Brief introduction on Tele-rehabilitation guidelines
Long-term management of rehabilitation care and services on the territory may obtain great support and improvement by using Information and Communication Technology (ICT).
More specifically, Telerehabilitation is now being called on to play an important role in improving the continuity and complementarity of rehabilitation care and services in
particular for elderly and for the chronic management of patients affected by orthopedic diseases, pulmonary diseases, neuropsychological diseases like Stroke, Traumatic brain
injury, Brain tumors, Infections, Post-surgical diseases, Neurodegenerative diseases (Multiple Sclerosis, Alzheimer, Parkinson, Huntington), Psychiatric Disorders.
Telerehabilitation services may have great potentialities in matching most of the requirements of the clinical guidelines for long-term management of rehabilitation (see for example
the UK Clinical Guidelines for long-term management of stroke patients: www.rcplondon.ac.uk); furthermore, not only they allow to extend rehabilitation treatment at home for as many
patients as possible: they may also stimulate and allow the design of completely new rehabilitative paradigms, which is extremely challenging.
However, in order to implement well-structured telerehabilitation programs and foster optimal telerehabilitation use, standardization is mandatory. Thus, actions aimed at standardizing
telerehabilitation practice i.e. delivering clinical evidence, defining clinical guidelines, and defining technical standards will surely help its broad implementation. In particular,
methods allowing for the direct comparison between the telerehabilitation and face-to-face assessments are particularly important and should be always taken into account in the
development of evidence-based guidelines.
Tele-rehabilitation Research Units in the world
Telerehabilitation Research Units (TRU) are growing up all over the developed countries at Universities, Research Centres on Telehealth, Health-related Associations and Companies,
etc, in order to answer the standardization issue in the field of TR Services, and several projects are currently carried out to the purposes.
CLEAR consortium, some partners of which are represented by research institutes involved in Telerehabilitation research, pursues the same targets as the TRUs, even though from
the deployment rather than from the research point of view. Actions, results and indications from most relevant TRUs are taken into account and considered as useful inputs for
CLEAR activities.
A brief overview of the most relevant TRUs and studies is here reported to focus on the importance of delivering evidence, standards, and best practice guidelines.
AETMIS
AETMIS (the Québec government agency responsible for health services and technology assessment) - www.aetmis.gouv.qc.ca - (last check 2010)
The Agency proposes some guidelines and technical standards and recommends that the Quebec Ministere de la Sante et des Services sociaux adopt them in cooperation with the authorities concerned. For example, in order to permit a quality practice environment, the Agency recommends changes and upgrade of the technical infrastructure in order to assure adequate bandwidth, data-compression protocols, data-packet loss, latency to be applied to the entire data capture, transmission and reception chain. Among the other interesting guidelines: i) telerehabilitation consultation rooms containing the appropriate equipment and accessories should be set up in the appropriate clinical settings and where the needs are the greatest; ii) human and organizational aspects must be taken into account to ensure the success of this type of activity; iii) legal and ethical aspects should also be considered; iv) a detailed economic analysis should be carried out prior to any massive investment in telerehabilitation.
ATA Telerehabilitation SIG
ATA Telerehabilitation SIG (American Telemedicine Association; Telerehabilitation Special Interest Group, www.americantelemed.org)
The Telerehabilitation SIG mission is to enhance access to rehabilitation services and support independent living through the use of telehealth technologies. Basically the group: i) develops innovative systems "tools" to be used for telerehabilitation; ii) collects data of evidence-based outcomes of telerehabilitation clinical applications; iii) acts as a resource for reimbursement issues. The 5 strategic goals of SIG are:
- Education, which means educating public and government about telemedicine and telehealth applications and benefits;
- Resources, which means that it serves as a clearinghouse for telemedicine/telehealth information and services;
- Networking, which means fostering community networking and collaboration among interested participants in medicine and technology;
- Research, which means promoting research and tele-education;
- Policy, which means spearheading the development of related public/program policies, clinical telehealth practice guidelines and technical industry standards.
Scottish Centre for Telehealth
Scottish Centre for Telehealth (www.knowledge.scot.nhs.uk)
1) Rehabilitation services which may use telerehabilitation should include:
- Direct intervention with the client (assessment, treatment, monitoring and education);
- Care coordination;
- Caregiver education;
- Consultation with specialist clinicians.
3) It is essential to review areas of rehabilitation need, especially in countries with dispersed population like Scotland.
Aims of the Telerehabilitation Project are:
- To review current rehabilitation services in Scotland for both adults and children;
- To consider the potential need for rehabilitation services over the next 5 years;
- To describe where and how telerehabilitation may help to optimise the rehabilitation services and prioritise areas for potential implementation in about 5 years time;
- To consider the cost/benefits of using telerehabilitation in Scotland.
Telerehabilitation Research Unit
Telerehabilitation Research Unit - The University of Queensland (www.uq.edu.au)
“The overall objective of the Telerehabilitation Research Unit is to develop, validate and implement telerehabilitation applications to improve access to allied health services
for persons with communication disorders, physical disability and/or hearing impairments both within the home, and in rural and remote environments”.
The Unit actions are mainly focussed on the following goals:
- clinical evidence: clinical evidence of Telerehabilitation interventions will be assessed through controlled clinical trials;
- clinical guidelines: it is mandatory to develop clinical guidelines for patient assessment and treatment through Telerehabilitation services;
- efficacy: the goal deals with the evaluation of efficacy of the treatment with respect to specific Telerehabilitation interventions;
- technology innovation: actions are focussed on the development of innovative ICT - hardware and software - solutions to support and facilitate the remote provision of health services;
- best practice guidelines: the Unit efforts are here addressed to the development of best practice guidelines for the establishment of telemedicine services;
- cost-benefit: studies are designed and implemented to investigate cost-benefit factors of Telerehabilitation services.