INTERNATIONAL CLINICAL PRACTICE GUIDELINE RECOMMENDATIONS FOR TELEREHABILITATION: ACTION AND IMPLEMENTATION
J. Deutsch1, J. O'Neil2, O. Ronzio3, T. Russell4
All authors, affiliations and abstracts have been published as submitted.
1Rutgers University, Rivers Lab - Department of Rehabilitation and Movement Science, Newark, United States, 2University of Ottawa, School of Rehabilitation Sciences, Ottawa, Canada, 3Maimonedes University, Physical Therapy, Buenos Aires, Argentina, 4University of Queensland, RECOVER Injury Research Centre Faculty of Health and Behavioural Sciences, Brisbane, Australia
Learning objective 1: Describe how the international clinical practice guidelines on telerehabilitation were developed.
Learning objective 2: Discuss and highlight the evidence of the seven key recommendations about intervention, examination, documentation, cost-effectiveness, adverse events and barriers and facilitators to implementation of telerehabilitation.
Learning objective 3: Illustrate how the recommendations could be applied within your current context.
Description: While telerehabilitation has traditionally been used to increase access to care for those in rural and remote areas, the COVID-19 pandemic has highlighted how important this mode of service delivery is when conventional in-person services are unavailable but has also exposed important gaps in knowledge. Indeed, the Covid-19 pandemic has demonstrated the need to diversify the ways physiotherapy is being delivered. Telerehabilitation is described as the provision of rehabilitation services remotely via telecommunications technologies. In the physiotherapy context, telerehabilitation provides an alternative rehabilitation service delivery method allowing further options to access health services such as rehabilitation. Over the last few years, the world has experienced a rapid adoption of telerabilitation which has highlighted significant gaps in knowledge and evidence around its implementation. It is then critical to identify the current literature on telerehabilitation to improve knowledge dissemination on the use of telerehabilitation. This could support clinicians world-wide in their evidence-based clinical implementation. The goal of this symposium is to improve overall knowledge around the use of telerehabilitation in physiotherapy and share strategies to facilitate implementation within clinical practice. A brief overview will be presented on how the international group with representatives from physical therapy associations of Australia, Argentina, Canada and the United States was formed, the process by which they developed the guideline and translated from it from English into Spanish. Then each presenter will discuss the recommendations, most salient evidence and strategies for implementation into practice.
First, Dr. Russell will discuss three recommendations related to clinical management. He will speak about the examination and intervention process for both fully implemented tele-rehabilitation and hybrid delivery (combination of in-person and telerehabilitation). He will highlight relevant literature on treatment outcomes for specific health conditions.
Second, Dr. O’Neil will discuss the remaining four recommendations targeting service provision. She will provide information on service provision including cost-effectiveness, service planning and delivery, and safety. She will discuss as well the strategies for addressing barriers and facilitators both for the clinician and the patient to implementing telerehabilitation.
Third, Dr. Oscar Ronzio’s talk will propose ways to apply these recommendations within various contexts and the importance of language translation for the adoption of practice guidelines.
A panel discussion will invite all attendees to examine how these recommendations could be implemented within their local context. We will support all participants to provide their lived experience and allow for a diverse and inclusive discussion on the implementation of telerehabilitation within various practice settings and education context. We will discuss, as well, how these recommendations could contribute to improving access to addressing global health needs while highlighting their contributions to the third Sustainable Development Goals (SDG) and the Rehabilitation 2030 Agenda. To facilitate participant participation and inclusion within the symposium, the panel will be able to take questions and translate in four languages including English, Spanish, Portuguese, and French.
Implication and conclusion: The speed of telerehabilitation adoption during COVID-19 exposed the gaps in knowledge about how to effectively and sustainable implement telerehabilitation in practice. Currently, clinician based their clinical decision on practical experience, developed expertise, and the available evidence. This session, highlighting the international clinical practice guideline recommendations will assist clinicians within the physiotherapy profession in their decision making and allow for high-quality person-centered telerehabilitation services as well as offer tools to influence policy making.
First, Dr. Russell will discuss three recommendations related to clinical management. He will speak about the examination and intervention process for both fully implemented tele-rehabilitation and hybrid delivery (combination of in-person and telerehabilitation). He will highlight relevant literature on treatment outcomes for specific health conditions.
Second, Dr. O’Neil will discuss the remaining four recommendations targeting service provision. She will provide information on service provision including cost-effectiveness, service planning and delivery, and safety. She will discuss as well the strategies for addressing barriers and facilitators both for the clinician and the patient to implementing telerehabilitation.
Third, Dr. Oscar Ronzio’s talk will propose ways to apply these recommendations within various contexts and the importance of language translation for the adoption of practice guidelines.
A panel discussion will invite all attendees to examine how these recommendations could be implemented within their local context. We will support all participants to provide their lived experience and allow for a diverse and inclusive discussion on the implementation of telerehabilitation within various practice settings and education context. We will discuss, as well, how these recommendations could contribute to improving access to addressing global health needs while highlighting their contributions to the third Sustainable Development Goals (SDG) and the Rehabilitation 2030 Agenda. To facilitate participant participation and inclusion within the symposium, the panel will be able to take questions and translate in four languages including English, Spanish, Portuguese, and French.
Implication and conclusion: The speed of telerehabilitation adoption during COVID-19 exposed the gaps in knowledge about how to effectively and sustainable implement telerehabilitation in practice. Currently, clinician based their clinical decision on practical experience, developed expertise, and the available evidence. This session, highlighting the international clinical practice guideline recommendations will assist clinicians within the physiotherapy profession in their decision making and allow for high-quality person-centered telerehabilitation services as well as offer tools to influence policy making.
References:
- Cottrell, Michelle A. and Russell, Trevor G. (2020).Telehealth for musculoskeletal physiotherapy. Musculoskeletal Science and Practice, 48 102193, 102193.
- Nelson, M., Bourke, M., Crossley, K. and Russell, T. (2020).Telerehabilitation is non-inferior to usual care following total hip replacement – A randomized controlled non-inferiority trial. Physiotherapy, 107, 19-27.
- Camden, C., & Silva, M. (2021). Pediatric telehealth: opportunities created by the COVID-19 and suggestions to sustain its use to support families of children with disabilities. Physical & Occupational Therapy In Pediatrics, 41(1), 1-17.
- Lee, A. C. (2020). COVID-19 and the advancement of digital physical therapist practice and telehealth. Physical therapy, 100(7), 1054-1057.
- Miller, M. J., Pak, S. S., Keller, D. R., & Barnes, D. E. (2021). Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic. Physical therapy, 101(1), pzaa193
- Jansson MM, Rantala A, Miettunen J, et al. The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis. J Telemed Telecare. 2020:Online
- Hwang R, Morris NR, Mandrusiak A, et al. Cost-utility analysis of home-based telerehabilitation compared with centre-based rehabilitation in patients with heart failure. Heart Lung Circ. 2019 Dec;28 (12):1795-803.
- Helleman J, Kruitwagen ET, van den Berg LH, et al. The current use of telehealth in ALS care and the barriers to and facilitators of implementation: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener. 2020;21(3):167-82.
- O'Neil J, van Ierssel J, Sveistrup H. Remote supervision of rehabilitation interventions for survivors of moderate or severe traumatic brain injury: A scoping review. J Telemed Telecare. 2020 Oct;26(9):520-535.
Funding acknowledgements: The American Physical Therapy Association funded the guideline development. None of the speakers received funding for their work on this project.
All authors, affiliations and abstracts have been published as submitted.
