Providers' Shift to Telerehabilitation at the U.S. Veterans Health Administration During COVID-19: Practical Applications

Abstract

Telerehabilitation provides Veteran patients with necessary rehabilitation treatment. It enhances care continuity and reduces travel time for Veterans who face long distances to receive care at a Veterans Health Administration (VHA) medical facility. The onset of the COVID-19 pandemic necessitated a sudden shift to telehealth–including telerehabilitation, where a paucity of data-driven guidelines exist that are specific to the practicalities entailed in telerehabilitation implementation. This paper explicates gains in practical knowledge for implementing telerehabilitation that were accelerated during the rapid shift of VHA healthcare from out-patient rehabilitation services to telerehabilitation during the COVID-19 pandemic. Group and individual interviews with 12 VHA rehabilitation providers were conducted to examine, in-depth, the providers' implementation of telerehabilitation. Thematic analysis yielded nine themes: (i) Willingness to Give Telerehabilitation a Chance: A Key Ingredient; (ii) Creativity and Adaptability: Critical Attributes for Telerehabilitation Providers; (iii) Adapting Assessments; (iv) Adapting Interventions; (v) Role and Workflow Adaptations; (vi) Appraising for Self the Feasibility of the Telerehabilitation Modality; (vii) Availability of Informal, In-Person Support Improves Feasibility of Telerehabilitation; (viii) Shifts in the Expectations by the Patients and by the Provider; and (ix) Benefit and Anticipated Future of Telerehabilitation. This paper contributes an in-depth understanding of clinical reasoning considerations, supportive strategies, and practical approaches for engaging Veterans in telerehabilitation.

Clinicians’ Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study

“…Access to rehabilitation can be especially challenging for individuals with disabilities in rural communities as well as those who are less able to attend in-person therapy due to distance, transportation, financial resources, and mobility challenges [ 1 - 3 ]. Ongoing rehabilitation often requires therapy over many sessions, which can be challenging for maintaining continuity of care when travel to appointments is required [ 4 ]. Ensuring equitable access to rehabilitation services by identifying, targeting, and removing barriers faced by underserved and vulnerable populations has been recognized as a key component of a comprehensive rehabilitation system [ 5 ].…”

Manifestation of Generalized Anxiety Disorder and Its Association With Somatic Symptoms Among Occupational and Physical Therapists During the COVID-19 Pandemic

“…For example, telerehabilitation can be expanded which includes the use of videoconferencing, phones, email, and apps for individual or group remote therapy sessions. Kreider et al ( 56 ) highlighted that telerehabilitation improved the patients' health and rehabilitation experience in addition to providing convenience, privacy, and comfort. They pointed out that telerehabilitation developed greater active participation and empowerment of the patients to carry out the rehabilitation programs.…”

Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches’ Expanded Services and Support during COVID-19

“…Prior to COVID-19, the primary strategies used by coaches to introduce Veterans to WH relied on face-to-face, in-person interactions. Although the VA has long been at the vanguard of developing and implementing tele-based delivery of healthcare services to Veterans [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], WH coaches had not formerly relied on telehealth approaches and had to pivot quickly to incorporate various technologies and resources into their daily work with Veterans, representing a substantial shift for the WH initiative.…”

“…The increased use of remote technologies that resulted from COVID-19 [ 54 ] has the potential to extend the meaning of patient-centered healthcare by enhancing the providers’ ability to see a patient within their home environment, and thus, potentially increasing their understanding of patients’ needs specific to their unique environmental context [ 54 ]. Ensuring that front-line health professionals have access to resources for addressing wide-ranging patient needs, including SDOHs, is key in a post-pandemic context [ 63 ].…”