The Basics of Telehealth Assessment and Treatment: Difference between revisions
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* | * 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 | ||
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|After the consultation | |After the consultation | ||
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== | == Plan your consultations: == | ||
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The consultant or therapist must always be prepared. The therapist must develop a list of the questions that will have be asked. The key examination points including active movements, passive movements and special tests must be organised to optimize best utilization of the session time. Identify if any of the assessment procedures may require assistance by a family member. | The consultant or therapist must always be prepared. The therapist must develop a list of the questions that will have be asked. The key examination points including active movements, passive movements and special tests must be organised to optimize best utilization of the session time. Identify if any of the assessment procedures may require assistance by a family member. | ||
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== Modifying assessment to fit a virtual audience == | |||
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Observation assessment when done virtually will depend of the view the angulation of the device is. To rely on observatory findings may be challenging as it demands proper alignment of the camera with respect t the body segments. Thus it would be appropriate to ask additional questions instead of as additional questions instead of your observation skills. Adaptations of the regular examination is essential, modifications of the special tests and the other evaluation methods is essential. | |||
'''Safety is priority:''' Before we venture into the technicalities of this section it is important to understand that safety f the client is and must be the prime concern of every therapist. In the unlikely event that something goes wrong, a therapist must be able to reach out to the patient or have a system in place | '''Safety is priority:''' Before we venture into the technicalities of this section it is important to understand that safety f the client is and must be the prime concern of every therapist. In the unlikely event that something goes wrong, a therapist must be able to reach out to the patient or have a system in place. Tests that are not safe to perform. Replace with another test or additional questioning or rather in-person. | ||
'''Camera placement:''' The placement must give a good view of the client. This can be done by a few trial placement areas tried out in the subjects vicinity (EG: on a table ,adjusting the tilt of the laptop or placing the ipad on a stand that is aligned to give a good view of the client a he/she performs what is asked of him/her. | '''Camera placement:''' The placement must give a good view of the client. This can be done by a few trial placement areas tried out in the subjects vicinity (EG: on a table ,adjusting the tilt of the laptop or placing the ipad on a stand that is aligned to give a good view of the client a he/she performs what is asked of him/her. | ||
'''Teach patients to perform the exercise:'''- There are multiple ways to teach a patient a particular exercise and continually monitor as it is done in a face to face rehabilitation session. These methods can be followed with family members assisting whenever required | '''Teach patients to perform the exercise:'''- There are multiple ways to teach a patient a particular exercise and continually monitor as it is done in a face to face rehabilitation session. These methods can be followed with family members assisting whenever required | ||
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* Sensors embedded in task devices if they are available can track and relay information to the therapist<ref>Brennan DM, Lum PS, Uswatte G, Taub E, Gilmore BM, Barman J. A telerehabilitation platform for home-based automated therapy of arm function. Conf Proc IEEE Eng Med Biol Soc 2011 Sep 3 (pp. 1819-1822). IEEE.</ref> | * Sensors embedded in task devices if they are available can track and relay information to the therapist<ref>Brennan DM, Lum PS, Uswatte G, Taub E, Gilmore BM, Barman J. A telerehabilitation platform for home-based automated therapy of arm function. Conf Proc IEEE Eng Med Biol Soc 2011 Sep 3 (pp. 1819-1822). IEEE.</ref> | ||
* Family member to assist if needed like with passive ROM | * Family member to assist if needed like with passive ROM | ||
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== Treatment: == | |||
What interventioans can be given safely as a part of telehealth: | |||
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# Exclude all reg flags | # Exclude all reg flags | ||
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Individually tailored | Individually tailored | ||
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Revision as of 20:00, 17 May 2020
Practice using different platforms:[edit | edit source]
Tele-Rehabilitation requires a strong platform that offers competent technical and technological services. They may fall under the following categories
Video conferencing: This is on a continuous online platform that permits dynamic interaction between the client and therapist. This may include platforms like skype, zoom, google duo, watssapp cal etc
Image transfer: This includes transfer of select images for the purpose of treatment.
Data transfer: This includes transfer of information through non image or vdieo methods like emialing medical records, exercise plans etc[1]
Technical support practice[edit | edit source]
- Technical support needed for a consultation includes
- Audio conference equipment
- Video conference equipment
- Computer networking (Wans and LANs)
- Broadband networks
- Satellite television which provide interaction[1]
More information on these technical aspects of dealing with a teleconsultation is given in the page, Practical considerations in Telehealth
Recommendations for Consultations:[edit | edit source]
It is always considered better to conduct mock consultations to evaluate any technical glitches that may occur and evaluate network strength
Before the Consultation |
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Start of the consultation |
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The consultation |
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Closing the consultaion |
|
After the consultation |
|
Plan your consultations:[edit | edit source]
The consultant or therapist must always be prepared. The therapist must develop a list of the questions that will have be asked. The key examination points including active movements, passive movements and special tests must be organised to optimize best utilization of the session time. Identify if any of the assessment procedures may require assistance by a family member.
Modifying assessment to fit a virtual audience[edit | edit source]
Observation assessment when done virtually will depend of the view the angulation of the device is. To rely on observatory findings may be challenging as it demands proper alignment of the camera with respect t the body segments. Thus it would be appropriate to ask additional questions instead of as additional questions instead of your observation skills. Adaptations of the regular examination is essential, modifications of the special tests and the other evaluation methods is essential.
Safety is priority: Before we venture into the technicalities of this section it is important to understand that safety f the client is and must be the prime concern of every therapist. In the unlikely event that something goes wrong, a therapist must be able to reach out to the patient or have a system in place. Tests that are not safe to perform. Replace with another test or additional questioning or rather in-person.
Camera placement: The placement must give a good view of the client. This can be done by a few trial placement areas tried out in the subjects vicinity (EG: on a table ,adjusting the tilt of the laptop or placing the ipad on a stand that is aligned to give a good view of the client a he/she performs what is asked of him/her.
Teach patients to perform the exercise:- There are multiple ways to teach a patient a particular exercise and continually monitor as it is done in a face to face rehabilitation session. These methods can be followed with family members assisting whenever required
- Prerecorded video
- Online video demonstration
- Display of visual feedback
- Video conferencing
- Sensors embedded in task devices if they are available can track and relay information to the therapist[3]
- Family member to assist if needed like with passive ROM
Treatment:[edit | edit source]
What interventioans can be given safely as a part of telehealth:
- Exclude all reg flags
- Rationale if a referral is necessary
- identifying a support network of seniors or experts in the field who can advice and assist at any stage required. This channel needs to be active and the clinicians must be able to contact , as an when necessary
- 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[4]
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
Recommendations to the Organizers[edit | edit source]
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[5]
Telerehablitation includes one mode of communication. In fact to optimize results and to evaluate adherence , multiple modes of of communication may be necessary, like video conferencing, telephone, desktop video phones, messaging devices, online chat sessions, video recordings, email.[6]
Patient guide:[edit | edit source]
- 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.
- 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
- 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
- Make sure to follow u on anything you have agreed to.
Evidences:[edit | edit source]
- Stroke rehabilitation: Quality of life, activities of daily living and upper limb function improved in the same capacity as that of face to face rehabilitation. No adverse events reported with the practice of telerehablitation,[6]
- ↑ 1.0 1.1 Australian Physiotherapy Association. Telehealth Guidelines. Available from: https://australian.physio/sites/default/files/APATelehealthGuidelinesCOVID190420FA.pdf (Accessed 17 May 2020)
- ↑ Specialty guides for patient management during the coronavirus pandemic. Clinical guide for the management of remote consultations and remote working in secondary care during the coronavirus pandemic. NHS Report number: 001559 [27/03/2020]
- ↑ Brennan DM, Lum PS, Uswatte G, Taub E, Gilmore BM, Barman J. A telerehabilitation platform for home-based automated therapy of arm function. Conf Proc IEEE Eng Med Biol Soc 2011 Sep 3 (pp. 1819-1822). IEEE.
- ↑ Chartered Society of Physiotherapy. Telephone Guidance from Musculoskeletal Practise. Avaialable from: https://www.csp.org.uk/news/coronavirus/remote-service-delivery-options/telephone-guidance-msk-practice
- ↑ Blacquiere D, Lindsay MP, Foley N, Taralson C, Alcock S, Balg C, Bhogal S, Cole J, Eustace M, Gallagher P, Ghanem A. Canadian stroke best practice recommendations: Telestroke best practice guidelines update 2017. Int J Stroke. 2017 Oct;12(8):886-95.
- ↑ 6.0 6.1 Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C. Telerehabilitation services for stroke. Cochrane Database of Syst Rev. 2013(12).