Implementation of a Framework for Telerehabilitation in Clinical Care Across the Continuum During COVID-19 and Beyond

Abstract

The COVID-19 pandemic has propelled an unprecedented global implementation of telemedicine and telerehabilitation as well as its integration into the healthcare system. Here, we describe the clinical implementation of the A3E framework for the deployment of telerehabilitation in the inpatient and outpatient rehabilitation continuum by addressing accessibility, adaptability, accountability, and engagement during the COVID-19 pandemic. By using an organized, coordinated, and stratified approach, we increased our telerehabilitation practice from 0 to more than 39,000 visits since the pandemic began. Learning from both the successes and challenges can help address the need to increase access to rehabilitation services even beyond the COVID-19 pandemic.

Therapeutic Exercise Interventions through Telerehabilitation in Patients with Post COVID-19 Symptoms: A Systematic Review

“…During the coronavirus pandemic, the need for maintenance of organ functions through rehabilitation and its continuation has put telerehabilitation programs in a status unusually seen before [13], not only during the acute phase but also in the postviral phase [14][15][16][17][18]. Such telerehabilitation demands and the consequent implementation of physiotherapy staff and training continue to this day [19,20]. Studies prior to the COVID-19 pandemic analyzed not only the therapeutic benefits of cardiac, neurological, or musculoskeletal telerehabilitation but also the cost savings for both healthcare providers and patients compared to traditional inpatient or face-to-face rehabilitation [21].…”

Feasibility of an Enhanced Therapy Model of Care for Hospitalized Stroke Patients

“…Together with knowledge that patients may tolerate shorter therapy sessions in the very early post-stroke period, the enhanced therapy model of care was developed by the stroke neurology team 13 . Based on these successes, this stroke ARISE model was later replicated in other clinical areas 14,15 …”

“…13 Based on these successes, this stroke ARISE model was later replicated in other clinical areas. 14,15 The stroke ARISE model provides daily PT, OT, and/or SLP depending on an individual's clinical presentation. Templated daily schedules are designed in collaboration with stroke unit nursing staff and leadership.…”

A Novel Way to Objectively Review Emerging Rehabilitation Technologies

“…15 In the innovation category, the MindMotion Go (MMGO) was deployed in the hospital, clinic, and home settings during the COVID-19 pandemic to extend rehabilitation with telerehabilitation even before the remote therapy monitoring reimbursement codes became available. 16 In the research category, an industrysponsored clinical trial was conducted with MedRhythms' wearable sensor paired with digital rhythmic auditory stimulation while listening to music for gait training poststroke, as part of a pivotal multicenter study for Food and Drug Administration approval. 17…”

“…The Mirrored Motion Works Bimanual Arm Trainer gamified rehabilitation device was deployed clinically across the continuum of care for rehabilitation of arm movement in individuals with poststroke hemiplegia as it provides training in out-of-synergy movements for profoundly weak patients who would otherwise be unable to participate in repetitive arm training 14 and primes the nervous system for upper limb therapy 15 . In the innovation category, the MindMotion Go (MMGO) was deployed in the hospital, clinic, and home settings during the COVID-19 pandemic to extend rehabilitation with telerehabilitation even before the remote therapy monitoring reimbursement codes became available 16 . In the research category, an industry-sponsored clinical trial was conducted with MedRhythms’ wearable sensor paired with digital rhythmic auditory stimulation while listening to music for gait training poststroke, as part of a pivotal multicenter study for Food and Drug Administration approval 17 …”