Virtual medical and rehabilitation appointments during COVID-19 could be paving the way to be a new norm, according to a recent review paper co-authored by Brodie Sakakibara (Kelowna, Canada) with the Centre for Chronic Disease Prevention and Management (CCDPM).
The paper, which examined six different clinical trials launched across Canada, has determined that virtual appointments, in the form of telerehabilitation, also work for people recovering from a stroke.
A patient is provided with a therapy programme, after suffering a stroke, to help regain loss of skills or motion, which can range from speech and memory, strength, balance and endurance. While not initially introduced for disease outbreaks, Sakakibara, a University of British Columbia assistant professor, in the Okanagan campus, says research shows remote therapy can be effective during stroke recovery.
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy,” says paper co-author Sakakibara. “These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes.”
To learn how effective telerehabilitation can be, the Canadian Heart and Stroke Foundation initiative launched six different clinical trials examining stroke telerehabilitation programmes across the country. People recovering from a stroke were provided with interventions ranging from lifestyle coaching to memory, speech skills and physical-exercise training.
“Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context,” says Sakakibara.
Sakakibara adds that the study authors determined there are important lessons learned from each of the six trials, noting that the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management and that patients mostly reported satisfaction with the telerehabilitation when therapists were trained appropriately, and when there was some social interaction.
Overall, clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible. However, since seniors are a key target group for stroke rehabilitation, as stroke is associated with aging, the technology needs to be easy to use and suit the needs of the end users.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow,” says Sakakibara. “While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care.”
Sakakibara notes COVID-19 has amplified the necessity for telehealth and telerehabilitation for many Canadians, especially those in remote areas and for the estimated 70% of stroke victims who are no longer able to drive.
“Prior to the outbreak, telehealth/rehabilitation was highly recommended in Canadian stroke professional guidelines, but was underused,” he says. “Now in response to COVID-19, the use of telerehabilitation has been accelerated to the forefront. Once these programs are implemented in practice, it’ll be part of the norm, even when the outbreak is over. It is important that we develop and study telerehabilitation programmes to ensure the programs are effective and benefit the patients.”
The review paper, published in Telemedicine and e-Health, was partially funded by the Heart and Stroke Foundation and was prepared by a team of researchers from across Canada.