Telehealth in Physical Medicine and Rehabilitation: A Narrative Review

Tenforde, Adam S.; Hefner, Jaye; Kodish-Wachs, Jodi; Iaccarino, Mary Alexis; Paganoni, Sabrina

doi:10.1016/j.pmrj.2017.02.013

Cited by 161 publications

(142 citation statements)

References 67 publications

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“…The provision of brief (ten minutes) mindfulness exercises via the internet proved a viable and accessible delivery format for an eight-week course [20]. The use of the internet and technology is a factor likely to support people with SCI in more effectively engaging in psychological interventions, given the potential functional, travel, and support-related limitations imposed by the injury [28]. Indeed, studies involving delivery of interventions in a face-to-face format demonstrated conflicting results, which could be an artefact of the potential difficulty faced by people with SCI in attending weekly and twice-weekly sessions over a period of weeks.…”

Section: Discussionmentioning

confidence: 99%

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review

Hearn

Cross

2020

BMC Neurol

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Background: Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. Methods: Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001). Results: Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. Conclusions: The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.

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Section: Discussionmentioning

confidence: 99%

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review

Hearn

Cross

2020

BMC Neurol

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“…This approach has been successfully applied to disorders, such as stroke [52] and paediatric headache [23], and may be a cost-effective model for provincial paediatric concussion programmes to incorporate especially where telemedicine sites require shared access to technological infrastructure and resources and where clinically indicated diagnostic tests and inperson sub-specialist consultations can be coordinated during the same visits to these centres (see Figure 1). In addition to facilitating initial assessments and follow-up appointments, recent studies suggest that other aspects of concussion care, such as psychiatric assessment and psychotherapy, follow-up for headache management, as well as cognitive rehabilitation can also be provided through telemedicine [53], thereby presenting additional potential opportunities to reduce travel costs for patients living in rural and remote communities.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba

Ellis

Boles

Derksen

et al. 2019

International Journal of Circumpolar Health

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Pediatric concussion patients living in northern communities in Canada can face unique challenges accessing primary and specialized healthcare. In this study we report the clinical characteristics, healthcare utilization, outcomes and estimated cost avoidance associated with a pilot pediatric concussion telemedicine program established between a multi-disciplinary pediatric concussion program in Winnipeg, Manitoba and a hospital in Thompson, Manitoba. From October 1st- July 1st, 2018, 20 patients were evaluated; mean age 13.1 years, 15 (75%) males and 14 (70%) self-identified as Indigenous. Injury mechanisms included hockey (50%), falls (35%) and assaults (15%). Median time from referral to initial consultation was 2.0 days. After screening by the neurosurgeon, 90% of patients underwent initial consultation via real-time videoconferencing with 80% managed exclusively through telemedicine. At the end of the study, 90% met the criteria for clinical recovery, one remained in treatment and one was discharged to a headache neurologist. Sixty-six telemedicine encounters were completed including 57 videoconferencing appointments and 9 telephone follow-ups representing an estimated cost avoidance of $40,972.94. This study suggests telemedicine may be a useful approach to assist pediatric concussion programs with delivering timely, safe and cost-effective care to patients living in medically underserviced remote and northern communities in Canada.

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“…This form of health care delivery most commonly uses technology that allows for both video and auditory communication to conduct clinical care outside of the traditional in‐office or hospital setting. The use of telemedicine for physiatry includes both inpatient and outpatient health care delivery, and this may be particularly important for individuals with disability and travel limitations 1 . Visits can be synchronous (real‐time interaction between patient and provider) or asynchronous.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine During COVID‐19 for Outpatient Sports and Musculoskeletal Medicine Physicians

Tenforde

Iaccarino

Borgstrom

et al. 2020

PM&R

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128

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Introduction The global pandemic due to SARS‐CoV‐2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. Objective To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. Design Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020‐17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. Primary Outcome Measures Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. Results Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow‐up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as “excellent” or “very good” across measures (91.6%‐95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no‐show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. Conclusions In summary, rapid expansion of telemedicine during the COVID‐19 pandemic was well‐received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.

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Telehealth in Physical Medicine and Rehabilitation: A Narrative Review

Cited by 161 publications

References 67 publications

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review

Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba

Telemedicine During COVID‐19 for Outpatient Sports and Musculoskeletal Medicine Physicians

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