The Basics of Telehealth Assessment and Treatment

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Recommendations to clinicians:

1. Exclude all reg flags
2. Identify patients who may need face- to face assessment
3. Rationale if a referral is necessary
4. identifying a support network of seniors or experts in the field who can advice and assist at any stafge required. This channel needs to be active and the clinicians must be able to contact , as an when necessary
5. The contact details shouldn't be kept confidential, it would even be recommended to get seperate lines and contact ids for this purpose, after the consultation the numbers must be deleted or stored only i the official records

Always maintain the records of the patients

Reduce the amount of identifiable patient details that you share digitally

Assessment needs:

Empowerment of the patient

Individually tailored

Not recommended to assess:

Assessing high risk patient or patients with potentially high risk conditions

Patients with internal examination including any pelvic area examination

Coniditions or comorbidities affecting the ability to us technology including delusion, anxieties about using tecnology

Deaf and dumb individuals, may be difficulat , however the use of assitive technolgy may aid the process

Key points to keep in mind:

Before the Consultation	Consider a pre call questionnaire (Self rating like in case of VAS or Body chart) Ask the client if they would like a partner or family member to be present during the consultation Schedule the consultation based on whom you need to see on a priority basis(clinical triaging in telehealth) Confirm if a video graphic consultation is clinically appropriate Use a room that is private and well lit Make sure the patients phone number is ready, in case the video graphic link gives trouble Keep the patients clinical records ready and preferably on another screen Prior to the session test the technology , if it is works as its supposed to.
Start of the consultation	Always initiate the consultation by calling the patient Check the connectivity and clarity by asking the subject of he/ can see or hear. A formal introduction to the patient is a must A verbal consent must be taken from the client before the commencement of the assessment procedures It is always better to look at the camera for the client to make eye contact and restore the subjects faith in you In case there are other consultants in the room they need to be introduced to the client
The consultation	Maintain written records as you would for a face-to -face consultation. Be aware that the video communication is slightly different in comparison to their In case you are preoccupied, making notes or reading medical records, let the patient know
Closing the consultaion	Summarize key points, incase something went wrong technically this would really help Clarify any doubts the patient might have Confirm i the patient is happy with the video method of telehealth Remind the client not to stop his routine medication in case of any co morbidities present Say goodbye and close the call
After the consultation	Update the records Schedule referrals or follow up appointments Make sure the exercises, if promised in the form of an email are sent Prompt follow up email needs to be sent, summarizing the necessary features of the teleconsultation Face to face appointments in case necessary must be scheduled

The process:

Begining:

Perform a brief visual assessment ( Is the patient distressed, gauge his ability to proceed with the assessment)

Understand the purpose of the consultation (assessment, medical records for leave, reassurance, referral etc)

Check the medical records, for the presence of high risk status or red flags or co morbidities (diabetes, steroids, pregnancy, chemotherapy, chronic kidney disease, etc)

Taking a history:

Remote examination

tests

Clinical Descision making:

Treatment plan

Recommendations to the Organizers

Telehealth networks must be establishes, preferably standardized software or systems

Consulting and refereeing sites must be made available , probably like a smaller unit for immediate consultation when required

Standardized, goal oriented and time driven protocols must be in place for the efficient delivery of rehabilitation services specially in he acute phase

Continuing education and mock simulation conditions are suggested to continually train and update professionals offering services

It neere means that telerehab includes one mode of communication. Infact to optimize reults and adehrence

Patient guide:

1. Decide what type of a consultation you would like or need (telephone consultation works well if a video isn't necessary). Video consultations are more reassuring due to the visual feedback.
2. Ensure your details last updated at the hospital are your current details (email id, phone number). locate a quite place, with good connectivity to the internet. test the device you will be using prior to the consultation. Make sure the Physical therapist has your credential details to know it is you and to respond timely. Login to the connection a few minutes prior to the consultation
3. During the process of the consultation, you can look at the screen, it isn't mandatory to look at the camera as this may be difficult. Any questions that require verification can be clarified. If the connection is disrupted in between , reconnect the call
4. Make sure to follow u on anything you have agreed to.

Evidences:

Stroke rehablitation:

Quality of life, Activities of daily living and upper limb function improved in the same capacity as that of face to face rehablitation. No adverse events reported with the practise of telerehablitation,