J. O'Neil1,2, M. Egan1,2, S. Marshall3,1, M. Bilodeau1,2, L. Pelletier4, H. Sveistrup1,2
1Bruyère Research Institute, Ottawa, Canada, 2University of Ottawa, Rehabilitation Sciences, Ottawa, Canada, 3Physical Medicine and Rehabilitation, Faculty of Medicine, Ottawa, Canada, 4University of Ottawa, Faculty of Social Sciences, Ottawa, Canada
Background: To support recovery at home, timely access to rehabilitation is key for individuals living in remote communities or who may have difficulties with transportation to rehabilitation clinics. Lifetime access to rehabilitation is critical for individuals living with chronic impairments such as poor balance, reduced mobility and low physical activity post traumatic brain injury (TBI). Increasing access to services through supervised teletherapy could improve uptake and impact of physiotherapy interventions.
Purpose: This study investigated the impact of two teletherapy supervision schedules in the delivery of a home-based intensive exercise intervention on dynamic balance, functional mobility and physical activity levels for survivors of moderate or severe traumatic brain injury.
Methods: A mixed-method approach using alternating single subject design (SSD) was used. Four survivors of moderate or severe TBI and four caregivers completed two intensive home-based telerehabilitation programs that differed only on supervision schedule: daily or weekly. The impact on physical activity levels, functional mobility, dynamic balance, fear of falling, satisfaction with life, and participation were measured. A step count and Five Time Sit to Stand were used to document change in physical activity levels and functional mobility. Dynamic balance was measured using the Community Balance and Mobility Scale (CB&M) (Howe, Inness, Venturini, Williams, & Verrier, 2006; Inness et al., 2011). Three participation questionnaires were completed pre-post each intervention phase
i) the Fall-Efficacy Scale International (Yardley et al., 2005;
ii) the Satisfaction with Life Scale (Diener, Emmons, Larsem, & Griffin, 1985); and
iii) the Participation subscale of the Mayo-Portland Adaptability Inventory.
i) the Fall-Efficacy Scale International (Yardley et al., 2005;
ii) the Satisfaction with Life Scale (Diener, Emmons, Larsem, & Griffin, 1985); and
iii) the Participation subscale of the Mayo-Portland Adaptability Inventory.
Results: Significant clinical improvements in mobility and balance were observed for all survivors. Three survivors exhibited an increase in physical activity during the intervention phases. A positive trend was observed between the weekly teletherapy supervision schedule and fear of falling for three survivors. Important functional gains (e.g. improved balance, decreased fatigue) were also reported by the dyads.
Conclusion(s): Preliminary result suggests that the physiotherapy teletherapy schedule influences the degree of improvement in the intervention outcome measures. Factoring dosage of remote supervision into intervention planning is key. Exercise programs delivered via teletherapy can be effective to improve mobility, balance as well as fear of falling for this population.
Implications: Physiotherapists, rehabilitation clinics and health organisations should consider implementing and adopting telerehabilitation services such as teletherapy as an additional method to provide home-based intensive exercise programs for survivors of moderate or severe TBI.
Funding, acknowledgements: Financial support was received from the Canadian Institute for Military and Veteran Health Research and TPL and a Spark-CABHI grant.
Keywords: Telerehabilitation, teletherapy, Traumatic Brain Injury, Home-based intervention
Topic: Innovative technology: robotics
Did this work require ethics approval? Yes
Institution: Bruyere Research Institute and University of Ottawa
Committee: Bruyère Research Institute Ethic Board and University of Ottawa REB
Ethics number: M16-18-038 and H-12-18-771
All authors, affiliations and abstracts have been published as submitted.
