Constraints on Adoption of Telehealth to Support Aging Populations
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This chapter examines how telehealth technology might support health care services for aging populations. Telehealth has been defined as the "remote provision of health care services and education by means of information and communications technology". The array of telehealth services includes those normally provided in real time, such as videoconferencing for telemental health therapy, telesurgery, and telerehabilitation. Often, rural populations have disproportionately older compared to younger residents, and telehealth is of special significance to these aging adults. In the case of aging adults, both providers and consumers, careful attention to their abilities will be a necessary condition in both designing and training telehealth use. Telehealth technology holds out the promise of delivering health care services to remote locales without requiring in-person visits by health professionals. A persistent issue for technology systems and telehealth systems is how to design adequate training.Keywords:
Telehealth
Telerehabilitation
Videoconferencing
Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized.
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This report describes our experience using low-and moderate-cost videoconferencing systems for telemedicine. After determining that low-cost systems using a standard personal computer and personal computer camera were unsatisfactory, a demonstration project was carried out using a $4000 self-contained videoconferencing unit (telemedicine in a box), using eight simulated telemedicine consultation scenarios. The quality of the videoconferencing was good for all eight scenarios. All eight consultation simulations demonstrated different ways of improving patient care. Two of the major problems hindering the broad proliferation of telemedicine (high cost and high complexity) are solved by the telemedicine in a box concept. Focussing on the telemedicine in a box concept when planning a telemedicine system will improve its feasibility in the real world of health care.
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Telerehabilitation, or the use of technology to provide rehabilitation services remotely, has been shown to be effective in a variety of settings. It has the potential to improve access to rehabilitation services for individuals living in rural or remote areas, reduce barriers to care such as transportation and childcare, and increase patient satisfaction. However, there are also potential drawbacks to telerehabilitation, such as the need for reliable internet access and privacy concerns. Overall, telerehabilitation can be a useful addition to traditional rehabilitation services, but further research is needed to fully understand its effectiveness and optimal implementation.
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Introduction: This study explores allied health students’ experience with and perceptions of telerehabilitation prior to and following the rapid transition of university clinical placements to telerehabilitation due to COVID-19. Methods: Semi-structured interviews were conducted with allied health students who had completed a clinical placement (between March and September 2020) at the University of Queensland that was rapidly transitioned to telerehabilitation due to COVID-19. Students were asked to report on their pre-conceptions, lived experience and post placement reflections of delivering consultations via telerehabilitation rather than in-person. Qualitative data were analysed using thematic content analysis. Results: 18 students (72% female, 20 to 31 years of age) from speech pathology (39%), physiotherapy (39%), occupational therapy (11%) and audiology (11%) conducted telerehabilitation consultations. Reflections on preconceptions of telerehabilitation nested under four themes: clinical effectiveness, interacting/communicating via telerehabilitation, technology and anticipation about a telerehabilitation placement. Experiences during placement clustered under similar topics of clinical effectiveness, interacting/communicating, practical aspects and technology. Reflections upon completion of placements related to experience in a global pandemic, benefits of combining technology and telerehabilitation, convenience, future use and knowledge, skills, and confidence with telerehabilitation. Conclusion: Despite initial concerns, students were able to rapidly transition to telerehabilitation and effectively deliver quality care, modify techniques, and achieve positive client outcomes. Student skills, knowledge and confidence improved with rapid exposure through learning “on the go”, and many indicated willingness to continue to use telerehabilitation in the future.
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Social telerehabilitation, which focuses on solving limitations and social issues associated with health conditions, represents a further specialization in telerehabilitation. Both telerehabilitation and social telerehabilitation are grounded in the delivery of rehabilitation services through telecommunication networks, especially by means of the Internet. Essentially, telerehabilitation comprises methods of delivering rehabilitation services using ICT to minimize the barriers of distance, time, and cost. One can define social telerehabilitation as being the application of ICT to provide equitable access to social rehabilitation services, at a distance, to individuals who are geographically remote, and to those who are physically and economically disadvantaged.
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Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8) and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD) age 73 (8) years, forced expiratory volume in 1 second (FEV1) 60 (23) % predicted) showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing.
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Telecommunications technologies spanning a wide range of functionality and cost offer valuable resources for supporting independent living and rehabilitation services. In this article, we review the technology that is used today and explore some potential directions for telerehabilitation. Because telemedicine and telerehabilitation are often closely associated with interactive videoconferencing, we include a discussion of videoconferencing options. However, with the convergence of voice, video, and data in the telecommunications industry, networking benefits go far beyond videoconferencing and point-to-point communications. Although some health care applications may demand greater network performance than can be supported on the Internet today, the federal government's Next Generation Internet Initiative is addressing many of these limitations. This article includes a brief discussion on what the Next Generation Internet can bring to telerehabilitation.
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Social telerehabilitation, which focuses on solving limitations and social issues associated with health conditions, represents a further specialization in telerehabilitation. Both telerehabilitation and social telerehabilitation are grounded in the delivery of rehabilitation services through telecommunication networks, especially by means of the internet. Essentially, telerehabilitation comprises methods of delivering rehabilitation services using ICT to minimize the barriers of distance, time, and cost. One can define social telerehabilitation as being the application of ICT to provide equitable access to social rehabilitation services, at a distance, to individuals who are geographically remote, and to those who are physically and economically disadvantaged.
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This study examined the feasibility and acceptability of a telerehabilitation program during the COVID-19 pandemic in a sample of adult patients with physical disabilities. Of the twenty-three patients enrolled, 11 agreed to participate in a video-based telerehabilitation program. Barriers and facilitators to the adoption of telerehabilitation were identified and clinical, demographic, and psychological variables were analysed as predictors of success. Age, cognitive reserve, and resilience were significant predictors of satisfaction with telerehabilitation (p<0.05). The telerehabilitation program was perceived as feasible and was well accepted by patients, despite some technology challenges. However, patients who took advantage of telerehabilitation perceived differences in the quality of service and preferred traditional in-person treatment to service delivery via telerehabilitation.
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Background: Telerehabilitation is emerging in Saudi Arabia. This study investigated occupational therapy professionals’ perspectives on using telerehabilitation in their practice. Method: Data were collected through semi-structured phone interviews conducted with nine Saudi occupational therapists. A pragmatic qualitative evaluation approach was used. Findings: Experience and perceptions of participants regarding telerehabilitation were represented as follows: awareness and knowledge of telerehabilitation; how telerehabilitation increases occupational therapy availability and access in Saudi Arabia; telerehabilitation in the pandemic; telerehabilitation is preferred; suitability of telerehabilitation in Saudi Arabia; telerehabilitation care pathways; telerehabilitation readiness in Saudi Arabia; and telerehabilitation willingness by Saudi occupational therapists. Conclusion: Saudi occupational therapists have good knowledge and awareness of telerehabilitation, and some had used it during the pandemic. They showed positive attitudes and a willingness to use telerehabilitation if appropriate technology infrastructure, official policy standards and guidelines, training, data security, and financial resources could be provided to support implementation.
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