Telerehabilitation: Policy Issues and Research Tools

Abstract

Abstr actThe importance of public policy as a complementary framework for telehealth, telemedicine, and by association telerehabilitation, has been recognized by a number of experts. The purpose of this paper is to review literature on telerehabilitation (TR) policy and research methodology issues in order to report on the current state of the science and make recommendations about future research needs. An extensive literature search was implemented using search terms grouped into main topics of telerehabilitation, policy, population of users, and policy specific issues such as cost and reimbursement. The availability of rigorous and valid evidence-based cost studies emerged as a major challenge to the field. Existing cost studies provided evidence that telehomecare may be a promising application area for TR. Cost studies also indicated that telepsychiatry is a promising telepractice area. The literature did not reference the International Classification on Functioning, Disability and Health (ICF). Rigorous and comprehensive TR assessment and evaluation tools for outcome studies are tantamount to generating confidence among providers, payers, clinicians and end users. In order to evaluate consumer satisfaction and participation, assessment criteria must include medical, functional and quality of life items such as assistive technology and environmental factors.

Challenges to the Emergence of Telerehabilitation in a Developing Country: A Systematic Review

“…Telemedicine is the delivery of healthcare services through information and communications technology (ICT) to a different, often distant, site (12). As a telemedicine subset, telerehabilitation (telerehab) is an emerging technology that uses electronic means in remotely conducting evaluation, consultation, therapy, and monitoring to provide rehabilitation care for patients in various locations, such as home, community, nearby health facility, and workplace (11)(12)(13).…”

“…Telemedicine is the delivery of healthcare services through information and communications technology (ICT) to a different, often distant, site (12). As a telemedicine subset, telerehabilitation (telerehab) is an emerging technology that uses electronic means in remotely conducting evaluation, consultation, therapy, and monitoring to provide rehabilitation care for patients in various locations, such as home, community, nearby health facility, and workplace (11)(12)(13). Despite its growing body of literature and scope of services in other, mostly developed, countries, telerehabilitation continues to face challenges or barriers to its emergence in less-developed countries like the Philippines, albeit its practical use to address the widening gap between the supply of and demand for rehabilitation services especially during unprecedented times like the coronavirus disease 2019 (COVID-19) pandemic, wherein face-to-face access to rehabilitation services is hampered (14).…”

The HAAPI (Home Arm Assistance Progression Initiative) Trial

“…Telerehabilitation is defined as the provision of rehabilitation services at a distance using information and communication technologies. 14 -18 It continues to grow as a service delivery alternative to traditional rehabilitation. Evidence exists demonstrating the value and effectiveness of TR stroke programs.…”

“…21,22 Some key policy issues that have an impact on the use of home-based TR include the following: cost, reimbursement, privacy and informed consent, fraud, liability, licensure, and systems security. 15…”

Using the Technology Acceptance Model to Identify Factors That Predict Likelihood to Adopt Tele-Neurorehabilitation

“…Although gains have been made in design of ICT to potentially enhance tele-neurorehabilitation, barriers to adoption that were identified more than 20 years ago remain apparent today ( 65 ). These barriers are relevant for both patients and prescribing clinicians and include poor computer self-efficacy, high computer anxiety, low perception of usefulness and a belief that the technology is not user-friendly ( 65 , 66 ). If we are to realize the full potential of tele-neurorehabilitation, it is of critical importance that we approach the topic using a validated and well-tested theoretical framework to guide and evaluate implementation.…”