Accessibility to Telerehabilitation Services for People With Multiple Sclerosis: Analysis of Barriers and Limitations

Abstract

Background: In multiple sclerosis (MS), telemedicine improves access to specialized medical care; however, barriers remain, including universal access and effective implementation. Focusing on telerehabilitation, ie, remotely delivered physical therapy, our goal was to identify barriers to telerehabilitation implementation and factors associated with patients completing telerehabilitation physical therapy treatment. Methods: Quantitative data included a review of electronic health records of patients with MS treated at the University of California San Francisco Physical Therapy Faculty Practice. We extracted demographic, clinical, and transit-related factors. For patients who scheduled an initial evaluation, we recorded the number of follow-ups, cancellations, completed physical therapy goals, and discharges. Qualitative data included interviews with 3 board-certified neurologic physical therapists and patients’ perspectives recorded in the subjective portion of physical therapy notes. Results: We identified 111 patients with at least 1 visit (in-person or telerehabilitation) to physical therapy (82 women; mean ± SD age, 54.2 ± 12.7 years). Patients with no disability (Expanded Disability Status Scale [EDSS] score, 0) were 73% less likely to schedule a follow-up appointment (in-person or telerehabilitation) than those with some disability (EDSS score, >0) (odds ratio, 0.27; 95% CI, 0.09–0.75; P = .012). Neurologic physical therapists identified reduced travel burden and scheduling flexibility as benefits of telerehabilitation vs in-person visits. Barriers to telerehabilitation included low technological literacy, cognitive impairment, and fall risk. Patients described scheduling conflicts and pain/illness as barriers to telerehabilitation. Conclusions: Patients with no disability were least likely to complete physical therapy treatment via telerehabilitation. Although both benefits and barriers to completing physical therapy via telerehabilitation are present, the neurologic physical therapists were supportive of a hybrid model for physical therapy.

Perceptions of Therapeutic Climbing for Patients with Multiple Sclerosis in Neurorehabilitation: A Qualitative Study

“…Another innovative approach would be to develop specialised apps that could serve various purposes, from tracking progress and scheduling sessions to providing virtual guidance and support [ 29 , 30 ]. Moreover, such apps could foster a sense of community among users by allowing them to share their achievements, challenges, and tips with others undergoing similar therapeutic processes while integrating gamification elements, such as rewards and challenges, could further enhance engagement, making the rehabilitation process more enjoyable and motivating.…”

Therapeutic Climbing for Patients with Multiple Sclerosis in Neurorehabilitation: A Qualitative Study

“…This approach not only ensures a structured and safe training environment but also capitalizes on the communal nature of climbing, potentially enriching the therapeutic experience. Another possibility would be to develop specialized apps [29,30].…”

Factors associated with the willingness to provide telerehabilitation by physiotherapists treating older adults or people with neurological diseases during the COVID-19 pandemic in Sweden

“…In the field of physiotherapy, TR can complement regular rehabilitation services, and previous studies support its effectiveness and feasibility [ 12 – 15 ]. Telerehabilitation has the benefit of reducing the physical burden on patients travelling to clinics and offers flexibility in scheduling for physiotherapists [ 16 ]. Research indicates that TR can improve functional outcomes and patient satisfaction in different patient groups, such as people living with neurological diseases or older adults [ 17 , 18 ].…”