Telerehab in the Age of Continuous Connection: A Post-Covid Boon

The COVID-19 pandemic has drastically changed most aspects of health care delivery. To protect health care workers and patients from disease transmission, policies were altered to enable widespread use of telecommunications technology in lieu of in-person clinical visits.  Rehabilitation delivery was dramatically altered as physical therapists turn to telehealth modalities to help them continue current patient treatment and potentially access remote populations. The shift to telerehabilitation further provides a unique learning opportunity for researchers and clinical experts as it fuels innovations optimizing health care delivery.

Telehealth is an umbrella term that encompasses a wide array of modalities, including both clinical and nonclinical services. Telerehabilitation is traditionally more explicitly related to clinical rehabilitation services with an emphasis on evaluation, diagnosis and treatment.
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Telerehabilitation may be provided in a variety of ways, including:

• Two-way real-time visits with audio, video, or both;
• Asynchronous e-visits;
• Virtual check-ins;
• Remote evaluations of recorded videos or images;
• Cellphone assessment and management services.

 
The US Department of Veterans Affairs was an early adopter of telerehabilitation for the provision of remote services including physical therapy. These DVA services were rapidly accelerating even prior to the pandemic. Covid 19 created a need for safer public health delivery and established new guidelines and precautions. The uptake of telerehabilitation in health systems across the globe was hampered by restrictions, regulations and reimbursement policies. Recent changes currently permit the use of telerehabilitation for physical therapy on a much wider scale. These unprecedented circumstances provide unique research opportunities to study the implementation and outcomes of telerehabilitation. 

Several medical reviews conclude that telerehabilitation is effective for patients with multiple sclerosis, musculoskeletal conditions and osteoarthritis. It is also suitable for various stages of motor function recovery. New studies suggest that telerehabilitation may further reduce health care costs, improve treatment adherence, expand physical function and thus quality of life. Most telerehabilitation studies evaluate the outcomes of synchronous, real-time time rehabilitation, although there is some evidence that asynchronous telemedicine can also be effective for specific patient populations, such as those following total joint replacement.
As the technology becomes more widely available, additional studies will emerge to address pressing questions about the feasibility, safety, and effectiveness of telerehabilitation modalities across subgroups of patient populations and environmental settings. Harnessing the power of data and analytics to learn what works best and eventually feed that knowledge back to patients, clinicians, other professionals, and stakeholders will create a continuous cycle of quality improvement. The data systematically integrates evidence established via iterative learning inherent to these modalities helping stakeholders in establishing its appropriate use for physical therapy delivery.

The effect of using telerehabilitation for treatment is likely to vary according to the patient’s condition and its severity. With sufficient planning to consider equipoise in care delivery, available capacity for research in practice during or after the pandemic, and appropriate methodological expertise, more rigorous study designs including pragmatic trials and hybrid implementation-effectiveness studies should be considered. Ultimately, if telerehabilitation interventions can yield outcomes equivalent to those of traditional care and are equally or more cost-effective, there would be strong evidence in support of sustaining telerehabilitation as a care delivery option after the pandemic subsides. It would be interesting to observe the effects of telerehabilitation service in improving health care infrastructure and efficiency of delivery, particularly for certain patient groups. Stakeholder involvement and innovative study strategies would be instrumental in designing and conducting research. Real world experiences should be used to integrate studies - as part of clinical practices - which would in turn accelerate the evaluation, approval and integration of the technology. It would also help researchers and practitioners in identifying best practices for telerehabilitation that are more likely to be adopted and scaled up both during and after the pandemic subsides. The new normal for rehabilitation services is likely to include telerehabilitation with variations according to differences in policies and particular health systems.