Journal Club: Exploring an Occupational Therapist's perspective on telerehabilitation Use With Spinal Cord Injury.

 

Journal Club is an opportunity for students within my program to explore different research articles related to Occupational Therapy and our services or clients to promote evidence-based practice. This month we discussed an Occupational Therapist's perspective on telerehabilitation services for clients with a spinal cord injury. I found this article extremely informative, and it really helped me to understand some of the pros and cons associated with telerehabilitation, a concept I have minimal familiarity with.

First, let me tell you a little bit about the article. 

Spinal cord injuries (SCI) are complex and affect multiple aspects of a client's life. It affects them physically, mentally, emotionally, and financially. Despite clients with SCI's need for specialized care, transportation to a facility where they can receive that care can be extremely challenging depending on access to caregivers, proximity to a facility, and adequate means of transport with accommodations. Telerehabiliative services can provide a suitable solution for these clients to provide needed care while removing undue burden for the client. 

Although research has shown positive outcomes for clients using telerehabilitation services, more research was deemed necessary to prove its efficacy, including what Occupational therapists (OT) thought of the services. This qualitative study was designed to do just that by exploring the clinician's perspectives on the significance and value of telerehabilitation for clients with SCI. In this study, 6 OTs with 5+ years of experience working with clients with SCIs, participated. The participants all participated in a semistructured interview covering the following topics: telerehabilitation in occupational therapy practice, benefits of and barriers to use, and appropriateness of feasibility to use with SCI. The individual proctoring the interview was a peer to other participants with over ten years of experience working with clients with an SCI as an OT, who privately reflected on their opinions throughout the interviews to reduce bias. 

Some key themes were identified upon coding and analyzing the responses, including communication, personal factors, beliefs, and barriers. Improved technological advances have made communication easier throughout the intervention process. OTs have more access to shared electronic documentation and fewer delays for clients needing care, including clients who may be socially isolated. Some personal factors addressed by the participants included a need for additional training on telerehabilitation and the differences, if any, in the scope of practice, licensure, and ethics associated with remote services. There were also concerns about ensuring patient privacy and noting the importance of direct, hands-on services when needed. Some beliefs included the ability of telerehabilitation services to improve opportunities for client education and increased access to services for individuals in rural areas who need more preventative interventions or follow-up. The identified barriers to services included financial status and cognitive ability to use the electronics and software necessary for telerehabilitation services. Some intervention techniques and skills must also be facilitated in a direct, hands-on environment. 

In conclusion, the article suggests that a hybrid model addresses all of these themes while providing the best opportunity for quality care while remaining inclusive to individuals in rural areas and financial barriers to access care. Telerehabiliative services would be the most successful supplemental intervention, providing spaces for client and caregiver education and home program assistance if the client can participate cognitively and financially in the telehealth services. The study did have some limitations, including a small sample size, convenient sampling, and researcher bias. During the class discussion, we also considered that increased opportunities for telerehabilitation services might reduce the incentive to seek direct care. Since OT services are formed around the therapeutic relationship between ourselves and our client, a purely virtual relationship might reduce our ability to interact without clients and ensure we provide holistic treatment. Overuse of telehealth services could also create an unrealistic workload for occupational therapists and lead to more significant burnout. Telehealth services could improve client performance if used to support direct care. 

If you want to read the article.....

Goel, R., Santurri, L., Fruth, S., Abzug, J. M., & Geigle, P. R. (2022). Telerehabilitation use with spinal cord injury: Occupational therapists’ perspective. American Journal of Occupational Therapy, 76, 7602205080. https://doi.org/10.5014/ajot.2022.045831

http://research.aota.org/ajot/article-pdf/76/2/7602205080/74060/7602205080.pdf by Univ of Tennessee, Delaney Weller o