Implementation of telerehabilitation in response to COVID-19: Lessons learnt from neurorehabilitation clinical practice and education

Abstract

The health response to the COVID-19 pandemic has had significant impacts on neurorehabilitation provision both internationally and in New Zealand. Telerehabilitation, the delivery of rehabilitation at a distance using information and communication technologies, was advocated as a means of addressing the rehabilitation needs of our patients while maintaining physical distancing and reducing the risk of viral transmission. Despite research evidence indicating that telerehabilitation is as effective as in-person rehabilitation for people with neurological conditions, there were significant challenges in delivering and sustaining telerehabilitation practice. We draw upon our experiences in delivering telerehabilitation in neurorehabilitation clinical practice and education to reflect on the process of practice change and to consider how these experiences can inform practice development in the future. We propose that rehabilitation organisations and physiotherapists continue to develop capability to provide telerehabilitation; that physiotherapists and the physiotherapy profession focus on translating their communicative, relational and clinical skills to the digital space to ensure they are competent in telerehabilitation; and that, as a profession, we focus on what constitutes "best practice" in telerehabilitation, and how in-person and telerehabilitation can be integrated to provide engaging, evidence-based and person-centred rehabilitation.

Physiotherapists’ Perspectives Towards Using Telehealth for Acute Concussion Care

“…These subthemes under the PT factor theme were supported by the experiences that Signal et al (2020) reported from a neurorehabilitation environment. In their experiential research, the key component were related to setup, assessment, and treatment considerations.…”

“…Considerations were given around the ability to engage in interdisciplinary care at the team as well as family levels. Although this study involved perceptions related to the adult concussion population, Signal et al (2020) reported similar aligning perspectives towards a team-oriented, family-centred approach when applying VPT to the paediatric concussion population. Concepts of trust and knowledge-sharing in an interdisciplinary setting may be associated with improved provider SE (Chang et al, 2015), as well as team self-reflection (Signal et al, 2020) when providing VPT.…”

“…Although this study involved perceptions related to the adult concussion population, Signal et al (2020) reported similar aligning perspectives towards a team-oriented, family-centred approach when applying VPT to the paediatric concussion population. Concepts of trust and knowledge-sharing in an interdisciplinary setting may be associated with improved provider SE (Chang et al, 2015), as well as team self-reflection (Signal et al, 2020) when providing VPT. Considerations were given by those authors around the physical environment that the patient would have to engage in therapy in, including safety concerns, and how their environment may impact service delivery.…”

“…Under assessment considerations, alignment was found with this study in regard to subjective, objective, and outcome measure considerations by the PT. The organizational setup subtheme was supported by Signal et al (2020), but also a main perceptual consideration of Caze II et al (2020), who found that when implementing telehealth with paediatric concussion patients and their families.…”

Effects of Telerehabilitation on Occupational Therapy Services in the Coronavirus Disease 2019 Era: An Umbrella and Mapping Review with Meta–Meta-Analysis

“…However, it is vital to observe that prescribing exercises to patients is a multifaceted process and demands advanced therapeutic knowledge to advance its effectiveness and adherence, including communication and education. As such, the implementation of TR to occupational therapy should be conducted based on a paradigm change to realize an effective patient-based TR [19].…”