Telerehabilitation for People With Physical Disabilities and Movement Impairment: A Survey of United Kingdom Practitioners

Abstract

Background Telerehabilitation is a feasible and potentially effective alternative to face-to-face rehabilitation. However, specific guidance, training, and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment are limited. Objective The aims of this survey of United Kingdom–based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practices in telerehabilitation for physical disabilities and movement impairment. The aim will be to use the findings to inform a practical tool kit and training package for telerehabilitation use. Methods UK rehabilitation practitioners were invited to complete an online questionnaire from November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups, and via social media. Closed questionnaire items were analyzed using descriptive statistics. Qualitative inductive analysis using NVivo was used for open responses. Results There were 247 respondents, of which 177 (72%) were physiotherapists and occupational therapists. Most (n=207, 84%) had used video-based consultations (typically supported by telephone and email), and the use of this method had increased in frequency since the COVID-19 pandemic. Practitioners perceived telerehabilitation positively overall and recognized benefits for patients including a reduced infection risk, convenience and flexibility, and reduced travel and fatigue. Common obstacles were technology related (eg, internet connection), practical (eg, difficulty positioning the camera), patient related (eg, health status), practitioner related (eg, lack of technical skills), and organizational (eg, lack of access to technology). Support from family members or carers was a major facilitator for successful remote consultations. Of the 207 respondents who had used video-based consultations, 103 (50%) had assessed physical impairments using this method, 107 (52%) had assessed physical function, and 121 (59%) had used patient-reported outcome measures. Although practitioners generally felt confident in delivering video-based consultations, they felt less proficient in undertaking remote physical assessments, expressing concerns about validity, reliability, and safety. Only 46 of the 247 (19%) respondents had received any training in telerehabilitation or video consultations, and some felt they were “feeling their way in the dark.” Practitioners desired training and guidance on physical assessment tools suitable for remote use, when to use video-based consultations or alternative methods, governance issues, digital platforms, and signposting to digital skills training for themselves and their patients. Conclusions In response to the COVID-19 pandemic, practitioners rapidly adopted telerehabilitation for people with physical disabilities and movement impairment. However, there are technical, practical, and organizational obstacles to overcome, and a clear need for improved guidance and training in remote physical assessments. The findings of this survey will inform the development of a tool kit of resources and a training package for the current and future workforce in telerehabilitation.

Telerehabilitation for physical disabilities and movement impairment: A service evaluation in South West England

“…Professional bodies and clinical networks have highlighted the marked variations in approaches to telerehabilitation between and even within organisations, expressing concerns about potential inequity and inefficiency 6–8 . The findings of our national survey of UK health and social care practitioners confirm these issues, with few practitioners receiving formal training and many reporting perceived low competence and confidence in carrying out remote physical assessments 9 …”

“…The findings from this service evaluation have been collated and triangulated with our scoping review 5 and survey 9 to inform the content of the Telerehab Toolkit (http://www.plymouth.ac.uk/research/telerehab). 10 The Toolkit was developed iteratively using the KTA framework, 13 and provides information and guidance for practitioners and patients, with a focus on telerehabilitation for people with physical disabilities and movement impairment.…”

“…[6][7][8] The findings of our national survey of UK health and social care practitioners confirm these issues, with few practitioners receiving formal training and many reporting perceived low competence and confidence in carrying out remote physical assessments. 9 Practitioners need to improve their knowledge and understanding of telerehabilitation for people with physical disabilities and movement impairment. In the Telerehabilitation Project, 10 we aimed to collate information on practitioner and patient experiences, challenges and facilitators, and best practice in telerehabilitation.…”

Authors' Responses to Peer Review of “Telerehabilitation for People With Physical Disabilities and Movement Impairment: A Survey of United Kingdom Practitioners”

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This paper [2]: The manuscript has been well written and well organized; it needs some minor revisions.Response: Thank you. We have responded to each of the points below.

XSL • FORenderX 2.

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Peer Review of “Telerehabilitation for People With Physical Disabilities and Movement Impairment: A Survey of United Kingdom Practitioners”

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Round 1 Review

General CommentsThe content of this paper [1] is of interest to the journal readership especially post COVID-19 pandemic and the rapid move to online practice in the rehabilitation field. It is reasonable to assume that online rehabilitation interventions are here to stay albeit to a different extent than during the pandemic.

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