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eHealthcare and Rehabilitation: What is the Evidence?

eHealthcare and Rehabilitation: What is the Evidence?. Sue Palsbo, PhD. Center for Health Policy, Research and Ethics. Need for Telerehabilitation. People with chronic or acute disabilities Cognitive (impaired way-finding; executive dysfunction) Physical (impaired mobility)

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eHealthcare and Rehabilitation: What is the Evidence?

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  1. eHealthcare and Rehabilitation:What is the Evidence? Sue Palsbo, PhD Center for Health Policy, Research and Ethics

  2. Need for Telerehabilitation • People with chronic or acute disabilities • Cognitive (impaired way-finding; executive dysfunction) • Physical (impaired mobility) • Areas with shortages of therapists • Transportation barriers

  3. Stance on Telerehabilitation • Varies by payer • Medicare • Medicaid • Major insurers • Varies by professional association • ASHA • APTA • AOTA

  4. What is Telerehabilitation? • Assessment (client and environmental status) • Intervention (treatment, management) • Consultation and peer support of other clinicians • Patient education, supervision

  5. Examples - OT • Diagnosis and Consultation • Home accessibility assessments

  6. Examples - PT • Wheelchair seating clinics • Minnesota  American Samoa • NYC (pressure pad mapping) • Diagnosis & consultation (Washington DC  American Samoa and Guam) • Pre-surgical exercise (Norway)

  7. Examples - SLP • Speech therapy • National Rehabilitation Hospital (stroke rehab) • Voice rehab (Hawaii  military bases) • Queensland, Australia (assessment) • Nova Scotia, Canada (swallowing) • Audiology • Utah State; Mayo Clinic; Santa Rosa, CA

  8. How Telepractice Is Being Used... • Audiologists: • Hearing screening • Hearing aid programming and counseling • Auditory brainstem response (ABR) • Otoacoustic emissions (OAEs) • Audiologic rehabilitation • Speech-Language Pathologists: • School-based service in remote/underserved areas • Voice, aphasia, or cognitive-communication treatment to satellite clinics from hospitals • Adjunct to home health visits • Specialized services such as laryngectomy rehabilitation and augmentative and alternative communication

  9. Face-to-Face Interaction Model • Face-to-Face SLP treatment sessions • Verbal & visual communication • Treatment Workspace – collaborative use of physical materials (e.g. workbooks, flashcards, etc.)

  10. RESPECT: REmote SPEech-language and Cognitive Treatment

  11. RESPECT: Client User Interface Functional reading task with video window Following directions task (shared whiteboard) with video window

  12. The Peer-Reviewed Evidence • Proof-of-concept or equivalence trials • Consultation and peer therapist support • Patient assessment, not therapy • Care supplementation, not care substitution

  13. Equivalence of Face-to-face and Videoconference Administration of the ESS and Functional Reach for Post-Stroke Patients • Sue Palsbo, PhD • National Rehabilitation Hospital / George Mason University • Stephen J. Dawson, PT • INTEGRIS/Jim Thorpe • Lynda Savard, PT • Sister Kinney Rehabilitation Institute • Marc Goldstein, EdD • American Physical Therapy Association

  14. Why is it so hard? (1) Be appropriate and relevant to people with stroke. (2) Have known psychometric properties (validity and reliability) published in peer-reviewed literature. (3) Wide use in research and clinical practice. (4) Be visually based (that is, the therapist can measure using televideo without touching the patient). (5) All measures can be completed within 30 minutes.

  15. Design Issues for Measuring Equivalence • Serial correlation bias • Measure simultaneously, not serially • Inter-rater reliability • Use measurement tools with published reliability values • Training • Bias in administration • Switch off the therapist conducting the assessment

  16. Measures • Functional reach • European stroke scale • Level of consciousness • Comprehension • Speech • Visual field • Gaze • Facial movement • Arm – maintain position when outstretched

  17. Measures, con’t. • Arm – raising • Wrist extension • Fingers • Leg – maintain position • Leg – flex • Dorsiflexion of foot • Gait

  18. Results • Functional reach: Lin’s rho – 0.98

  19. Conclusions • Evidence for eHealth and Rehabilitation assement and management are skimpy – at the moment! • Growing interest in post-stroke rehabilitation • SLP is most conducive to e-therapy using televideo & things that can be digitized (swallowing) • PT will have more limited visual therapy applications (but growing use with e-robotics) • Rapid growth in telerehabilitation e-therapy over next 5 years

  20. Funding • Robert Wood Johnson Foundation, Methodologies Grant, #49143 • US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR), Rehabilitation Engineering and Research Center (RERC) on Telerehabilitation #H133E990007-00C

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