Munce Sarah, Andreoli Angie, Bayley Mark, Guo Meiqi, Inness Elizabeth L, Kua Ailene, McIntyre McKyla
KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
JMIR Rehabil Assist Technol. 2023 Mar 10;10:e44591. doi: 10.2196/44591.
Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented.
The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally.
The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis.
A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of "infrastructure, equipment, and space" and "leadership and organizational support"; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit.
Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future.
尽管新冠疫情促使针对有康复需求患者的远程医疗得以迅速实施和推广，但远程康复的整体推广速度较慢。
本研究旨在从加拿大及国际康复专业人员的角度，了解新冠疫情期间实施远程康复以及使用多伦多康复远程康复工具包的经验。
本研究采用定性描述方法，包括电话或视频会议支持的访谈和焦点小组。参与者包括康复服务提供者以及使用过多伦多康复远程康复工具包的医疗保健领导者。每位参与者参加一次约30 - 40分钟的半结构化访谈或焦点小组。采用主题分析来了解提供远程康复和实施多伦多康复远程康复工具包的障碍和促进因素。研究团队的三名成员独立分析一组相同的访谈记录，并在每组分析后会面讨论他们的分析结果。
共有22名参与者，包括7次访谈和4次焦点小组。参与者的数据来自加拿大（艾伯塔省、新不伦瑞克省和安大略省）和国际地点（澳大利亚、希腊和韩国）。共有11个地点参与，其中5个专注于神经康复。参与者包括医疗保健提供者（即医生、职业治疗师、物理治疗师、言语语言病理学家和社会工作者）、管理人员和系统领导者，以及研究和教育专业人员。总体而言，确定了4个主题，包括（1）远程康复的实施考虑因素，包括“基础设施、设备和空间”以及“领导和组织支持”2个子主题；（2）远程康复带来的创新；（3）该工具包作为实施远程康复的催化剂；（4）改进该工具包的建议。
这项定性研究的结果证实了一些先前确定的实施远程康复的经验，但从加拿大和国际康复提供者及领导者的角度出发。这些发现包括充足的基础设施、设备和空间的重要性；组织或领导支持在采用远程康复中的关键作用；以及获取实施资源的必要性。重要的是，我们研究中的参与者将该工具包描述为促成网络机会的重要资源，并强调转向远程康复的必要性，尤其是在疫情早期。本研究的结果将用于改进该工具包的下一版本（工具包2.0），以在未来为有需要的患者促进安全、可及和有效的远程康复。
