Introduction
This page is designed to guide you through the prerequisites for a telehealth assessment. It discusses the effectiveness of telehealth in different situations and provides various telehealth treatment principles that may be helpful when consulting via digital technology.
Telehealth services are real-time virtual access (i.e. synchronous) store-and-forward (asynchronous) or remote patient monitoring. [1]
Types of Platforms
Telerehabilitation requires a robust platform to deliver competent technology and technical services. They may fall into the following categories
Videoconferencing: This is a continuous online platform that allows dynamic interaction between client and therapist. This may include platforms such as skype zoom google duo Whatsapp
Image Transfer: This includes transferring selected images for therapeutic purposes.
Data transmission: This includes the transmission of information by non-image or video methods, such as emailing medical records, exercise programs, etc. [2]
Technical Support
Technical support required for consultation includes:
- Audio conference equipment
- Video conference equipment
- Computer networking (WANs and LANs)
- Broadband networks
- Provide interactive satellite TV[2]
For more information on these technical aspects, see the Practical Considerations in Telehealth page
Recommendations for Consultations
It is always considered best to conduct a mock consultation to assess any technical failures that may occur and to assess network strength[3]
Consider a pre-call questionnaire before the consultation (self-assessment, such as a VAS or body chart) Ask the client if they would like a partner or family member to be present during the consultation Schedule the consultation based on who you need to see first (clinical triage Considerations for Telemedicine) to confirm the clinical appropriateness of videographic consultations. Use a private and well-lit room Make sure the patient’s phone number is ready in case there is a problem with the video call link Have the patient’s clinical note ready, preferably in another location Screen tests the technology before the meeting to check that it works as expected. Counseling starts Counseling starts by asking if the subject can see and hear you Check connectivity and clarity Must be formally presented to the patient Verbal consent is required Yes Taken from the client before the assessment begins In some countries you must verbally verify the status the patient is in to confirm that you have permission to assess/treat the patient and to ensure that he/she Have confidence in you If there are other consultants in the room, they need to be introduced to the client Instruct the patient on what to do or how to reconnect if the session ends prematurely or the internet or audio connection is poor Face-to-face consultation Please note that video communication is slightly different than face-to-face communication If you are engrossed in taking notes or reading medical records, please inform the patient and explain to the patient in advance the closing consultation summary points – this is This is especially important if technical difficulties arise during the consultation Clarify any doubts the patient may have Confirm that the patient is comfortable with the video method of telemedicine Remind the client not to discontinue their regular medication in the event of any comorbidities Say goodbye Update records after conclusion of call consultation Schedule referrals or follow-up appointments Ensure you email any practice you stipulate/commit to Send timely follow-up emails summarizing necessary features of remote consultation Must make any necessary face-to-face appointments scheduled[4]
Plan Your Consultations
A counselor or therapist must always be ready. The therapist must develop a list of questions that must be asked. Key test points including active actions, passive actions, and special tests must be organized to optimize the best use of class time. Determine if any evaluation procedures may require the assistance of a family member. [3]
Modify assessments to accommodate virtual audiences
Observational assessments upon virtual completion will depend on the view and angle of the device. Relying on the observatory’s findings can be challenging because it requires properly aligning the camera with the body part. Therefore, it is appropriate to ask some additional questions Complement your observations. Adjusting periodic inspections and revising special tests and other assessment methods is essential. [3]
Initial Setup: From time to time it may be necessary to visit the patient’s residence and set up where to place the video equipment. This facilitates the assessment process and allows for continuous monitoring of the patient while they are exercising.
Safety is a top priority: Before we dive into the technical details of this section, it’s important to understand that client safety is the number one concern every therapist must have. In case of a problem, the therapist must be able to reach the patient or A system is in place. Performing an unsafe test should be replaced with another test or additional questioning, or rather in person.
Placement of the camera for the patient: The placement must provide a good view of the client. This can be done by experimenting with several trial placement areas. (e.g., tilting a laptop on a table or placing an iPad on a stand aligned to provide a good view of the client while they perform tasks ask them.
Therapist’s camera position: The patient needs to see the therapist’s entire face while speaking. When demonstrating exercises, the patient needs to see the therapist’s entire body if possible. The therapist should have enough room to move around the camera. When moving the camera display Practice on the floor Make sure you have a stable surface to place the camera on so you don’t have to hold the device or place it on the floor. [5]
Adaptation description: The description must be clear and specific. Always prefer to use non-medical terms. If assistance from a family member is needed, the instructions must be very specific about where the hands are and which direction (towards which part) the movement is must happen.
Session time: The initial assessment may take more time, and subsequent sessions may take less time. Session times may be extended due to technical failures and poor connections.
Assessment Practicalities
Make sure you are fully prepared for any telehealth consultation, especially the initial assessment, and consider the following:[3]
- Have a list of questions and tests on hand. When getting started with telehealth, you can feel overwhelmed with technology and troubleshooting, and a checklist can help you stay on track
- Think of other questions to ask the patient. For example, if you can’t see the whole patient because of poor setup when testing forward flexion, you can ask how far down they can reach – fingertips to mid-knee tibia ankle.
- Consider which orthopedic tests are more valuable than telemedicine and whether they can be performed on their own.
- For passive and active range of motion, you need to consider the angle of the patient to the camera. If you cannot measure with a goniometer, consider a different testing method.
- Therapists can provide pre-recorded videos to patients before the session, teaching them how to perform specific tests during the consultation. Or give them directions on what to expect for the test, such as a chair or bed.
- Can show family members how to perform passive range of motion
- Consider which tests cannot be performed safely or effectively without your direct assistance. Are these tests critical to your clinical reasoning process about a patient’s diagnosis or direction of treatment? Whether a test can be adequately replaced by another test or additional tests question? Or do you need to evaluate the patient yourself to make a definitive diagnosis? [3]
- A new musculoskeletal assessment framework published on Cureus provides musculoskeletal clinicians working in primary care with pre-consultation guidance and step-by-step remote examination guidance to align their assessments with published evidence and community-sourced best practice; it is also Includes patient and clinician resources (patient information booklet and exam photos). The framework recommends adapting the traditional technique of “seeing and feeling moving” to “seeing and moving”, reflecting the growing role of patient participation in the virtual world Consultation[6]
To learn more, follow this link: Framework for Telemusculoskeletal Assessment: Guidelines for Primary Care
Treatment
What interventions can you safely take as part of telehealth
In chronic musculoskeletal disorders, telemedicine and rehabilitation services are widely accepted. [7] Studies show that physical therapy in telemedicine is effective in:
- Chronic joint pain or osteoarthritis (osteoarthritis of the knee [8] and arthritis of other joints) [9]
- Shoulder hemiarthroplasty
- Total hip replacement
- Nonspecific low back pain that is subacute in nature
- Chronic non-specific neck pain[10]
- Total knee arthroplasty[11]
- Degenerative lumbar spinal stenosis [12]
Telemedicine is not suitable for interventions such as manual treatment of soft tissue techniques or any technique that requires a therapist to perform hands-on work on the client. [13]
Patient Education
75% of people look for answers about their health online. It has also been shown that 40-67% of people rely on online platforms, including health-related apps, for basic healthcare information. This tells us that telemedicine has a huge customer base. however it is It is important to steer these individuals in the right direction, as they may have reservations about using it as a primary source of treatment. Therefore, education about telemedicine, general expectations for recovery, and information about patient-specific circumstances must be clear and based on Simple and stylish. Patients can be asked to register on the online interface portal and post their questions if necessary. It is ideal to organize regular patient education sessions. [14] Many patients often perceive telemedicine as appropriate for follow-up care rather than initial evaluation. Therefore, the therapist needs to educate the client/patient on how the system works and help and reassure him/her in case of any difficulties. [2]
Exercise Therapy
There are a variety of ways patients can be taught specific exercises and monitored continuously during face-to-face rehab sessions. These methods can be carried out with the help of family members when needed
- Prerecorded video
- Online video demonstration
- Display of visual feedback
- Video conferencing
- Sensors embedded in the task device (if available) can track and relay information to the therapist [15]
- Family members provide assistance when needed, such as passive ROM videos
Functional Rehabilitation
Functional targets must be customized individually. In fact, most chronically ill patients prefer telemedicine to regular rehabilitation because it is cost-effective, saves time, and reduces absenteeism due to illness. Websites and apps can be used instead of phone and video methods Communicate to allow monitoring of practice and ongoing recording of progress. This approach has been shown to be more effective for exercising consistently. Therefore, telerehabilitation is a very suitable rehabilitation method
- Educate patients about their condition
- Advise patients on self-management techniques
- Prescription of exercises
- Advice on physical activity and individualized programs
- Monitoring progress and follow up
Recommendations to the Organizers
- A telemedicine network must be prioritized using standardized software or systems
- Consultation and referral sites must be available for immediate consultation when required
- Goal-oriented and time-driven standardized protocols must be developed to effectively deliver rehabilitation services, especially in the acute phase
- Continuing education and simulation of simulated conditions are recommended to continuously train and update the professionals who provide the service [16]. A recent study by Luke Davies et al. [17]. An international core competency framework was developed for physiotherapists to deliver quality care via videoconferencing. The framework outlines 60 specific capabilities across seven domains that will contribute to:
- Instruct physiotherapists on the knowledge and skills needed to deliver quality care via video conferencing
- Training Physiotherapists in a Digital Environment &
- To inform the future development of physical therapy courses and professional development programs that offer telemedicine.
- Telerehabilitation includes a mode of communication. In fact, to optimize results and assess compliance, multiple modes of communication may be required, such as video conferencing phones, desktop video phones, messaging devices, online chat sessions, video recordings, emails. [18]
Patient Guide
- Decide what type of consultation you want or need (telephone consultations work well if video is not required). Video consultations are more reassuring due to visual feedback.
- Make sure your last updated details at the hospital are your current details (email ID phone number). Find a quiet place with a good internet connection. Test the equipment you will be using before consulting. Make sure the physiotherapist has your credential details to know it’s you And respond promptly. Log in to connect a few minutes before the consultation
- You can look at the screen during the consultation, but it is not necessary to look at the camera as this can be difficult. Any issues requiring verification can be clarified. If the connection is lost, reconnect the call
- Make sure to follow up on anything you agree to.
Additional Resources
- International Physiotherapist Core Competency Framework – Melbourne School of Health Sciences
References
- ↑ Cabrera CI, Ning AY, Cai Y, D’Anza B. Systematic review of telehealth cost minimization for patients and health systems in otolaryngology. Laryngoscope. 2021 Aug;131(8):1741-8.
- ↑ Jump up to:2.0 2.1 2.2 Australian Physiotherapy Association. Telehealth Guidelines. Available from: https://australian.physio/sites/default/files/APATelehealthGuidelinesCOVID190420FA.pdf (Accessed 17 May 2020)
- ↑ Jump up to:3.0 3.1 3.2 3.3 3.4 Cottrell, M. General Patient Assessment and Management in Telehealth. Course. Plus. 2020
- ↑ Specialty guides for patient management during the coronavirus pandemic. Clinical guide for the management of remote consultations and remote working in secondary care during the coronavirus pandemic. NHS Report number: 001559 [27/03/2020]
- ↑ WebPT. The Rehab Therapist’s Guide to Practicing Telehealth.
- ↑ Murray T, Murray G, Murray J. Remote Musculoskeletal Assessment Framework: A Guide for Primary Care. Cureus. 2021 Jan;13(1).
- ↑ Jansons PS, Haines TP, O’Brien L. Interventions to achieve ongoing exercise adherence for adults with chronic health conditions who have completed a supervised exercise program: systematic review and meta-analysis. Clin Rehabil. 2017 Apr;31(4):465-77.
- ↑ Yang Y, Li S, Cai Y, Zhang Q, Ge P, Shang S, Han H. Effectiveness of telehealth-based exercise interventions on pain, physical function and quality of life in patients with knee osteoarthritis: A meta-analysis. J Clin Nurs. 2022 Jul 25.
- ↑ Ezzat A, Kemp J, Heerey J, Pazzinatto M, Silva DDO, Dundules K, Barton C. Implementing telehealth-delivered group-based education and exercise for osteoarthritis during the COVID-19 pandemic: A mixed-methods evaluation. J Sci Med Sport. 2022 Nov;25:S9–S10.
- ↑ Özel M, Kaya Ciddi P. The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: A randomized controlled trial. J Telemed Telecare. 2022 May 16:1357633X221095782.
- ↑ LeBrun DG, Martino B, Biehl E, Fisher CM, Gonzalez Della Valle A, Ast MP. Telerehabilitation has similar clinical and patient-reported outcomes compared to traditional rehabilitation following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4098-4103.
- ↑ Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin rehabil. 2017 May;31(5):625-38.
- ↑ Rush KL, Hatt L, Janke R, Burton L, Ferrier M, Tetrault M. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. Patient Educ Couns. 2018 Aug 1;101(8):1310-21.
- ↑ Rush KL, Hatt L, Janke R, Burton L, Ferrier M, Tetrault M. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. Patient Educ Couns. 2018 Aug 1;101(8):1310-21.
- ↑ Brennan DM, Lum PS, Uswatte G, Taub E, Gilmore BM, Barman J. A telerehabilitation platform for home-based automated therapy of arm function. Conf Proc IEEE Eng Med Biol Soc 2011 Sep 3 (pp. 1819-1822). IEEE.
- ↑ Blacquiere D, Lindsay MP, Foley N, Taralson C, Alcock S, Balg C, Bhogal S, Cole J, Eustace M, Gallagher P, Ghanem A. Canadian stroke best practice recommendations: Telestroke best practice guidelines update 2017. Int J Stroke. 2017 Oct;12(8):886-95.
- ↑ Davies L, Hinman RS, Russell T, Lawford B, Bennell K, Billings M, Cooper-Oguz C, Finnan K, Gallagher S, Gilbertson DK, Holdsworth L. An international core capability framework for physiotherapists to deliver quality care via videoconferencing: a Delphi study. Journal of Physiotherapy. 2021 Sep 11.
- ↑ Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C. Telerehabilitation services for stroke. Cochrane Database of Syst Rev. 2013(12).