Applying Telehealth Technologies and Strategies to Provide Acute Care Consultation and Treatment of Patients With Confirmed or Possible COVID-19

Abstract

Background and Purpose: The COVID-19 pandemic continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multiorgan failure. These complications require rehabilitative care. Considering the contagious nature of COVID-19 and the necessity to decrease the volume of health care professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can audiovisual technologies employed by telehealth and telerehabilitation help? Case Description: This case discusses the Baylor Scott and White Institute for Rehab (BSWIR) Physical Medicine and Rehabilitation (PMR) department COVID-19 acute care therapy team's creation of a telehealth strategy to provide early rehabilitative intervention without increasing the odds of disease transmission. Outcomes: The COVID-19 therapy team created a simple process for identifying and triaging care for patients with possible or confirmed COVID-19. These patients were evaluated and treated by the dedicated team using telehealth strategies. A structured risk-benefit analysis was used to determine when in-room care was indicated. Discussion: Acute care physical therapy, occupational therapy, and speech-language pathology telehealth strategies can add value by mitigating COVID-19–related harm and influencing recovery, while not unnecessarily becoming additional disease vectors consuming personal protective equipment. COVID-19 is not only an aggressive respiratory illness similar to acute respiratory distress syndrome but also highly contagious and a risk for health care providers. Telehealth strategies allow therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation. Telehealth strategies can be more prevention-focused while the patient is experiencing relatively good health with goals to maximize strength and endurance before the disease process evolves to critical illness. As COVID-19 progresses, therapy can help mitigate potential complications associated with prolonged intensive care unit stay and ventilator management.

The utility of physiotherapy assessments delivered by telehealth: A systematic review

“…Variability was also observed across the utility studies, with participant numbers ranging from one (case studies) to 2249 [ 72 ]. There was inconsistency in the execution of telehealth assessments across practice settings, with some participants accompanied by a friend or relative [ 50 , 60 , 74 ], teacher’s aide [ 63 ] or health practitioner (nurse or less experienced physiotherapist) [ 10 , 46 , 50 , 53 , 76 ] to assist with the assessment. The experience levels of clinicians conducting telehealth assessments also varied.…”

Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform

“…This finding is important because of social distancing guidelines and increased utilization of telehealth platforms. Due to the COVID-19 pandemic, many clinicians and patients must interact in a virtual environment and most clinical measurements have only been tested for their psychometric properties for in-person clinical assessments (Exum et al, 2020;A. C. Lee, 2020).…”

“…This finding is important because of social distancing guidelines and increased utilization of telehealth platforms. Due to the COVID-19 pandemic, many clinicians and patients must interact in a virtual environment and most clinical measurements have only been tested for their psychometric properties for in-person clinical assessments ( Exum et al, 2020 ; A. C. Lee, 2020 ). Testing the psychometric properties of clinical measurements in a virtual environment is crucial for accurate documentation and tracking patient progress during the COVID-19 pandemic.…”

“…Even though CV angle is a valid measurement in clinical settings, the current circumstances present a unique problem. With the increased utilization of telehealth due to social distancing guidelines, physical therapists (PTs) are delivering care through telehealth (Exum et al, 2020;A. C. Lee, 2020).…”

“…Even though CV angle is a valid measurement in clinical settings, the current circumstances present a unique problem. With the increased utilization of telehealth due to social distancing guidelines, physical therapists (PTs) are delivering care through telehealth ( Exum et al, 2020 ; A. C. Lee, 2020 ). Increased use of telehealth means that PTs are now required to assess and treat patients using some type of video conferencing application such as a HIPAA-compliant video-based telehealth platform.…”