Telerehabilitation: A New Model for Home-based Therapy

1. Telerehabilitation:A New Model forHome-based Therapy Présenté par / Presented by: Lisa Sheehy, PT, PhD December 12, 2018

2. Outline • Definitions • Examples • Benefits/Potential Barriers • Research • Clinical Scenario

3. Definition - Telemedicine • “Telemedicine uses telecommunications technology to provide clinical health care at a distance. It helps improve access to medical services that often would not be available consistently in distant rural communities.” • OTN • eVisit - Telehomecare • eConsult - Telestroke • eCare - Virtual house calls

4. Definition - Telehealth • “Telehealth involves the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long distance patient/clinician contact and care, advice, reminders, education, intervention, monitoring and remote admissions” • Wikipedia • - Professional development

5. Definition - Telerehabilitation • “Telerehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet” • Wikipedia • Clinical assessment • Therapy

6. Benefits The biggest advantage of telerehabilitation is its ability to bring health care TO the patient

7. Examples – Parkinson’s Disease Adapted Tango for People with Parkinson’s Disease Seidler et al., J Telemed Telecare 2017;23:740-6 (St. Louis, MO)

8. Examples – Cardiac Rehab Cardiac Rehab Maddison et al., Heart 2018;0:1-8 (Geelong, Australia) Busch et al., J Telemed Telecare 2009;15:112 (Bad Rothenfelde, Germany)

9. Examples – Upper Extremity / Stroke Upper Extremity Telerehab for Chronic Stroke Dodakian et al., Neurorehabil Neural Repair 2017;31:923-33 (Irvine, California)

10. Examples – Total Knee Replacement In-home Telerehabilitation After Total Knee Replacement Moffet et al., J Bone Joint Surg Am 2015;97:1129-41 (Université Laval)

11. Examples – Communication Post-stroke TeleRehab for Post-stroke Communication Deficits Using Mobile Technology Providence Healthcare K. Mallet & D. Dowlatshahi, ongoing research at The Ottawa Hospital

12. Examples - COPD Long-Term Telerehabilitation for Chronic Obstructive Pulmonary Disease Patients Zanaboni et al., BMC Pulmonary Medicine 2016;16:126 Zanaboni et al., J Telemed Telecare 2013; 19:425-429

13. Examples – Sub-acute Stroke Home-based virtual reality training after discharge from hospital-based stroke rehabilitation: A parallel randomized feasibility trial H. Finestone, L. Sheehy et al., ongoing research at Bruyère

14. Benefits • The biggest advantage of telerehabilitation is its ability to bring health care TO the patient • Rural areas / Underservicedareas • Rehab in the patient’s own home • Comfortable in familiar surroundings • Don’t like to exercise in a group • Family members can be involved • Convenient - work around your own schedule

15. Benefits • The biggest advantage of telerehabilitation is its ability to bring health care TO the patient • No transportation hassles • Weather is not a factor • Ongoing / No session breaks • Can provide options during gaps in • other services • Can help rehabilitation to begin • as early as possible, be prolonged • and continue during the recovery • phase • Reduced length of stay / Earlier discharge

16. Benefits • The biggest advantage of telerehabilitation is its ability to bring health care TO the patient • Technology is less of a barrier than many think • Can provide services to more patients, and more therapy to each patient • Cost-effective – can be cheaper on the healthcare system and on participants • Research shows equal or better outcomes compared to other methods of rehab delivery

17. Potential Barriers / Things to Consider • Lack of socialization • opportunities • How is assessment/ • reassessment performed? • Need good follow-up from • therapists/providers • Inability to do hands-on therapy • Asynchronous vs. synchronous • monitoring • Confidentiality • Safety

18. Potential Barriers / Things to Consider • Technology issues • Learning curve • Use of complex treatment and monitoring devices (robotic devices etc.) • Characteristics of the games/activities/exercises

19. Potential Barriers / Things to Consider • Health-care funding and policy • Who are the providers?? • Scientific evidence • Acceptability by patients and providers

20. Where next?? • Advertise the benefits • Address the barriers • Coordinate the systems • Continue the research Deliver the right care, in the right place, at the right time.

21. Research in Telerehab for Neuro PT • Multiple Sclerosis • Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS. (review, Rintala et al. 2018) • Low-level evidence supporting telerehabilitation for short-term and longer-term improvement in function, impairments and participation. (Cochrane review; Khan et al. 2015) • Traumatic Brain Injury • Mitii programme produced an increase in lower extremity strength that was statistically significant but not clinically significant. (Baque et al. 2017)

22. Research in Telerehab for Neuro PT • Cerebral Palsy • Remotely supervised sensory integration balance training • Mitii program produces some improvement in motor processing, visual perception and physical capacity (Piovesana et al, 2017) • Stroke • Telerehabilitation interventions have better or equal beneficial effects on motor, higher cortical and mood disorders compared with conventional face-to-face therapy. (review, Sarfo et al, 2018) • Insufficient evidence to make any conclusions regarding effectiveness; no studies on cost-effectiveness (Cochrane review, Laver et al, 2013)

23. Research in Telerehab for Neuro PT • Parkinson’s Disease • No reviews; some very early results suggest that telerehab is as good as in-clinic rehab, but cheaper.

24. Clinical Scenario • Think of a patient or group of patients that you have worked with recently. • Think about their need for rehabilitation or rehabilitative exercise at home. • Think about ways to accomplish that – how you do it now, and possible options using telerehabilitation. • Are there any barriers or facilitators specific to your situation that would have to be addressed?

25. Thank You!! • Questions?? Lisa Sheehy Bruyère Research Institute lsheehy@bruyere.org