Practical Considerations in Telehealth
Introduction to Telehealth[edit | edit source]
The ubiquitous nature of technology in our daily lives has paved the way for the development of alternative methods of healthcare delivery. Telehealth is an effective "next-gen" solution that helps clients receive equivalent if not better care than traditional practices.[1][2][3] To ensure the most effective, safe, and responsible delivery of physiotherapy services through the means of telehealth, some prerequisites need to be met.[4]
Overview of Practical Considerations in Telehealth[edit | edit source]
There are four domains that need to be considered to ensure the appropriate delivery and consumption of telehealth services.[4]
Technology[edit | edit source]
The patient and therapist would both need access to the appropriate technology to enable telehealth. They must include all components mentioned below. These need to be tested each time before commencement to ensure no disruption during the session.[5] The assistance of IT professionals may be required in some cases.[6]
Internet connectivity: The download speed determines the quality of the video stream, hence, a minimum connection of 50Mbps will enable real-time viewing with minimum to no buffering at 720p. A wired broadband connection will ensure the lowest latency and highest connection speed. Mobile internet and WiFi are inherently slower and may suffer due to environmental barriers such as walls.
Camera: Laptops usually have poor-quality inbuilt webcams. A dedicated HD webcam or any hand-held device with a high-resolution front-facing camera can be used instead. It must ideally have a minimum resolution of 720p and a wide field of view enabling better visibility of a larger area that will facilitate detailed assessments. Ensure that the subject is centered and the camera is at eye-level. The face and upper body should be clearly visible. Adjust focus in case the video is not sharp. Mounting the camera on a tripod may improve image stability and sharpness. Position the camera at least 5 feet away from the subject for maximum coverage, or as per the specifications of the camera. The camera must be facing in a direction opposite to that of the light source ( for example, the camera must not face a window). Additional lighting may be needed to adjust the exposure.
Microphone: A headset or dedicated microphone may considerably enhance audio-quality over inbuilt audio solutions in consumer electronic devices. Wired headsets have no latency and must be used over Bluetooth audio. Do not speak too close or too far from the microphone as it would cause the volume to vary. During movement, audio may not be captured clearly and a lavalier or body mic would be more appropriate over a stationary microphone. A pop filter and foam windscreen will further enhance audio by removing ambient noise.
Software: There are multiple applications available on various platforms for all categories of devices that can be used to assist the practice of telehealth. Each application must be reviewed and assessed for applicability with respect to each client's unique needs. It must be stressed that the software chosen must be user-friendly and intuitive in addition to other clinical considerations. These applications must be downloaded prior to the session and regularly updated for newer features and security patches.
Additional hardware: Based on the unique needs of the telehealth setting, additional peripherals may be required. These could include input devices such as touchscreen display units, styli, or assessment tools such as electronic stethoscopes.
Environment[edit | edit source]
The role of the environment must not be undermined. The following recommendations will assist in designing or modifying your telehealth set-up.[5][7]
Location: The therapist can choose between the workplace or his home based on convenience and other factors mentioned below. The client must choose a room that is private and usually unoccupied by other family members. In case, a special task needs to be assessed in a specific environment, the location can be changed accordingly.
Space: The room must be large enough to allow the evaluation of gait and the utilization of assistive devices such as wheelchairs or walkers.
Decor: The background must be stationary and of neutral coloring. A green screen can be used if a neutral background is unavailable. Furniture must be moved out of the way to prevent accidents and occluding the line of view.
Equipment: Tools necessary for assessment must be kept close-by and must be arranged in an organized fashion for ease of use and preventing undue delays. They can be placed over a trolley to enable ease of transportation.
Lighting: A well-lit room, between 300-500 lux, is a basic requirement to ensure ideal video capture. Depending on the time of day and the number of windows available, additional lighting sources may be required. A light source must also face the subject since overhead lights alone will cast shadows obscuring visibility. Artificial light sources employing fluorescent bulbs are preferred over incandescent bulbs due to their proximity to white light which will ensure that all subjects in the image maintain their natural colors. This is essential if the client is older since they would suffer from poor color perception.
Noise level: Ambient noise can be controlled by timing the session at the appropriate time. In case levels are still too high, noise reduction techniques may need to be employed. Keeping the door and windows closed may dampen noise but also considerably increase echo. Other methods include the installation of sound-absorbing ceiling tiles, acoustic panels, and carpets.
Therapist[edit | edit source]
The therapist is the facilitator and therefore can either make or break the process.[4][5]
Bedside/"webside" manner:
Assessment skills:
Safety:
Client selection:
Technodexterity:
Client[edit | edit source]
The client must fully understand the telehealth model and decide for himself whether it is the appropriate delivery method for him.[4][5]
Consent:
Data privacy:
Role of caregivers:
Finance:
Ethics:
- Video: minimum requirements device with microphone and camera and a stable internet connection
- Environment for both therapist and patient:
- Space
- Clear form clutter
- Private
- Furniture required and how it should be arranged
- Equipment required
- Background: preferably stationary.
- Lighting: clearly see your patient at all times. Above or behind computer screen. Close curtain and turn on the lights. Work with patient
- Noise: eliminate background noise, radio or television. Headset with microphone useful for therapist.
- Clothes the patient is wearing, light plain color
- Position relative to the camera, front on. Face and upper chest in view. Are you looking at the patient or the camera. When demonstrating the action, position yourself correctly.
- Continually ask patient to reposition the camera and themselves - get the patient position right
- Position yourself to avoid mistakes with goniometry assessment.
These videos will assist you in designing your own telehealth sessions.
Resources[edit | edit source]
https://www.who.int/goe/publications/goe_telemedicine_2010.pdf
https://www.wcpt.org/sites/wcpt.org/files/files/congress/19/Presentations/WCPT-06.pdf
http://www.apta.org/Telehealth/
https://www.apta.org/Telehealth/Implementation/
http://www.apta.org/Telehealth/COVID-19/Modalities/
https://australian.physio/sites/default/files/APATelehealthGuidelinesCOVID190420FA.pdf
https://www.running-physio.com/telehealth
References[edit | edit source]
- ↑ Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clinical rehabilitation. 2017 May;31(5):625-38.
- ↑ Van Egmond MA, van der Schaaf M, Vredeveld T, Vollenbroek-Hutten MM, van Berge Henegouwen MI, Klinkenbijl JH, et al. Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis. Physiotherapy. 2018 Sep 1;104(3):277-98.
- ↑ Chumbler NR, Quigley P, Li X, Morey M, Rose D, Sanford J, et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke. 2012 Aug;43(8):2168-74.
- ↑ 4.0 4.1 4.2 4.3 Cottrell, M. Clinical Triaging and Practical Considerations in Telehealth. Course. Physioplus. 2020
- ↑ 5.0 5.1 5.2 5.3 Australian Physiotherapy Association. Telehealth Guidelines. Available from: https://australian.physio/sites/default/files/APATelehealthGuidelinesCOVID190420FA.pdf (accessed 10 May 2020)
- ↑ Baker J, Stanley A. Telemedicine Technology: a Review of Services, Equipment, and Other Aspects. Curr Allergy Asthma Rep. 2018 Sep 26;18(11):60.
- ↑ Krupinski EA. Telemedicine Workplace Environments: Designing for Success. Healthcare. 2014 Feb 24;2(1):115-22.
