THE USE OF DIGITAL REHABILITATION AND ITS IMPLICATION IN ENHANCING CONTINUITY OF CARE AMONG USERS OF PHYSIOTHERAPY SERVICES IN RWANDA

I. Musabyemariya¹, B. Byukusenge², J. Niyonsenga³, J.D. Bigirimana Ngamba⁴

Background: Access to rehabilitation services including physiotherapy is a global concern, especially in low and middle-income countries. Since the recorded of its first confirmed case of COVID-19 on 14^th March 2020, Rwanda has faced remarkable challenges in physical and functional rehabilitation services delivery. Although the government highly encouraged the hospitals to use technology in healthcare services delivery, many institutions failed to establish the service digitalization due to financial constraints. In partnership with Humanity & Inclusion, HVP Gatagara Orthopedic and Rehabilitation hospital which is one of three specialized hospitals in Rwanda is the first hospital that uses digital rehabilitation as a response to the COVID-19 pandemic.

Purpose: This implementation report describes the use of digital rehabilitation, a new approach in Rwanda to ensure continuity of care for service users of the physiotherapy department at HVP Gatagara during the lockdown period.

Methods: The project used the following methods:
1: Basic training of 9 physiotherapists from HVP Gatagara on Digital rehabilitation
2: A WhatsApp group was created to share practical experiences and challenges
3: Weekly phone and video conference call follow up of users by physiotherapists
4:Telephone call interview was conducted on a convenient sample of 30 service users representing all 30 districts of Rwanda to collect service users’ perceptions of digitalized service.
5:Thematic Analysis was done to evaluate the intervention

Results: Our findings showed that the use of digital rehabilitation has significantly improved adherence to home exercise programs and reduces services costs. The respondents reported that digital rehabilitation broke the barrier of geographical accessibility, and encouraged their autonomy and confidence. Physiotherapists report that the use of written home program prescriptions,  explanatory videos, and synchronous video conference improved their clinical reasoning, updated their knowledge, and reduced the use of routine observed among experienced therapists.

Conclusion(s): The project results highlight that the use of digital rehabilitation enhances continuity of care. Physiotherapists should practically integrate the new technology in the management of different cases to ensure quality services that meet the needs of service users and improve their quality of life. Some cases show improvement with digital rehabilitation especially in children in light of parents’ active engagement in doing home program exercises with their children who easily accept their parents than physiotherapists. Parents also reported that this approach has improved their confidence in doing home program exercises for their children as well as emotional attachment.

Implications: The results from this project may be used and serve in future interventions to address the global challenge regarding access to physical and functional rehabilitation services in low and middle-income countries. Future comparative studies should be done to explore the effectiveness of digital rehabilitation compared with face to face treatment, and the combination of both approaches.                    
                                                                                                                                     

Funding, acknowledgements: We acknowledge the support of the Humanity&Inclusion Rwanda Program for the financial support for the implementation of this project.

Keywords: Digital rehabilitation, access to rehabilitation services

Topic: COVID-19

Did this work require ethics approval? No

Institution: HVP GATAGARA RWANDA

Committee: N/A

Reason: innovative ways based on evidence to address the needs of users of rehabilitation services during Covid-19 pendemic in Rwanda