances in technology and the use of telerehabilitation is showing its use in conjunction with in-person visits is extremely beneficial. Replacing a patient?s entire in-person care may not be the answer, but using telehealth as a way to complement patient care is valuable and advantageous to healthcare professionals looking to save money, save time, and provide quality care. Russel T.G. stated (after conducting a pilot study exploring the feasibility and effectiveness of an Internet-based telerehabilitation application), ?A failure to integrate telehealth into routine clinical practice as the evidence emerges would constitute a grave disservice to clients? (5).
(1) D, Kairy, Lehoux P, Vincent C, and Visintin M. "A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation.." US National Library of Medicine National Institutes of Health. Disabil Rehabil., 2009. Web. 19 Sep 2012..
(2) Schmeler, Mark, Richard Schein, Michael McCue, and Kendra Betz. "Telerehabilitation Clinical and Vocational Applications for Assistive Technology: Research, Opportunities, and Challenges." International Journal of Telerehabilitation. University Library System, University of Pittsburgh , 2009. Web. 19 Sep 2012..
(3) Lemaire, E. D., Boudrias, Y., & Greene, G. (2001). Low-bandwidth, internet-based videoconferencing for physical rehabilitation consultations. Journal of Telemedicine and Telecare, 7(2), 82-89.
(4) Hatzakis, M., Haselkorn, J., Williams-Avery, B. K., & Rodriguez, A. (2001). Proportion of veterans with multiple sclerosis receiving pharmacology therapy for fatigue. International Journal of MS Care, 3(2), 4.
(5) Russell TG. Telerehabilitation: a coming of age [editorial]. Aust J Physiother. 2009;55:5?6.
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