KT to Practice Setting

Highlighted Abstracts

Below are highlighted abstracts on different diagnoses with a supplementary corresponding resource to assist in telehealth practice. Posted dates are noted for time frame reference.

Telehealth KT to Practice

Fall Prevention (posted November 2022)

Helpful Resources:

TUG

This app provides the Timed Up to Go Test (TUG). It has written instructions with pictures and articles to introduce TUG. Follow this link to learn about this app and its use in Telehealth practice: https://drive.google.com/file/d/1-VzwOUThrAYX0BCfsRJEHp0Cnj8c7mIx/view

Abstract:

Bernocchi P, Giordano A, Pintavalle G, et al. Feasibility and Clinical Efficacy of a Multidisciplinary Home-Telehealth Program to Prevent Falls in Older Adults: A Randomized Controlled Trial. J Am Med Dir Assoc. 2019;20(3):340-346. doi:10.1016/j.jamda.2018.09.003

Objectives: The aim of this study was to determine the feasibility and efficacy of a 6-month tele-rehabilitation home-based program, designed to prevent falls in older adults with 1 or more chronic diseases (cardiac, respiratory, neuromuscular or neurologic) returning home after in-hospital rehabilitation for their chronic condition. Patients were eligible for selection if they had experienced a fall during the previous year or were at high risk of falling.

Design: Randomized controlled trial. Tele-rehabilitation consisted of a falls prevention program run by the physiotherapist involving individual home exercise (strength, balance, and walking) and a weekly structured phone-call by the nurse inquiring about the disease status and symptoms and providing patient support.

Setting and participants: Two hundred eighty-three patients (age 79 ± 6.6 years; F = 59%) with high risk of falls and discharged home after in-hospital rehabilitation were randomized to receive home-based program (intervention group, n = 141) or conventional care (control group, n = 142).

Measures: Incidence of falls at home in the 6-month period (primary outcome); time free to the first fall and proportion of patients sustaining ≥2 falls (secondary outcomes).

Results: During the 6 months, 85 patients fell at least once: 29 (20.6%) in the Intervention Group versus 56 (39.4%) in the control group (P < .001). The risk of falls was significantly reduced in the intervention group (relative risk =0.60, 95% confidence interval: 0.44-0.83; P < .001). The mean ± standard deviation time to first fall was significantly longer in intervention group than control group (152 ± 58 vs 134 ± 62 days; P = .001). Significantly, fewer patients experienced ≥2 falls in the intervention group than in the control group: 11 (8%) versus 24 (17%), P = .020.

Conclusions: A 6-month tele-rehabilitation home-based program integrated with medical/nursing telesurveillance is feasible and effective in preventing falls in older chronic disease patients with a high risk of falling.

Online Access: https://pubmed.ncbi.nlm.nih.gov/30366759/

Consultative Care (posted October 2022)

Helpful Resources:

DD SIG: CSM 2022 Platform Award: Consultative Coaching Model for Long-Term Exercise Engagement in People with Huntington’s Disease- with Lori Quinn

Description: In this episode, we highlight the winners of our platform award at CSM 2022. Lori Quinn talks to Chris Burke about her team’s research on long-term PT follow up to promote exercise in people with HD. They discuss findings related to feasibility, participant engagement, and outcomes related to function, disease progress and physical activity during the year-long study. They also discuss innovative models to provide care for and do research with people with HD, and unique challenges in the HD population. Whether you missed it at CSM or are looking for bonus clinical insights beyond the platform, this is definitely worth a listen!

Abstract:

Shih, Hai-Jung Steffi et al. Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study. Journal of Neurologic Physical Therapy. 2022; 46(4): 240-250

Background and Purpose:

Physical activity (PA) has many known benefits for people with Parkinson disease (PD); however, many people do not meet recommended levels of frequency or intensity. We designed Engage-PD, a PA coaching program delivered via telehealth and grounded in self-determination theory to promote PA uptake and facilitate exercise self-efficacy in people with Parkinson disease. This study aimed to determine the feasibility and preliminary efficacy of Engage-PD, and to explore whether baseline characteristics were associated with outcomes.

Methods:

A single cohort of people with PD (n = 62, Hoehn and Yahr I-III) participated in the 3-month Engage-PD program, which consisted of up to 5 telehealth coaching sessions delivered by physical therapists. Feasibility was evaluated based on recruitment and retention rates, along with participants' feedback. Planned and unplanned PA, exercise self-efficacy (ESE), and individualized goals were assessed pre- and post-intervention. Relationships between baseline characteristics and changes in planned PA and ESE were also evaluated.

Results:

Recruitment (62%) and retention (85%) rates were high, and the intervention was well accepted and perceived by the participants. From pre- to postintervention, participants increased planned PA (d = 0.33), ESE (d = 1.20), and individualized goal performance (d = 1.63) and satisfaction (d = 1.70). Participants with lower baseline planned PA experienced greater improvements in planned PA, and those with lower baseline ESE experienced greater improvements in ESE.

Discussion and Conclusions:

A telehealth PA coaching program for people with PD was feasible and potentially efficacious. Physical therapist-led coaching may be an important component of a consultative model of care starting early in the disease process.

Online Access: https://pubmed.ncbi.nlm.nih.gov/36170256/ Article Also available in JNPT October 2022

Outcome Measures (posted September 2022)

Helpful Resources:

The ANPT TH Task Force recently posted the following resources to guide clinicians in the selection and performance of outcome measures during telehealth assessments with individuals with neurologic conditions.

Traffic Light Performance Based Outcome Measures

Traffic Light Patient Reported Participation Measures

Abstract:

Bird M, Peel F, Schmidt M, Fini N, Ramage E, Sakakibara B, Simpson D, Mather C, Cadilhac D, Ahuja K, Bridgman H, English C

Mobility-Focused Physical Outcome Measures Over Telecommunication Technology (Zoom): Intra and Interrater Reliability Trial

JMIR Rehabil Assist Technol 2022;9(3):e38101

Background: Rehabilitation provided via telehealth offers an alternative to currently limited in-person health care. Effective rehabilitation depends on accurate and relevant assessments that reliably measure changes in function over time. The reliability of a suite of relevant assessments to measure the impact of rehabilitation on physical function is unknown.

Objective: We aimed to measure the intrarater reliability of mobility-focused physical outcome measures delivered via Zoom (a commonly used telecommunication platform) and interrater reliability, comparing Zoom with in-person measures.

Methods: In this reliability trial, healthy volunteers were recruited to complete 7 mobility-focused outcome measures in view of a laptop, under instructions from a remotely based researcher who undertook the remote evaluations. An in-person researcher (providing the benchmark scores) concurrently recorded their scores. Interrater and intrarater reliability were assessed for Grip Strength, Functional Reach Test, 5-Time Sit to Stand, 3- and 4-Meter Walks and Timed Up and Go, using intraclass correlation coefficients (ICC) and Bland-Altman plots. These tests were chosen because they cover a wide array of physical mobility, strength, and balance constructs; require little to no assistance from a clinician; can be performed in the limits of a home environment; and are likely to be feasible over a telehealth delivery mode.

Results: A total of 30 participants (mean age 36.2, SD 12.5 years; n=19, 63% male) completed all assessments. Interrater reliability was excellent for Grip Strength (ICC=0.99) and Functional Reach Test (ICC=0.99), good for 5-Time Sit to Stand (ICC=0.842) and 4-Meter Walk (ICC=0.76), moderate for Timed Up and Go (ICC=0.64), and poor for 3-Meter Walk (ICC=–0.46). Intrarater reliability, accessed by the remote researcher, was excellent for Grip Strength (ICC=0.91); good for Timed Up and Go, 3-Meter Walk, 4-Meter Walk, and Functional Reach (ICC=0.84-0.89); and moderate for 5-Time Sit to Stand (ICC=0.67). Although recorded simultaneously, the following time-based assessments were recorded as significantly longer via Zoom: 5-Time Sit to Stand (1.2 seconds), Timed Up and Go (1.0 seconds), and 3-Meter Walk (1.3 seconds).

Conclusions: Untimed mobility-focused physical outcome measures have excellent interrater reliability between in-person and telehealth measurements. Timed outcome measures took approximately 1 second longer via Zoom, reducing the reliability of tests with a shorter duration. Small time differences favoring in-person attendance are of a similar magnitude to clinically important differences, indicating assessments undertaken using telecommunications technology (Zoom) cannot be compared directly with face-to-face delivery. This has implications for clinicians using blended (ie, some face-to-face and some via the internet) assessments. High intrarater reliability of mobility-focused physical outcome measures has been demonstrated in this study.

Online Access at: https://rehab.jmir.org/2022/3/e38101

Acquired Brain Injury (posted August 2022)

Helpful Resources:

Virtual Brain Injury Support Groups

The Brain Injury Association of America provides a great resource list for those seeking support. “Seeking support online can be very helpful. Whether you are an individual living with a brain injury or a caregiver, it helps to know you are not alone. Scroll down to find virtual support groups for you and your family.”

Abstract:

Subbarao BS, Stokke J, Martin SJ. Telerehabilitation in Acquired Brain Injury. Phys Med Rehabil Clin N Am. 2021 May;32(2):223-238. doi: 10.1016/j.pmr.2021.01.001. Epub 2021 Mar 6. PMID: 33814054.

Introduction: With the rapid shift to telemedicine brought on by the COVID-19 pandemic, providers in all specialties have been required to adapt to caring for individuals remotely. As a patient population, those with acquired brain injuries, which include stroke and traumatic brain injury (TBI), most often require long-term care and follow-up but face unique physical, mental, and psychological challenges in consistently attending in office visits. Thus, telemedicine provides an opportunity not only to keep those individuals safe but to improve outreach and ensure compliance with a rehabilitation plan. As there are journals already dedicated to in-depth strategies for the rehabilitation of patients with acquired brain injuries (please see Physical Medicine and Rehabilitation Clinics of North America: Traumatic Brain Injury Rehabilitation and Physical Medicine and Rehabilitation Clinics of North America: Stroke Rehabilitation), this article focuses on optimal techniques and special considerations for effective management in a telerehabilitation setting.

Key Points:

Telehealth visits for patients with acquired brain injuries and their caregivers can ease the burden of transportation, improve compliance, and increase overall satisfaction.
Management strategies are largely unaffected in the telehealth setting, and telerehab options have been found to be equal or superior to in-person therapy to treat many associated deficits.
Telehealth evaluations can be reliable and often equivalent to in-person examinations but remember to ensure safety when asking a patient to perform any challenging or complex physical examination maneuvers.
Because of the limitations of the telemedicine physical examination, a thorough history is invaluable and will help focus on your assessments.
Trust your gut. If you suspect any red flag symptoms, no matter how subtle, error on the side of safety and have the patient be evaluated in person or through the emergency department.

Check access at: https://pubmed.ncbi.nlm.nih.gov/33814054/

Traumatic Brain Injury (posted July 2022)

Helpful Resources:

Love Brain

Interactive Programs Over Zoom

Love Your Brain has a selection of 6 week programs that include online yoga, mindfulness, education, and support for individuals with brain injury. “Imagine being able to tap into your superpower: your mindset. Our free six-week online programs offer peer support and tools for anyone looking to cultivate mental flexibility, physical strength, positive thinking, and more!”

Abstract:

Betts S, Feichter L, Kleinig Z, O'Connell-Debais A, Thai H, Wong C, et al. Telerehabilitation Versus Standard Care for Improving Cognitive Function and Quality of Life for Adults with Traumatic Brain Injury: a Systematic Review. The Internet Journal of Allied Health Sciences and Practice. 2018 Jan 01;16(3), Article 9.

Traumatic brain injury (TBI) is the most significant cause of death and severe disability following major trauma within Australia. Populations at risk include young adults aged 15 to 34, older adults, and military personnel. The main form of intervention following traumatic brain injury is rehabilitation, which places a large demand on the healthcare system. Telerehabilitation involves interventions delivered via telecommunication, which can improve accessibility and reduce this burden. There have been no systematic reviews conducted on the effectiveness of telerehabilitation in treating traumatic brain injury.

Purpose: To examine the effectiveness of telerehabilitation for adults with traumatic brain injury.

Methods: A systematic search of Medline, Embase, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, The Cochrane Library, OTSeeker and Google Scholar was conducted. Studies were included with participants aged 18 to 64 with traumatic brain injury and receiving telerehabilitation interventions. Methodological quality was assessed using the critical appraisal tools: Critical Appraisal Skills Programme (CASP) checklist for randomised controlled trials, and McMaster Critical Review for Quantitative Studies for non-randomised studies.

Results: Three randomised controlled trials, one pseudo-randomised controlled trial, one case-control trial and one pre-post case series were included in this systematic review. Critical appraisal of the included studies revealed overall methodological quality to be moderate. A range of interventions with differing parameters were used as part of telerehabilitation. Collectively, there is some consistent evidence to indicate that telerehabilitation may be equally effective as other forms of care in the delivery of cognitive and psychological interventions, in addressing memory and depressive symptoms for adults with mild to severe traumatic brain injury. However, it is unclear if it is superior to other forms of care.

Conclusions: A small number of studies have investigated the effect of telerehabilitation for adults with traumatic brain injury. The current evidence base is limited due to lack of standardised intervention parameters, outcomes measures and robust sample size. Despite these limitations, telerehabilitation may offer a complementary model of care for adults with traumatic brain injury, especially in instances where traditional models of care may not be readily accessible (such as those in rural and remote areas).

Full text can be located at: https://nsuworks.nova.edu/ijahsp/vol16/iss3/9/

Spinal Cord Injury and Cardiovascular Health (posted June 2022)

Helpful Resources:

Cardiovascular Disease and SCI Fact Sheets

Abstract:

McMillan DW, Astorino TA, Correa MA, Nash MS, Gater DR. Virtual Strategies for the Broad Delivery of High Intensity Exercise in Persons With Spinal Cord Injury: Ongoing Studies and Considerations for Implementation. Front Sports Act Living. 2021 Aug 6;3:703816. doi: 10.3389/fspor.2021.703816. PMID: 34423292; PMCID: PMC8377288.

Spinal cord injury (SCI) results in a multitude of metabolic co-morbidities that can be managed by exercise. As in the non-injured population, manipulation of exercise intensity likely allows for fruitful optimization of exercise interventions targeting metabolic health in persons with SCI. In this population, interventions employing circuit resistance training (CRT) exhibit significant improvements in outcomes including cardiorespiratory fitness, muscular strength, and blood lipids, and recent exploration of high intensity interval training (HIIT) suggests the potential of this strategy to enhance health and fitness. However, the neurological consequences of SCI result in safety considerations and constrain exercise approaches, resulting in the need for specialized exercise practitioners. Furthermore, transportation challenges, inaccessibility of exercise facilities, and other barriers limit the translation of high intensity "real world" exercise strategies. Delivering exercise via online ("virtual") platforms overcomes certain access barriers while allowing for broad distribution of high intensity exercise despite the limited number of population-specific exercise specialists. In this review, we initially discuss the need for "real world" high intensity exercise strategies in persons with SCI. We then consider the advantages and logistics of using virtual platforms to broadly deliver high intensity exercise in this population. Safety and risk mitigation are considered first followed by identifying strategies and technologies for delivery and monitoring of virtual high intensity exercise. Throughout the review, we discuss approaches from previous and ongoing trials and conclude by giving considerations for future efforts in this area.

Free Full Text Available: https://pubmed.ncbi.nlm.nih.gov/34423292/

Multiple Sclerosis (posted May 2022)

Helpful Resources:

NCPAD

14 Weeks to a Healthier You
The National Center on Health, Physical Activity and Disability offers a free personalized web-based physical activity and nutrition program. This is intended for people with mobility limitations, chronic health conditions and physical disabilities. This program is a great resource to share with patients! https://www.nchpad.org/14weeks/index.php

Abstract

Xiang XM, Bernard J. Telehealth in Multiple Sclerosis Clinical Care and Research. Curr Neurol Neurosci Rep. 2021;21(4):14. Published 2021 Feb 28. doi:10.1007/s11910-021-01103-4

Purpose of review: The COVID-19 pandemic has provided us with a unique opportunity to experiment with telehealth and evaluate its benefits and limitations. This review discusses the impact of telehealth on multiple sclerosis (MS) care and research in adults and children.

Recent findings: Telehealth visits for MS patients have been shown to reduce missed workdays and costs for patients. Brief telephone-based counseling may be associated with better adherence to disease-modifying therapy, although results of multiple home-based tele-rehabilitation for people with MS have been equivocal. Overall, patients and providers have reported high levels of satisfactions with telehealth. Several remote disability measures and numerous other technological tools have emerged for use in remote MS research and care. Major challenges of telehealth include limitations to performing a complete neurologic exam and disparities in access to telehealth amongst vulnerable populations with limited access to virtual platforms. Following the rapid expansion of telehealth during the pandemic, it is highly likely that we will continue to embrace the benefits of this valuable tool. Future directions for improving telehealth should include more evidence-based research on the diagnostic accuracy in neuroimmunology and reducing disparities in the access to telehealth. Full Text Available Here

Amyotrophic Lateral Sclerosis (posted April 2022)

"Telehealth and the Evolution of Clinical Care During COVID-19 …"
Welcome to Connecting ALS. In this episode we are focusing on the evolution of clinical care during the COVID-19 pandemic and how telehealth has quickly moved from an ideal to a reality.
(click the title for a direct link to the episode)

Abstract

Geronimo A, Wright C, Morris A, Walsh S, Snyder B, Simmons Z. Incorporation of telehealth into a multidisciplinary ALS Clinic: feasibility and acceptability. Amyotroph Lateral Scler Frontotemporal Degener. 2017 Nov;18(7-8):555-561. doi: 10.1080/21678421.2017.1338298. Epub 2017 Jul 5. PMID: 28678542.

Objective: The practice of telehealth in the care of patients with ALS has received little attention, but has the potential to change the multidisciplinary care model. This study was carried out to assess the feasibility and acceptability of telehealth for ALS care via real-time videoconferencing from the clinic to patients’ homes. Methods: Patients and caregivers engaged in live telehealth videoconferencing from their homes with members of a multidisciplinary ALS care team who were located in an ALS clinic, in place of their usual in-person visit to the clinic. Participating patients, their caregivers, and health care providers (HCPs) completed surveys assessing satisfaction with the visit, quality of care, and confidence with the interface. Mixed methods analysis was used for survey responses. Results: Surveys from 11 patients, 12 caregivers, and 15 HCPs were completed. All patients and caregivers, and most HCPs, agreed that the system allowed for good communication, description of concerns, and provision of care recommendations. The most common sentiment conveyed by each group was that telehealth removed the burdens of travel, resulting in lower stress and more comfortable interactions. Caregivers and HCPs expressed more concerns than patients about the ways in which telehealth fell short of in-person care. Conclusions: Telehealth was generally viewed favorably by ALS patients, caregivers, and multidisciplinary team members. Improvements in technology and in methods to provide satisfactory remote care without person-to-person contact should be explored.

Full Text Available At: https://www.tandfonline.com/doi/abs/10.1080/21678421.2017.1338298?journalCode=iafd20

Vestibular Rehabilitation (posted March 2022)

Helpful Resources:

Vestibular SIG: Telehealth Update- Episode 57

Host Maureen Clancy PT, DPT, OCS is joined by Sara Oxborough PT in an update on the use of telehealth for vestibular rehabilitation. They discuss best practices for treating vestibular conditions in this medium, changes that have occurred related to the Covid-19 pandemic and resources for further information

Abstract:

Harrell RG, Schubert MC, Oxborough S, Whitney SL. Vestibular Rehabilitation Telehealth During the SAEA-CoV-2 (COVID-19) Pandemic. Front Neurol. 2022;12:781482. Published 2022 Jan 20. doi:10.3389/fneur.2021.781482

During the COVID-19 pandemic, physical therapists transitioned to provide telehealth in the United States. We sought to determine the experiences of physical therapists delivering telerehabilitation for vestibular disorders including barriers, preferences, and concerns. A survey was created using the results of a focus group and previously published studies. The survey was distributed across social media sites and through email- the link was sent to the orthopedic, neurologic, and geriatric academies of the American Physical Therapy Association list serves. The email was also shared with each of the 50 state chapters of the American Physical Therapy Association. The survey was broken down into five sections: demographic information, physical therapists' general impressions of telehealth, physical therapists' comfort level treating various vestibular diagnoses, and common barriers physical therapists experienced during telehealth sessions. There were 159 completed surveys. More than 80% of physical therapists surveyed agreed that telehealth was an effective platform for vestibular physical therapy. When asked whether physical therapists felt the patient had similar health outcomes with telehealth versus clinic care 68% of physical therapists agreed. For the physical therapists who treated posterior or horizontal canal benign paroxysmal positional vertigo via telehealth, more than 50% were comfortable treating these conditions via telehealth. In analyzing common peripheral vestibular diagnoses treated via telehealth including bilateral vestibular loss, Meniere's disease, and vestibular neuritis more than 75% of the physical therapists reported comfort treating these diagnoses. Similarly, more than 75% of physical therapists who treated central vestibular diagnoses- including mild traumatic brain injury and vestibular migraine- via telehealth reported being comfortable treating these diagnoses. Physical therapists reported several barriers to tele healthcare ranging from concerns about testing balance with no caregiver present (94%) to challenges with providing a written home exercise program (33%). Physical therapists report that telehealth is a viable mechanism for providing rehabilitation for persons with balance and vestibular disorders. For common diagnoses, most physical therapists were comfortable treating vestibular disorders via telehealth. While barriers remain including maintaining patient safety and being able to complete a thorough vestibular exam, telehealth for vestibular physical therapy services holds promise for the delivery of virtual care.

Available Free Full Text Online

Stroke (posted February 2022)

ViaTherapy- available on the App Store or Google Play

ViaTherapy is an app for occupational therapists and rehabilitation providers actively engaged in the rehabilitation of those with arm impairment after a stroke. The app represents over 5 years of work by an international panel of stroke rehabilitation researchers and clinicians from Physiatry, Neurology, and Physical & Occupational Therapy. The collective expertise encompassed research interests in epidemiology, motor control, and knowledge translation.

Use ViaTherapy to learn about the latest therapies, recall established therapies, and create a customized rehabilitation plan for your patient.

This app is not intended for direct use by patients. Please seek a doctor’s advice before making any medical decisions.

Abstract

Emily R Ramage, Ba Physio(Hons), Natalie Fini, PhD, Elizabeth A Lynch, PhD, Dianne L Marsden, PhD, BAppSci (Physiotherapy), Amanda J Patterson, PhD, M Nut.Diet, BSc, Catherine M Said, PhD, B App Sci (Physio), Coralie English, PhD, Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke—A Scoping Review, Physical Therapy, Volume 101, Issue 6, June 2021, pzab073, https://doi.org/10.1093/ptj/pzab073

Objective: The COVID-19 pandemic has seen a rapid shift to telehealth-delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy, and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke.

Methods: Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weight-bearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another, and results synthesized narratively

Results: Seven studies (2 randomized trials, 1 mixed-methods, and 4 pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment, and 2 (29%) studies included only participants who walked independently. Adherence (reported in 3 studies) and satisfaction (reported in 4 studies) were good, and no serious adverse events (data from 4 studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance, and in-person exercise prescription. However, there is limited high-quality evidence of efficacy.

Conclusion: We identified strategies used in research to date that can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services.

Impact: The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers and optimize safety and adherence for telehealth interventions involving activities in weight-bearing or standing positions.

Link to Free Article: https://academic.oup.com/ptj/article/101/6/pzab073/6145897?login=false

Wellness and Parkinson’s Disease (posted January 2022)

Helpful Resources

The Unexpected Successes and Challenges of Virtual Visits with Clients. How To Help Your Clients Get Even Better Going Virtual

Abstract

Lori Quinn, Chelsea Macpherson, Katrina Long, Hiral Shah, Promoting Physical Activity via Telehealth in People With Parkinson Disease: The Path Forward After the COVID-19 Pandemic?, Physical Therapy, Volume 100, Issue 10, October 2020, Pages 1730–1736, https://doi.org/10.1093/ptj/pzaa128

Objective: There is mounting evidence in support of exercise and physical activity as a first-line approach to managing symptoms and potentially altering disease progression in people with Parkinson disease (PD). For many patients, a critical gap is the need for expert guidance to overcome barriers, set realistic goals, and provide personalized advice to optimize exercise uptake and adherence. The purpose of this case report is to describe a physical activity coaching program (Engage-PD) for individuals newly diagnosed with PD and to highlight rapid modifications made to this program in response to the COVID-19 pandemic.

Methods (Case Description): Engage-PD is a single cohort implementation study of a coaching intervention grounded in self-determination theory being conducted at Columbia University Parkinson’s Foundation Center of Excellence in New York City, NY (USA), the early epicenter of the COVID-19 pandemic in the United States. The project was uniquely positioned to be adapted to telehealth delivery and to address an immediate need for support and guidance in the home environment, including people with early-mid–stage PD. Participants completed baseline and follow-up (3 months) assessments and participated in up to 4 coaching sessions, all delivered via a telehealth platform. The intervention incorporated 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake.

Results: While the program is ongoing, 52 referrals were received and 27 individuals with PD enrolled in the first 2 months of the pandemic for a recruitment rate of 52%. Although direct comparisons with pre-coronavirus recruitment are difficult due to the recency of the Engage-PD implementation study, this recruitment rate was larger than expected, which may have been due to several factors (eg, most patients had limited, if any, access to in-person programs and therapy services during this time, so the Engage program filled an immediate need to provide exercise and activity guidance). There was a wide range of scores for both baseline physical activity and self-efficacy measures.

Conclusion: Remotely delivered interventions may serve as a sustainable platform for physical activity coaching programs for people with PD as well as other neurodegenerative diseases.

Impact: With the uncertainty brought about by the current pandemic, this case report highlights the opportunity to shift the current model of care for individuals with neurodegenerative diseases such as PD.

Link to Free Article: https://academic.oup.com/ptj/article/100/10/1730/5876269?login=true

Telehealth Research (posted December 2021)

Helpful Resources

Discover telehealth research studies funded through Health and Human Services (HHS). Follow this link for more information!

Abstract

Kienle, G.S., Werthmann, P., Grotejohann, B. et al. Addressing COVID-19 challenges in a randomised controlled trial on exercise interventions in a high-risk population. BMC Geriatr 21, 287 (2021). https://doi.org/10.1186/s12877-021-02232-8

Background: The coronavirus disease 2019 (COVID-19) pandemic is a threat to ongoing clinical trials necessitating regular face-to-face, in-person meetings, particularly in participants with a high risk of complications. Guidance on how to handle and safely continue such trials is lacking. Chronically ill elderly individuals require-in addition to protection from infection-regular physical exercise and social contact to remain healthy. Solutions on how to handle these conflicting necessities are needed. The ENTAIER-randomised controlled trial was investigating the influence of mindful movements on fall risk, fear of falling, mobility, balance, life quality, and other outcomes. The study population was planned to comprise of 550 chronically ill elderly individuals with a high risk of falling. The movements were regularly performed in coached groups over 6 months. After the trial began, COVID-19 lockdowns stopped all in-person meetings, and it was expected that the limitations of this pandemic would continue for a long term. Therefore, the exercise programme, which involved complex movements and was typically conducted face-to-face in groups, had to be substituted by a telemedicine programme within a short timeframe. The objectives, therefore, were to identify challenges and tasks that could to be resolved and steps that could to be taken to achieve high-quality, efficacy, safety, and enable human encounter and motivation.

Methods: We proceeded with four steps: 1) A literature review on the quality and feasibility issues of telemedicine in general, and specifically, in exercise training in elderly individuals. 2) Participation in two international telemedicine task forces on integrative medicine, particularly, mind-body medicine. 3) Interviews with study therapists, (for practical purposes, eurythmy therapists and Tai Chi teachers are summarized here as therapists) personnel, and international experts on providing mindful movement exercises and other physiotherapies via live telecommunication technology, and with scientists and patient representatives. 4) Final evaluation by the core trial team and subsequent planning and implementation of changes in the trial organisation.

Results: Various tasks and challenges were identified: for the technical equipment for therapists and patients; for the ability of therapists and trial participants to adequately manage the technology and telemedicine intervention; the reservations and concerns about the technology among therapists and participants; safety and data protection in using the technology; and study design. The two major options found on how to continue the trial in the COVID-19 situation were a complete switch to telemedicine and a partial switch in the form of risk management implemented into the former design.

Conclusions: The management of an ongoing clinical trial in a national or international crisis with a minimum of available time and extra financial resources, alongside with two checklists on steps and procedures for trial continuation and telemedicine implementation, may be informative for other researchers or healthcare providers faced with similar challenges and making similar decisions in the current situation or similar future scenarios. TRAIL REGISTRATION: www.drks.de . DRKS00016609. Registered July 30, 2019.

PMID: 33933014

Link to free article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087880/

Getting Started in Telehealth (posted November 2021)

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Knowledge Translation

ANPT Conference Poster: Mobile Applications in Neurologic Clinical Practice - October 2022

ANPT telehealth taskforce members evaluated several mobile health applications that are available for neurological PT clinical practice for assessment, treatment and education. Click here to access the poster.

Telehealth Evidence Summaries

Current evidence (2017-2022) on telehealth in specific neurological conditions were systematically gathered and evaluated by two independent reviewers using the Oxford Center for Evidence-Based Medicine (OCEB) Levels of Evidence tool.[1] The methodological quality of the articles was assessed using the PEDro scale and a 16-item quality assessment checklist. [2,3]

References:

Oxford Centre for Evidence-Based Medicine. Jeremy Howick, Iain Chalmers, Paul Glasziou, Trish Greenhalgh, Carl Heneghan, Alessandro Liberati, Ivan Moschetti, Bob Phillips, and Hazel Thornton. “The 2011 Oxford CEBM Levels of Evidence (Introductory Document)”. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy. 2003 Aug 1;83(8):713-21.
Gard E, Lyman A, Garg H. Perinatal Incontinence Assessment Tools: A Psychometric Evaluation and Scoping Review. J Womens Health (Larchmt). 2022 Aug;31(8):1208-1218. doi: 10.1089/jwh.2021.0353. Epub 2022 Feb 25. PMID: 35230163.