Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study

Abstract

Objective COVID-19 has widely affected delivery of health care. In response, telerehabilitation (TR) has emerged as alternative care model. Aims were: (1) describe baseline patient characteristics and available unadjusted outcomes for episodes of care administered during COVID-19 using TR vs. traditional in-person care, (2) describe TR frequency levels by condition and telecommunication modes. Methods A descriptive retrospective observational design was used to report patient variables and outcomes including physical function, number of visits, and patient satisfaction, by TR frequency (few, most, or all visits) and telecommunication modes. Standardized differences were used to compare baseline characteristics between episodes with and without TR. Results Sample consisted of 222,680 patients [59% female; mean age (SD) = 55(18)]. Overall TR rate was 6% decreasing from 10% to 5% between 2nd and 3rd quarters of 2020. Outcome measures were available for 90% to 100% of episodes. Thirty-seven percent of clinicians administered care via TR. Patients treated using TR compared to in-person care were more likely to be younger, and live in large metropolitan areas. From those with TR, 55%, 20%, and 25% had TR during few, most, or all visits, respectively. TR care was administered equally across orthopedic body parts, with lower use for non-orthopedic conditions such as stroke, edema, and vestibular dysfunction. TR was primarily administered using synchronous (video or audio) modes. The rate of patients reported being very satisfied with their treatment results was 3% higher for no TR compared to TR. Conclusions These results provide new knowledge about to whom and how TR is being administered during the pandemic in outpatient rehabilitation practices throughout the USA. The database assessed was found to be suitable for conducting studies on associations between TR and diverse outcome measures, controlling for a comprehensive set of patient characteristics, to advance best TR care models, and promote high quality care. Impact This study provided detailed and robust descriptive information using an existing national patient database containing patient health and demographic characteristics, outcome measures, and TR administration data. Findings support the feasibility to conduct future studies on associations between TR care and patient outcomes, adjusting for a wide range of patient characteristics and clinical setting factors that may be associated with the probability of receiving TR. Finding of limited and decreasing use of TR over the study period calls for studies aimed to better understand facilitators and inhibitors of TR use by rehabilitation therapists during everyday practice to promote its use when clinically appropriate.

Perceptions of Telehealth Physical Therapy Among Patients with Chronic Low Back Pain

“…For example, Werneke and colleagues reported on >220,000 episodes of care in outpatient therapy settings nationwide and found only 5–10% included telehealth in the second and third quarter of 2020. 6 National studies indicate that the uptake of telehealth for behavioral health and primary care has been much greater. 5 Limited experience with telehealth physical therapy both before and after the onset of COVID-19 may contribute to perceptions that telehealth is a less viable option for physical therapy.…”

“… 3 Exercise, advise, and education are first-line interventions for chronic LBP, 3 , 16 and these treatments are also more readily adaptable to telehealth delivery, suggesting the potential for telehealth physical therapy to be effectively adapted to telehealth, despite perceptions of physical therapists and patients. Emerging studies examining physical therapy provided using telehealth suggest that outcomes are equivalent to in-person care, 6 , 17 and future protocols may make greater use of hybrid in-person and telehealth approaches to allow for physical contact while also making use of remote technologies. Much of the existing evidence supporting telehealth physical therapy used hybrid approaches, 18 and this approach may be more satisfactory to patients.…”

“…COVID-19 prompted rapid acceleration of telehealth delivery across all sectors of health care including physical therapy. 6 , 7 The rapidity of this transition did not permit lengthy consideration of public perceptions or willingness to participate in telehealth delivery of specific services. Considering the low utilization before COVID-19, it is unclear whether patients would consider telehealth physical therapy equivalent to in-person care.…”

Biopotential Signal Monitoring Systems in Rehabilitation: A Review

“…During this period, the rehabilitation concept considerably changed: the need for home medical assistance for a new idea of rehabilitation phase in older people both with and without COVID-19, in patients affected by neuromotor disease, in subjects with limited movements after injury or accident and athletes is becoming essential to help these people in maintaining their daily activities. In this context, tele-rehabilitation became an effective and well-accepted method of providing outpatient and community rehabilitation services to support family and caregivers in the assessment of the home environment, patient monitoring and outpatient therapies [16][17][18]. In emergencies such as the COVID 19 pandemic, access to health services is restricted due to the risk of infections and limitations of health resources [14,19].…”

Perceived Usefulness of Telerehabilitation of Musculoskeletal Disorders: A Belgium–France Pilot Study during Second Wave of COVID-19 Pandemic

“…COVID-19 has strongly affected the delivery of healthcare in physiotherapy. In response, telerehabilitation (TR) has emerged as an alternative care model [2].…”