Telerehab? It can work, but training is needed

Telemedicine in rehabilitation has promise, but healthcare providers say they need proper training to make it work.

Therapists in the United Kingdom generally viewed telerehabilitation positively, according to a new study published in the Journal of Medical Internet Research (JMIR).

But many said they were sorely lacking in training. Only 19% of the 247 participants said they had been trained in doing video consultations.

Most practitioners (72%) said they generally felt confident in delivering video consultations. However, therapists said they were less confident in performing physical assessments of patients remotely.

“Although practitioners have rapidly adopted remote ways of working and viewed telerehabilitation positively overall, there are technical, practical, and organizational obstacles to overcome to maximize the success of this approach,” the study concluded. “There is a clear need for improved guidance and training, particularly surrounding physical and movement-oriented assessments.”

Most said telehealth has a place in rehabilitation practices, but they said it would be used best to support in-person therapy and not as a substitute.

Telehealth exploded in popularity out of necessity due to the coronavirus pandemic. In the U.S., the federal government reported a 63-fold increase in the use of telehealth among Medicare recipients. Healthcare groups are urging the federal government to allow expanded use of telehealth beyond the pandemic.

The study examined how British rehabilitation therapists adapted to the realities of practicing during the COVID-19 pandemic. The survey was done between November and December 2020.

Most therapists who participated in the survey said remote rehabilitation offered some value to patients, specifically in curbing the risk of COVID-19 infection, reduced travel burdens and greater convenience.

The study suggested telerehab isn't the right option for some patients, including seniors or some individuals with disabilities.

More than half (56%) said video visits weren’t suitable for some patients with cognitive disabilities or people with visual or sensory impairments. Nearly half of the participants (46%) said the severe disability of the patient posed obstacles to video consultation.

Most therapists (71%) who did video consultations said they were challenged by technical issues, including the placement of the camera. But most (59%) felt they could overcome the technical challenges.

The majority of respondents who did video consultations accepted the validity of the reports of patients, but some had concerns in doing the appointments remotely.

Roughly one-third of therapists (34%) said they worried about the accuracy of the video consultations. Some said they were unsure about the reliability of the self-reporting of patients, and some voiced concerns about the influence of family members.

To make telerehab work, most said the cooperation of family members and caregivers is critical. Family members can help patients with some of the assessments or assist with technology issues.

In video visits, therapists should make sure they are communicating well with their patients, the study’s authors noted. They should ensure patients understand instructions and shouldn’t rush. Providers should give patients resources ahead of the appointment.

Therapists should schedule at least the same amount of time for a video appointment as an in-person visit. It’s also best to focus on a couple of key outcomes in a session rather than cramming in too much, the study’s authors said.

Healthcare organizations should focus on giving providers the training they need for telerehab, from handling the technology to offering guidelines on doing video evaluations. Healthcare groups also need to be sure providers have the right equipment and the proper space for telehealth visits, the study said.