[SHORT ARTICLE] Tele rehabilitation: two-year experience in conducting medical assessments via tele link

by Nalinda Andraweera, Consultant Physician in Rehabilitation Medicine,
Modbury Public Hospital, Adelaide, Australia.

Introduction

Telemedicine has been practised for many
decades since initial documentation in 1940s when
radiology images were sent between two townships
in Pennsylvania via telephone lines. Bioinstrumentation and transmission of astronauts’ vital parameters to ground based flight surgeons came to
forefront during NASA’s space programme in 1960s.
During following decades, telemedicine was used in
multiple medical specialties as a mode of patient
assessment. Use of telemedicine in Rehabilitation
Medicine is relatively recent. As multidisciplinary
coordinated care led by rehabilitation physicians and
allied clinicians is required, proformas are used in
tele rehabilitation assessments. Proformas help to
generate a clinical document with medical and allied
health assessments in one clinical record. Currently,
delivery of rehabilitation services is further empowered, enhanced and in evolution with the installation of dedicated software programmes for use by
allied health clinicians. Most units operating tele
medicine for rehabilitation medical services use
trained proctor with the client/patient to enable
more comprehensive examination to aid clinical
decision when the physician is stationed in a distant
site.

Evidence

Current evidence based on multi centre trials
suggest that well conducted tele rehabilitation enable
clinical outcomes similar to face to face rehabilitation.
Advantages of tele rehabilitation being low cost and
the ability to provide an increased volume of therapy
[1]. Drawbacks include limitations in detailed examination and negative implications in rehabilitation goal setting. If patients are reviewed early, frequent
and active communication is carried out during tele
rehabilitation, patient centred goal setting can be
improved [2].

Methodology

Client assessments were from a city Hospital in
Adelaide (Modbury Hospital) linked via a video link
to a regional general hospital (Riverland General
Hospital in Berri) 241 kilometres from Adelaide.
Period assessed is from May 2016 to September 2018.
Fortnightly tele ward rounds and additional initial
inpatient and outpatient assessments were conducted via a video link. Both inpatient and outpatientclients were informed and educated about method of
tele medicine and tele rehabilitation and consent was
obtained for video-based assessments with the
physician. A trained proctor was present at each
assessment.
Tele rehabilitation services were provided using
a secure, encrypted platform with privacy and
confidentiality maintained. Video link was established via a licenced communication provider enabling an uninterrupted video connection linking
patient and proctor with the physician. Electronic
transfer of clinical records was done using a secure
health email platform.
Trained proctor was a clinical nurse practitioner,
physiotherapist or an occupational therapist trained
to aid in clinical examinations required for musculoskeletal and neurological examination. Proformas were emailed to the physician prior to patient
assessment with medical history, current vital
parameters, medications and initial allied health
assessments. Video based clinical assessments were
recorded in a client proforma and a clinical report
was generated. Radiology and haematology/
biochemistry investigations were reviewed using a
medial investigation software used in South
Australian Health Service (Oasis). Urgent images
requested by the physician were done locally or at a
private service provider and snip tooled using a
licenced health imaging access pathway. Allied
health clinicians recorded initial functional levels
using FIM (Functional Independent Measure).
Following patient assessment, patient centred
realistic goals were discussed with the patient and
the multi-disciplinary team via video link.

Results

Assessments done from 18 May 2016 to 17
September 2018 were assessed. A total of 236 Tele
medicine assessments were completed for patients/
clients admitted for rehabilitation. Average duration
for an assessment was 26 minutes. Patient satisfaction
on telemedicine assessments was 100%.

Conclusion

Tele medical assessments of patients admitted
for rehabilitation is currently gaining momentum and
more health funding is allocated for further expansion
of tele medicine and tele rehabilitation. Carrying out
medical assessments via a licenced video linkage
allows clients/patients to be reviewed with minimal
delay, closer to their homes and without the need to
travel to a specialist centre in a city. Tele medical
assessments save time for physicians as no travel time
is required, objective assessments can be done
effectively with the help of a trained proctor. Assessment reports can be generated with minimal delay using proformas and electronically transferred to
local GPs and multidisciplinary rehabilitation team
members comprising physiotherapists, occupational
therapists, nurse practitioners, social workers and
nutritionists/dieticians. Tele medical assessments in
rehabilitation aid uninterrupted rehabilitation service
provision in a distant site. Patient satisfaction is high.

References

  1. O’Neil O, Fernandez MM, Herzog J, Beorchia M, Gower V,
    Gramatica F, et al. Virtual Reality for Neurorehabilitation:
    Insights From 3 European Clinics. PM R. 2018; 10(9S2):
    S198-S206.
  2. Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers
    and facilitators to goal-setting during rehabilitation for
    stroke and other acquired brain injuries? A systematic
    review and meta-synthesis. Clin Rehabil. 2016; 30(9):
    921-30.

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