Tele Rehabilitation for Older Adults

Introduction:

Telehealth technologies allow for the distribution of healthcare services and the exchange of information between a healthcare provider and a patient in different geographical locations and provide an important avenue to reach people who live in rural communities. Tele rehabilitation refers to the provision of rehabilitation services through remote means using telecommunication technology. Medical fields that utilize tele rehabilitation include physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Different specialties of medicine can utilize tele rehabilitation according to their need, such as urology-related follow ups for urinary tract infections and evaluating bladder volumes, gastrointestinal evaluations for progression of bowel programs, nutrition management, sexuality education, and management, management of pain weaning from medications, adjusting medications, etc.

What Are the Types of Tele Rehabilitation?

Tele rehabilitation can occur in two ways:

1. Depending on the Location - Either the person who is conducting the tele rehabilitation and monitoring, assessing, and rehabilitating patients at a community center or rehabilitating patients directly connecting to the patient’s home.

2. Depending on the Method - Either there is a real-time visit with audio, video, or both via phone or laptop, or there are recorded videos or images of exercises sent to the patient, and again, the patient records themselves performing those exercises and sends it back to the healthcare provider, or there is telephone assessment done, and guidance is given to the patient.

What Are the Things Required for Tele Rehabilitation?

The key requirement for achieving success is tele rehabilitation is that the patient should be able to operate technological devices independently or with family members or career assistance with informed consent and also the willingness to participate in supervised exercise training using a technological device. Other things required are as follows-

• End user, usually smartphones or webcam-installed computers with the facilities of text messaging, video conferencing, and motivational interviewing.

• Client therapist interface that is Bluetooth or Wi-Fi secures.

• Central cloud server that stores data and provides secure access for documentation and monitoring the progress.

• Medical history of the patient that includes medications, vaccinations, and associated diseases.

• Objective measures to assess the height, weight, blood pressure, and oxygen level of the patient.

• Environment/home history or virtual tour of the area to be used for exercise and asses suitable exercising equipment, walking track options, chairs, and most appropriate steps, etc.

• Non-technical considerations such as screen size, angle of the laptop, distance, height of the patient, the chair's height, and the table's height, etc.

How to Establish Tele Rehabilitation Services?

Tele-rehab has three parties in general: a patient, a health care provider, and a technology service provider. There are certain types of tele-rehab services training that are given to the patient, such as video conference training, camera-based training, robot-assisted training, wearable sensor training, app-based training, and virtual reality training. To access the service, individuals need to patient is first required to book a service for initial evaluation, and after pre-assessment, a consent form and a checklist will be prepared for the guidelines of using tele-rehab services and given to the patient. Then a teleconsultation session will be scheduled, and during that, a personalized daily training plan will be implemented. The plan will also consist of progress records, monitoring, and follow-up of the patient.

What Are the Exclusion Criteria in Tele Rehabilitation?

There are certain conditions under which tele rehabilitation cannot be done, such as

• Cognitive impairment.

• Unstable neurological diseases.

• Unable to participate due to musculoskeletal disorders.

• Poor balance and the risk of falling without direct face-to-face supervision.

• The patient lives alone and is not confident about participating in the program.

• Hearing impairment.

• Eyesight impairment.

• Inability to operate the technological device.

What Are the Benefits of Tele Rehabilitation?

The following things can help people understand the benefits of tele rehabilitation-

• The patient is not required to endure extended waiting periods and queues in clinics/hospitals.

• A high degree of patient satisfaction.

• It is time-saving.

• Face-to-face consults.

• Less commute involved.

• Older persons do not need to go to the health center and directly manage it at home by themselves.

• Less caregiver burden.

• After hip replacement therapy, older patients want to stay the least amount of time in a hospital; in that case, tele rehabilitation plays a role.

• Patient comfortability is the most important when speaking of tele rehabilitation at home after older patients have had major surgery or are dealing with a disease.

• Increased patient reach/access.

• Decreased missed visit rates.

• Cost saving by reducing the number of hospital visits that comes with travel expenses.

• It provides a service that is otherwise not available.

• Fewer chances of catching a hospital-related infection.

• It can support patients with long-term healthcare needs.

• Increased training intensity with technology.

What Are the Barriers to Telerehabilitation?

Certain barriers include-

• Limited resources.

• Lack of healthcare professionals performing telerehabilitation.

• Internet issues.

• Difficulty in assessment.

• No evidence-based guidelines.

• Lack of technical expertise.

• Managing legal issues surrounding patient privacy and confidentiality.

• Certain conditions require a hands-on approach.

• Patients cannot be examined physically.

• Language and communication barriers.

• Lack of awareness about telehealth.

What Are the Guidelines That Are Followed in Tele Rehabilitation?

There are three important things that are considered-

1. Patient-Centered - The older adult being served should be at the center of all decision-making. The older adult’s care preferences, goals, wishes, abilities, support system, and conditions should be accounted for.

2. Equitable and Accessible - Regardless of age, ability, socioeconomic status, health literacy, technology literacy, and access, everyone should have equitable access to an equal level of high-quality care.

3. Integrated and Coordinated - Systems should be set to facilitate access to the info and support necessary to provide quality care to older adults. This includes cooperation and communication between and within systems and stakeholders.

Conclusion:

Tele rehabilitation is a growing area in the healthcare sector, and with advancements in medical technologies, it acts as a boon, especially for the geriatric population, who are often associated with comorbidities and other geriatric disorders such as frailty and gait disorders. Tele rehabilitation increases the level of treatment for older people with disorders not only in physical but mental well-being as well; it also contributes to lower hospital expenses and strengthens conventional face-to-face practice.