Development and Evaluation of a Training Package to support the Remote Assessment and Management of People with Movement Impairment and Disability

Purpose

Telerehabilitation is a feasible, acceptable and potentially effective alternative to face-to-face rehabilitation. However, there was limited specific guidance, training and support for physiotherapists and other practitioners who undertake remote assessments in people with physical disabilities and movement impairment (Anil et al 2021). 

The aims of the project were to: 

  • Understand practitioners’ and patients’ experiences of telerehabilitation, including challenges and facilitators in successful implementation of telerehabilitation; 

  • Explore practitioners’ self-perceived competence and confidence in carrying out remote physical assessments; 

  • Identify knowledge gaps and training needs; 

  • Collate examples of best practice and recommendations. 

The ultimate aim was to use this information to inform the development of an online toolkit and training package for practitioners and patients. 

Approach

Three main methods were used: 

  1. Scoping review of the literature to identify existing guidance in telerehabilitation for physical disabilities and movement impairment 

  2. Online survey of UK rehabilitation practitioners 

  3. Service evaluation in five South West health and social care organisations 

The findings from the three components of the project were triangulated to inform the development of the Telerehab Toolkit. The resource was developed iteratively using the Knowledge to Action Framework (Graham et al 2006), with feedback from practitioners and patients sought at various stages of development. 

Outcomes

Although many practitioners reported that they felt competent in delivering video-based consultations, they were less confident in undertaking remote physical assessments. They identified a need for guidance and training in various aspects of telerehabilitation, including information governance and safety, remote outcome measures and assessment tools, technology, improving digital skills, and deciding when it was most appropriate to use video, telephone or face-to-face consultations. 

 

Challenges in telerehabilitation included: 

  1. technological issues (e.g. internet connection) 

  2. practical issues (e.g. difficulties seeing patients {eg positioning camera to view specific body parts or movements} and assessing their movements under some circumstances {eg balance, mobility, specific muscle/sensory testing),  

  3. patient-related challenges (e.g. limited digital skills), 

  4. inability to provide ‘hands-on’ interventions,  

  5. concerns about the reliability, validity and safety of remote physical assessments.  

Support from family members before, during and after a remote consultation was a major facilitator. 

 

Key themes in best practice were: person-centred and tailored care; clear and open communication and observation; and preparation and planning. 

Cost and savings

The project was funded by an NIHR (MRC Section) Covid-19, Research Council Grant (reference: MR/V021060/1) in July 2020.   

 

The Telerehab Toolkit is publicly available, free of charge at: www.plymouth.ac.uk/research/telerehab  

 

A health economics analysis was not part of this project and hence it is not possible to state whether there is increased productivity or efficiency as a result of the project.  

Implications

This project highlights the importance of educating and upskilling the current and future workforce in the safe and effective use of telerehabilitation for people with physical disabilities and movement impairment, including people recovering from COVID-19. The Telerehab Toolkit is a free and publicly accessible online resource that shares best practice on this subject. The Toolkit has been disseminated widely to individuals, universities, and health and social care organisations, relevant forums and professional groups (eg CSP, British Society of Rehabilitation Medicine, Community Rehabilitation Alliance) and lay organisations (e.g. MS Society) with the aim of enhancing translation to education and clinical practice.  

 

The Toolkit includes: 

  • A patients’ guide to remote appointments; 

  • How-to guide to remote consultations for practitioners; 

  • Remote measures and assessment tools; 

  • Specialist guides for patients with different needs; 

  • Telerehab for patients recovering from Covid-19; 

  • Case reports; 

  • Video guides; 

  • A training checklist 

and more. 

Top three learning points

What did you learn from doing the project? 

  1. When undertaking a project it is crucial to involve the end user (practitioners, patients and their family members) throughout the development process to ensure the project aims and outcomes are meaningful. This project demonstrated that telerehabilitation is valued by service users and practitioners as an option for service delivery. 

  2. When developing a new resource, research what is already available; rather than repeating information it is better to provide links to existing resources. Make contact with other researchers to ensure activity undertaken is complementary. 

  3. Plan dissemination carefully and continue to collect feedback on the resource alongside dissemination. Quantitative data (e.g. analytics reports) and qualitative feedback from users are both important to monitor impact. 

Funding acknowledgements

This research was funded by UK Research and Innovation - Medical Research Council (UKRI–MRC) (Award Number: COV0079).  The views expressed are those of the authors and not necessarily those of the UKRI-MRC. 

Additional notes

The Telerehab Toolkit is available from: www.plymouth.ac.uk/research/telerehab  

Our Twitter handle is @telerehab1. 

If you have any further questions about the project, please e-mail: telerehab@plymouth.ac.uk.  

To date we have published three articles related to this project (Anil et al 2021, Jones et ak 2021, Buckingham et al 2022)    

 

 

References 

Anil K et al. Scope, context, and quality of telerehabilitation guidelines for physical disabilities: a scoping review. BMJ Open, 2021. 11(8): e049603. 

 

Buckingham S et al. Telerehabilitation for people with physical disabilities and movement impairment: A survey of United Kingdom practitioners.  JMIRx Med. 2022;3(1):e30516. 

   

Graham ID, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006. 26(1):13-24. 

 

Jones R et al. Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study. JMIRx Med. 2021;2(3):e30233.