Case Report: Using a Remote Presence Robot to Improve Access to Physical Therapy for People with Chronic Back Disorders in an Underserved Community

Abstract

Purpose: The purpose of this case study was to evaluate the delivery of an inter-professional (IP) spinal triage management approach to chronic back disorders using remote presence robotic technology as an innovative form of telerehabilitation in a northern Saskatchewan community. Methods: The IP team, consisting of a local nurse practitioner (NP) and a physical therapist in an urban centre, completed a comprehensive neuromusculoskeletal assessment of, and one follow-up visit with, a post-surgical spinal patient. Treatment included detailed education regarding self-management after spinal surgery, provision and progression of home exercises, and reassurance. The patient was then referred to regional, in-person physical therapy care to complete her treatment. Results: A semi-structured interview with the NP revealed a high level of satisfaction; qualitative themes included the value of IP practice and the benefit to the patient of telerehabilitation achieved through patient-centred care. In a post-treatment survey, the patient expressed a high level of satisfaction with and appreciation for the patient-centred approach and the IP team. Objective clinical improvements in spinal and straight-leg raise movements were noted at the final telerehabilitation session. Conclusion: This report demonstrates the feasibility of delivering IP spinal triage management using telerehabilitation, specifically remote presence robotics, in a remote setting. Further research should include larger scale studies that investigate health, system, and economic outcomes as well as comparative studies for other forms of telehealth technology.Key Words: inter-professional relations; low back pain; physical therapists; robotics; telerehabilitation. RÉ SUMÉObjectif : l'objectif de cette é tude de cas é tait d'é valuer le recours à une approche interprofessionnelle (IP) de gestion du triage des problè mes rachidiens pour traiter les problè mes chroniques de dos à l'aide d'une technologie robotique de pré sence à distance comme forme novatrice de té lé ré adaptation dans une communauté du nord de la Saskatchewan. Mé thode : l'é quipe IP, formé e d'une infirmiè re praticienne locale et d'un physiothé rapeute d'un centre urbain, a effectué une é valuation neuromusculosquelletique exhaustive d'une patiente ayant subi une chirurgie rachidienne et l'a revue pour une visite de suivi. Le traitement incluait une formation dé taillé e sur l'autogestion à la suite d'une chirurgie rachidienne, des exercices à faire à la maison ainsi que du ré confort. La patiente a ensuite reç u des soins en physiothé rapie à la clinique ré gionale pour complé ter le traitement. Ré sultats : l'entrevue semi-structuré e avec l'infirmiè re praticienne a ré vé lé une grande satisfaction; les thè mes qualitatifs incluaient la valeur de la pratique IP et les avantages pour la patiente de la té lé ré adaptation obtenue grâ ce à des soins axé s sur le patient. Dans un sondage ré alisé aprè s le traitement, la patiente a exprimé une grande satisfaction et appré ciation de ...

<p>Experience of patients and practitioners with a team and technology approach to chronic back disorder management</p>

“…The health providers in the present study described the mutual professional benefit, in terms of capacity building on the rural team, as well as enhanced practice due to the interprofessional team. This was also identified by practitioners who utilized remote presence robotics (another form of telehealth) to address a CBD case in remote northern Canada 21…”

“…Effective interprofessional practice was a primary theme identified in our study. The present study builds on the N of 1 study by Lovo Grona et al21 with a larger sample, different technology, and a different rural community location. The CIHC identified six competency domains of interprofessional practice: interprofessional communication, patient/client/family/community-centered care, role clarification, team functioning, collaborative leadership and interprofessional conflict resolution 22…”

“…The obvious disadvantage to PT over telehealth is the inability of the PT to directly perform physical components of the assessment. To address this, Lovo Grona et al completed a lumbar neuromusculoskeletal assessment and management protocol for a CBD patient using remote presence robotics,21 in which an urban PT consultant joined an NP and patient in a remote northern area. This case study was the first known team and technology approach to management of CBD in the literature.…”

“…In a systematic review, Kairy et al reported limited available evidence on patient experience with telerehabilitation 24. One study reported positive experiences among 5 patients who were cared for by a PT using telehealth,25 and a single case study reported on the experience of a patient and NP who utilized a team and technology approach 21. The present study will build on the case study by Lovo Grona et al, which examined the experience of one patient and one practitioner with a team and technology approach to care 21…”

Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services

“…It has also been shown to be a valid and reliable intervention for musculoskeletal physical therapy conditions ( Lee et al, 2018 ). Intervention studies comparing in-person to telerehabilitation physical therapy demonstrated similar improvements in health outcomes including pain and function ( Lovo Grona et al, 2016 ). In physical therapy for developmental disorders, telerehabilitation has been used as an alternative to in-person treatment with success ( Olson et al, 2018 ).…”