Telerehab: Technology Meets Physio Care

Abstract

Telerehabilitation (Telerehab) refers to the use of digital
communication technologies, such as computers
and mobile devices, to access remote physiotherapy
services and manage health care. These technologies
can be used by patients from home or utilized by physiotherapists
to enhance health care delivery.
For instance, consider how telerehab could support
stroke recovery. Patients could use their mobile phone
or other devices to upload health data such as food
logs, medications, dosages, and blood pressure for
remote review by a nurse, who provides feedback electronically.
They might also watch instructional videos
on managing blood pressure or download apps to track
it. Based on their diet and health metrics, an app could
help estimate daily salt intake. Online patient portals
enable scheduling appointments, requesting home
exercise plans, or emailing physiotherapists for advice.
Additionally, patients can order medical supplies and
medications online, while mobile gait analysis at the
doctor’s office could eliminate the need for specialized
appointments. Reminders via email, text, or phone can
alert patients when reassessments or preventive care,
such as gait analysis, are due. The goals of telerehab,
sometimes referred to as e-health or m-health (mobile
health), include improving access to health care for
individuals in rural or remote areas. Telerehab makes
services more convenient for those with mobility challenges,
time constraints, or limited transportation. It
also enhances access to medical specialists, improves
care coordination between patients and health care
teams, and supports patient self-management. Numerous
telerehabilitation (telerehab) services offer significant
benefits to patients. For example, many primary
care clinics provide online patient portals that serve as
secure alternatives to email, which is generally not
recommended for sharing confidential medical information.
These portals allow patients to communicate
securely with their physiotherapists and manage various
aspects of their care, such as reviewing summaries
of previous visits, scheduling appointments, or
requesting appointment reminders. If your doctor is
part of a large health care system, the portal may also
serve as a centralized communication platform for any
specialists you see.(1)
Some clinics also offer virtual appointments, allowing
you to consult with your doctor or a nurse via online
video conferencing. These virtual consultations
provide an effective way to continue receiving care
from your regular physician when an in-person visit
isn’t necessary or feasible. Additionally, web-based
"visits" with a doctor or nurse practitioner are available
for minor ailments, much like the services offered
by walk-in clinics. Larger companies may include
virtual doctor visits as part of their health care plans.
When you access these services, you’re guided
through a series of questions, after which a physiotherapist
can prescribe medications, suggest home care
strategies, or refer you for further medical care.
Physiotherapy call centers, staffed by trained professionals,
provide another telerehab option. These
centers use a question-and-answer format to offer
advice on managing care at home. However, they do not diagnose illnesses or prescribe medications.2
While these services are highly convenient, they also
have limitations. Virtual treatments may not be coordinated
with your primary care provider, which means
essential details from your medical history might not
be considered. Furthermore, the reliance on computer-
driven decision-making may not be ideal for those
with complex medical needs. Without an in-person
assessment, the accuracy of diagnosis could also be
compromised. Additionally, virtual appointments may
limit the opportunity for shared decision-making
between you and your doctor, particularly when it
comes to adjusting treatment plans if initial approaches
are ineffective.
Several technologies allow physiotherapists or health
care teams to monitor your health remotely. These
include mobile apps or web-based platforms where
you can upload health data, such as blood pressure
readings, for review. Other tools, like wireless devices
that transmit data on blood pressure, blood glucose, or
lung function, can send real-time health information
directly to your care team.(3)
Wearable devices offer the ability to automatically
record and transmit important health data, such as
heart rate, blood glucose levels, gait, posture control,
tremors, physical activity, and sleep patterns. For older
adults or individuals with dementia, home monitoring
devices can track changes in daily routines, such as
detecting falls.
Doctors also use technology to enhance patient care.
For instance, virtual consultations allow primary care
physicians to consult with physiotherapy specialists
when they need additional input on a diagnosis or
treatment plan. During this process, the community
physiotherapist may send examination notes, medical
history, test results, and imaging, such as X-rays, to the
specialist for review. The specialist might then respond
electronically, conduct a virtual appointment with the
patient at the doctor’s office, or request an in-person
meeting. These virtual consultations can reduce
unnecessary referrals to specialists, cut down on wait
times, and eliminate the need for travel.
An electronic personal health record (PHR) system is
another valuable tool that allows individuals to
manage and maintain their own health information. A
PHR app can be accessed at any time via a web-enabled
device like a smartphone, tablet, or computer. In
an emergency, a PHR can provide crucial information
to medical personnel, such as current diagnoses, medications,
allergies, and contact details for your physician.
Many apps are available to help people organize
their medical data in one secure place, enabling users
to store health records, track vital signs, monitor caloric
intake, schedule medication reminders, and record
physical activity such as step counts.(4)
Technology holds great potential to improve the quality
of health care, making it more efficient, better coordinated,
and more accessible. Telerehabilitation can
bring health services closer to home, increasing convenience
and reducing barriers to care. Though research
on telerehab is still in its early stages, it is expanding
rapidly. For example, a 2016 study found that both
telephone-based support and telemonitoring of vital
signs for patients with heart failure reduced the risk of
death and hospitalization while improving their quality
of life.(5)
While telerehab can help coordinate care, there is also
a risk of fragmented care, which can lead to gaps in
treatment, overuse of medical services, misuse of medications,
or unnecessary duplication of care. Additionally,
access to telerehab services may be affected by
factors such as the cost of services, insurance coverage,
and regional internet access. Insurance reimbursement
for telerehab services still varies by location and
type of insurance, and those who might benefit the
most from improved access to care could face limitations
due to the availability of affordable technology
and internet services.(1-5)