Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA.
MaccabiTech Institute for Research & Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel.
Phys Ther. 2021 Jul 1;101(7). doi: 10.1093/ptj/pzab110.
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.
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.
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.
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.
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.
COVID-19 广泛影响了医疗保健的提供。为此，远程康复（TR）已成为替代护理模式。目的是：（1）描述在 COVID-19 期间使用 TR 与传统面对面护理相比，管理的护理时段的基线患者特征和可用的未调整结局；（2）按疾病和远程通信模式描述 TR 频率水平。
采用描述性回顾性观察设计，根据 TR 频率（少数、多数或所有就诊）和远程通信模式报告患者变量和结局，包括身体功能、就诊次数和患者满意度。采用标准化差值比较有和无 TR 时段的基线特征。
样本包括 222680 名患者（59%为女性；平均[标准差]年龄=55[18]岁）。总体 TR 率为 6%，2020 年第二季度至第三季度从 10%降至 5%。90%至 100%的时段可获得结局测量值。37%的临床医生通过 TR 提供护理。与面对面护理相比，接受 TR 治疗的患者更年轻，且居住在大都市区。在接受 TR 的患者中，分别有 55%、20%和 25%在少数、多数或所有就诊时段接受 TR。TR 护理在骨科身体部位中平等分配，对非骨科疾病（如中风、水肿和前庭功能障碍）的使用较少。TR 主要通过同步（视频或音频）模式进行。与没有 TR 相比，报告对治疗结果非常满意的患者比例高 3%。
这些结果提供了有关在美国门诊康复实践中，在大流行期间向谁和如何提供 TR 的新知识。评估的数据库被发现适合进行关于 TR 与各种结局测量之间关联的研究，控制患者特征的综合组，以推进最佳 TR 护理模式，并促进高质量的护理。
本研究使用包含患者健康和人口统计学特征、结局测量值和远程康复（TR）管理数据的现有全国性患者数据库，提供了详细而可靠的描述性信息。研究结果支持未来开展关于 TR 护理与患者结局之间关联的研究，调整与接受 TR 相关的广泛的患者特征和临床环境因素，以促进在临床合适时使用 TR。研究期间发现 TR 的使用有限且逐渐减少，这需要研究旨在更好地了解康复治疗师在日常实践中使用 TR 的促进因素和抑制因素，以促进在临床合适时使用 TR。
