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M. Marelli1, A. Fleety1, R. Shaheen1, M. Abdullah1, H. Yousef1
1Humanity & Inclusion, Rehabilitation Technical Unit, Lyon, France
Background: As the COVID pandemic hits the Middle-East region, governments restricted movements within their territory and only basic services were allowed to operate. Rehabilitation facilities were among those forced to close and people with injuries as well as people with disabilities risked to remain without direct rehabilitation services for weeks or months.
Purpose: Foreseeing the development of secondary complications in people with injuries and people with disabilities who could not receive regular rehabilitation services for long time, Humanity and Inclusion (HI) activated a Tele-Rehabilitation system.
This approach has been tested with projects in the Gaza Strip, Lebanon and Jordan. The purpose of this lesson learnt paper is to analyze challenges and added values that a distant modality brings to the rehabilitation service provision compared to the use of the more classic home-based or center-based modality. Furthermore, we observed if home-based rather than center-based modality supports or obstructs the shift to distant services.
This approach has been tested with projects in the Gaza Strip, Lebanon and Jordan. The purpose of this lesson learnt paper is to analyze challenges and added values that a distant modality brings to the rehabilitation service provision compared to the use of the more classic home-based or center-based modality. Furthermore, we observed if home-based rather than center-based modality supports or obstructs the shift to distant services.
Methods: A committee was established, composed by 1 Regional Rehabilitation Technical Specialist and 4 National Rehabilitation Technical Specialists (representing about 30 rehabilitation professionals) from the Gaza Strip, Lebanon and Jordan. The committee explored challenges and added values of tele-rehabilitation under 8 thematic: Logistic & Material, Internet & phone connection, Setting of rehabilitation sessions, Methodology of treatment, Quality of treatment, Caregiver’s role, Documentation, and Referrals.
The qualitative analysis has been carried out by committee members divided in 2 mixed countries groups to ensure communication, deeper scrutiny and avoid focusing on one context. Groups then presented to the whole committee their findings and feedbacks from other committee members were considered.
The qualitative analysis has been carried out by committee members divided in 2 mixed countries groups to ensure communication, deeper scrutiny and avoid focusing on one context. Groups then presented to the whole committee their findings and feedbacks from other committee members were considered.
Results: We faced challenges in implementing tele-rehabilitation both from home-based projects and center-based projects. Among the most evident challenges we list: lack of stable internet connection, patient's low trust of the caregiver facilitation skills, difficulty in (re)assessing the patient and in monitoring the quality of sessions.
Nevertheless, tele-rehabilitation also brought added values to the implementation of projects, such as: no barriers in physically access centers and transportation, possibility to use different communication methods and time flexibility of patient and caregiver.
During the analysis we also found specific challenges to adapt center-based project to tele-rehabilitation modality: patients used to train with machinery practiced with household materials more difficultly, rehabilitation professionals had difficulties in giving suggestions to adjust the settings when unaware of the home environment and, privacy issues were reported, especially in lockdown situations.
On the other hand, there were specific aspects of the home-based approach that eased the implementation of tele-rehabilitation, such as: therapists and patients already knew of proven effective settings and materials for the sessions, as well as training and relationship with caregivers were already strongly established.
Nevertheless, tele-rehabilitation also brought added values to the implementation of projects, such as: no barriers in physically access centers and transportation, possibility to use different communication methods and time flexibility of patient and caregiver.
During the analysis we also found specific challenges to adapt center-based project to tele-rehabilitation modality: patients used to train with machinery practiced with household materials more difficultly, rehabilitation professionals had difficulties in giving suggestions to adjust the settings when unaware of the home environment and, privacy issues were reported, especially in lockdown situations.
On the other hand, there were specific aspects of the home-based approach that eased the implementation of tele-rehabilitation, such as: therapists and patients already knew of proven effective settings and materials for the sessions, as well as training and relationship with caregivers were already strongly established.
Conclusion(s): Even though there were many challenges common to every project for the tele-rehabilitation implementation, some aspects of the home-based approach made it easier to shift to tele-rehabilitation compared to project used to a center-based approach.
Implications: Thanks to this investigation we are now able to support projects with do’s and don’ts guidelines for an easy shift towards tele-rehabilitation modality.
Funding, acknowledgements: We want to thank:
Department for International Development (DFID) – United Kingdom
Bureau of Population, Refugees, and Migration (BPRM) – United States
Department for International Development (DFID) – United Kingdom
Bureau of Population, Refugees, and Migration (BPRM) – United States
Keywords: Tele-rehabilitation, Middle-East, Home-based vs Center-based
Topic: COVID-19
Did this work require ethics approval? No
Institution: Humanity & Inclusion (HI)
Committee: Middle-East Regional Technical Specialists
Reason: The paper is an internal lesson learnt practice, it aimed to compared already used methodologies. No patients data has been examined.
All authors, affiliations and abstracts have been published as submitted.
