Day 1 :
Université de Sherbrooke, Faculty of Medicine and Health Science, Sherbrooke, Quebec, Canada
Keynote: What should be used for in-home telerehabilitation: Generic videoconferencing systems or specialized platforms? A review of our 10 years’ experience
Time : 9:0:0
Dr Michel Tousignant, P.T, Ph.D., hold a Telerehabilitation research Chair since 2011. He is also the assistant-dean of the Rehabilitation program for the Faculty of Medicine and Health Sciences (U. de Sherbrooke). His research program focuses on the effectiveness and costs of implementing telehealth in rehabilitation. He received nearly $ 7M in grants as a researcher or co-principal investigator and $ 17M as a co-investigator. He have more than 80 publications, to my credit, in refereed journals and more than 200 presentations at national and international congresses.
Background: In-home telerehabilitation is defined as the action of providing physical rehabilitation from a clinical site to a patient’s home using video, audio and data channels over an internet connection. These interventions present a challenge from a technical point of view. Technical requirements and clinical constraints guide the choice of the correct system to use in such an application. In recent years, many solutions have been used and deployed by research and clinical teams. Purpose: To present the pros and cons of generic videoconferencing and specialized telehealth systems. Methods: Using in-depth analysis of currently available platforms and hands-on experience of the research team (over 250 participants with more than 40 clinicians, including students, over the course of 9 clinical projects), solutions were compared to guide users towards the best solution for their needs. Results: Generic videoconferencing platforms are readily and easily available, well known, usually have a low software and hardware cost and provide sufficient videoconferencing for telerehabilitation. However, they usually lack features such as external sensor support, remote camera control, multiple cameras and session history. They might also have important security and confidentiality concerns since the data may transit and be stored on uncontrolled or unsecured servers. Specialized systems address security issues by hosting the server in a local network or by providing security certifications on servers hosted by the provider. Such solutions also allow for sensor support (usually in a limited way) and a user interface specifically designed for clinical applications. Conclusion: Considering that each population has its own clinical needs, it is important to carefully choose the correct solution and consider every aspect of the clinical approach before choosing a solution. Specific features such as security aspects and sensors usage might have a great impact on the outcomes of the project.
- Physical Therapy Science Physiotherapy in sport related injuries Advancement in Physiotherapy Manual & Manipulative Therapy Artificial Physiotherapy Methods Womens Health & Palliative Care
1Université de Sherbrooke, Faculty of Medicine and Health Science, Sherbrooke, Quebec, Canada
Dr Helene Corriveau, P.T, Ph.D., is a Full professor at the Faculty of Medicine and Health Sciences (U. de Sherbrooke) and a researcher at the Research Center on Aging at the Sherbrooke Geriatric University Institute. She received nearly $ 7M in grants as a researcher or co-principal investigator and $ 17M as a co-investigator. Her research program focus on the understanding the implementation of various integrated intervention programs (Taichi, Telerehabilitation). As principal/co-principal investigator, she has received over $32M in funding. She have more than 80 publications, in refereed journals and more than 170 presentations at national and international congresses.
For stroke patients who return home with residual impairments, the literature supports the need to organize outpatient rehabilitation services. The minister of Health in Canada, has identified telerehabilitation as one of the priorities to respond to this demand. Consequently, it was imperative to demonstrate the conditions to have a successful implementation of physiotherapy telerehabilitation. Purpose: The main objective is to evaluate the facilitator and barriers of the implementation of telerehabilitation for a physiotherapist. Methods: The in-home telerehabilitation services were implemented in a public health establishment and it targeted post-stroke patients that needed physiotherapy external rehabilitation. The services that were implemented included: teletreatment and teleconsultation. Barriers and facilitators targeted by physiotherapist were compiled along the intervention process by an online technical quality survey done after each intervention follow by an interview. Results: Eleven (66 years ± 14) participants have finished both interventions and overall the physiotherapist did 77 rehabilitation sessions. The physiotherapist (n=3) was satisfied at 80.3 % for the technical quality. The mains facilitators were possibility to push the limits of rehabilitation and increase participation of patients (less exhausted by traveling and less of a burden on caregivers). The mains obstacles were the risk of using a new way to provide the only treatment that was received by the patients and the therapy selection and prioritization. To improve the quality of the intervention, a “clinical super-user” was trained to rapidly solve technological problems (e.g. sound, video problems) and many requests from the clinicians were fulfilled (e.g. wider camera angle).
Conclusion: This implementation project, which provided telerehabilitation in a public healthcare system, encountered challenges at different stages. However, the collaboration between physiotherapist and public multidisciplinary teams to solve these problems was successful
Johns Hopkins Hospital Rehabilitative Services,USA
Purpose:Currently at Johns Hopkins Hospital, there is an ongoing quality improvement initiative investigating the benefits associated with the implementation of the Low Back Pain Clinical Practice Guidelines on a large clinical scale. The purpose of this educational session is to provide attendees with the framework required for performing similar projects within other healthcare systems. Additionally, we will discuss potential research implications for these types of initiatives.
The current standard of practice for the treatment of mechanical low back pain is “broken”. There is significant cost associated with this treatment and its subsequent protocol. As a result, the incidence of disabling LBP continues to grow and serves as a major burden on healthcare utilization. In 2012, the Orthopaedic Section of the APTA published the Low Back Pain Clinical Practice Guidelines. Although these guidelines are based on best evidence, they themselves have not been studied on a large scale. Currently, at Johns Hopkins Hospital, there is an ongoing quality improvement initiative that seeks to explore the benefits of guideline-adherent therapy. The objectives for this initiative include the following:
- Improve quality of care through guideline adherent therapy education and training
- Monitor changes in quality of care through improved outcomes collection processes
- Track changes in utilization and outcomes and communicate these to payers
Utilize gathered data for future research studies
- Validation of Clinical Practice Guidelines
- Benefits of residency and fellowship training
The session will be broken down into multiple sections in order to give attendees a “how to” type of learning experience. The main sections of the talk are as below
- How to identify areas in the need of improvement across the clinical staff
- How to best address make these changes through education and training
- How to establish baseline levels of performance and track changes in performance following educational interventions
- Discuss potential research opportunities that these data may support
By the end of this session, our goal is that attendees will have a blueprint for performing similar quality improvement initiatives and research within their own healthcare systems.