Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study
Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study
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DOI：
10.1093/ptj/pzab110
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发表时间：
2021-04-13
期刊：
影响因子：
3.2
通讯作者：
Hayes, Deanna
中科院分区：
文献类型：
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作者：
Werneke, Mark W.;Deutscher, Daniel;Hayes, Deanna
Objective. COVID-19广泛影响了医疗保健的提供。作为回应，远程康复（TR）已成为替代护理模式。目的是：（1）描述基线患者特征和COVID-19期间使用TR与传统面对面护理进行的护理事件的可用未经调整的结果，（2）按条件和电信模式描述TR频率水平。采用描述性回顾性观察设计，按TR频率（少数、多数或全部访视）和电信模式报告患者变量和结局，包括身体功能、访视次数和患者满意度。标准化的差异被用来比较有和没有TR的发作之间的基线特征。样本包括222，680例患者（59%为女性;平均[SD]年龄= 55 [18]岁）。于二零二零年第二及第三季度，整体回收率为6%，由10%下降至5%。90%至100%的发作可获得结局指标。37%的临床医生通过TR管理护理。与亲自护理相比，使用TR治疗的患者更可能更年轻，并且生活在大都市地区。在TR患者中，分别有55%、20%和25%在少数、大多数或所有访视期间发生TR。TR护理在骨科身体部位之间的管理是平等的，非骨科疾病（如中风、水肿和前庭功能障碍）的使用率较低。TR主要使用同步（视频或音频）模式进行管理。与TR相比，无TR的患者对治疗结果非常满意的比例高出3%。这些结果提供了新的知识，谁和如何TR是在大流行期间管理在门诊康复实践在整个美国。评估的数据库被发现适合于进行TR和不同结局指标之间的关联研究，控制一组全面的患者特征，以推进最佳TR护理模式，并促进高质量的护理。本研究使用现有的国家患者数据库（包含患者健康和人口统计学特征、结局指标和远程康复（TR）管理数据）提供了详细和可靠的描述性信息。研究结果支持未来进行TR护理与患者结局之间相关性研究的可行性，调整可能与接受TR概率相关的广泛患者特征和临床环境因素。在研究期间，TR的使用有限且减少，这一发现要求进行旨在更好地了解康复治疗师在日常实践中使用TR的促进剂和抑制剂的研究，以在临床适当时促进其使用。
Objective. COVID-19 has widely affected delivery of health care. In response, telerehabilitation (TR) has emerged as alternative care model. Aims were: (1) to describe baseline patient characteristics and available unadjusted outcomes for episodes of care administered during COVID-19 using TR versus traditional in-person care, and (2) to describe TR frequency levels by condition and telecommunication modes.Methods. A descriptive retrospective observational design was used to report patient variables and outcomes including physical function, number of visits, and patient satisfaction, by TR frequency (few, most, or all visits) and telecommunication modes. Standardized differences were used to compare baseline characteristics between episodes with and without TR.Results. Sample consisted of 222,680 patients (59% female; mean [SD] age = 55 [18] years). Overall TR rate was 6% decreasing from 10% to 5% between second and third quarters of 2020. Outcome measures were available for 90% to 100% of episodes. Thirty-seven percent of clinicians administered care via TR. Patients treated using TR compared with in-person care were more likely to be younger and live in large metropolitan areas. From those with TR, 55%, 20%, and 25% had TR during few, most, or all visits, respectively. TR care was administered equally across orthopedic body parts, with lower use for nonorthopedic conditions such as stroke, edema, and vestibular dysfunction. TR was primarily administered using synchronous (video or audio) modes. The rate of patients reported being very satisfied with their treatment results was 3% higher for no TR compared with TR.Conclusions. These results provide new knowledge about to whom and how TR is being administered during the pandemic in outpatient rehabilitation practices throughout the United States. The database assessed was found to be suitable for conducting studies on associations between TR and diverse outcome measures, controlling for a comprehensive set of patient characteristics, to advance best TR care models, and promote high-quality care.Impact. This study provided detailed and robust descriptive information using an existing national patient database containing patient health and demographic characteristics, outcome measures, and telerehabilitation (TR) administration data. Findings support the feasibility to conduct future studies on associations between TR care and patient outcomes, adjusting for a wide range of patient characteristics and clinical setting factors that may be associated with the probability of receiving TR. The finding of limited and decreasing use of TR over the study period calls for studies aimed to better understand facilitators and inhibitors of TR use by rehabilitation therapists during everyday practice to promote its use when clinically appropriate.