We evaluated the effectiveness of telerehabilitation for promoting RTW among injured workers. We hypothesized that mode of service delivery (telerehabilitation, in-person, or hybrid) would not impact RTW or patient-reported clinical outcome measures in a statistically significant manner.
We conducted a pragmatic, quasi-experimental study comparing workers who received care delivered completely via telerehabilitation since the start of the COVID-19 pandemic to those receiving completely in-person services or hybrid services. We used province-wide data on all injured workers undergoing rehabilitation at WCB-contracted facilities throughout the province. Mode of service delivery (telerehabilitation, in-person, or hybrid) as tracked by WCB-Alberta was the main intervention variable examined in this study. The dataset included a variety of descriptive variables including demographic factors (e.g., age, gender), occupational factors (e.g., National Occupational Classification code, employment and working status, modified work availability), and treatment factors (e.g., number and type of health care services received before beginning rehabilitation, days between workplace accident and admission for rehabilitation, program length). Potential confounders also included patient-reported outcome measures (PROMs) collected at intake to rehabilitation. Descriptive statistics analyzed demographics, occupational factors, and PROMs. Kruskal-Wallis tests investigated differences between mode of delivery and changes in PROM scores. Logistic and Cox proportional hazard regression examined associations between mode of delivery and RTW status or days receiving wage replacement benefits in the first year post-discharge, respectively.
A slight majority of 3,708 worker sample were male (52.8%). Mean (standard deviation (SD)) age across all delivery formats was 45.5 (12.5) years. Edmonton zone had the highest amount of telerehabilitation delivery (53.5%). The majority of workers had their program delivered in a hybrid format (54.1%) and returned to work (74.4%) at discharge. All PROMs showed improvement although differences across delivery formats were not clinically meaningful. Delivery via telerehabilitation had significantly lower odds of RTW at discharge (Odds Ratio: 0.82, 95% Confidence Interval: 0.70-0.97) and a significantly lower risk of experiencing suspension of wage replacement benefits in the first year following discharge (Hazard Ratio: 0.92, 95% Confidence Interval: 0.84-0.99). Associations were no longer significant when confounders were controlled for.
RTW outcomes were not statistically different across delivery formats, suggesting that telerehabilitation is a novel strategy that may improve equitable access and earlier engagement in occupational rehabilitation. Factors such as gender and geographic location should be considered when deciding on service delivery format.
Delivery of occupational rehabilitation services via telerehabilitation appeared to result in comparable RTW outcomes when compared to in-person or hybrid delivery of services. Telerehabilitation may be a suitable alternative for injured workers with musculoskeletal conditions, improving equitable access and earlier engagement in occupational rehabilitation.
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