Physiatry Forward: Telerehabilitation
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Telerehabilitation in the Time of COVID-19

Authors: Marcalee Alexander, MD, CEO of Telerehabilitation International, and Jaye Hefner, MD, Chief of Medicine at Spaulding Rehabilitation Hospital

Do you feel like someone turned on a lightbulb and telemedicine just appeared as a new concept? We feel this way too, even though we have been practicing it for many years.

On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) announced it will temporarily pay clinicians to provide telehealth services for Medicare beneficiaries. The COVID-19 pandemic has provided PM&R the platform to move forward with telehealth (which encompasses telerehabilitation, teleconsultation, telemedicine, and remote nonclinical services) as a method of care delivery that ensures access for all — whether in times of crises or mobility difficulties for persons with disabilities. This excruciating moment in time has come to tackle the barriers of access to the basic principles of maximizing function and quality of life in PM&R.

There are limited published studies to evaluate the use of telehealth in PM&R. Cheville1 has documented benefits of telerehabilitation for cancer care, and telerehabilitation has been shown to be comparable to face-to-face care for stroke and MS. Others have used telerehabilitation to treat children, while in many VA settings it has been used for initial training for equipment prescriptions and extensively in SCI. Companies also offer virtual physical, occupational, speech and psychotherapy.

Unfortunately, the COVID-19 pandemic has resulted in a trial-by-fire approach for many physiatrists. This is an unprecedented time when federal regulations that were barriers to telehealth including reimbursement, HIPAA-compliant software, state licensing and credentialing have been lessened to provide care to our patients to decrease exposure and flatten-the-curve. All healthcare providers must rapidly adopt and embrace telehealth.

Overnight facilities are now rapidly transitioning to 100% virtual capacity for outpatient PM&R services. Regardless of what diagnostic group you treat, telehealth will be a big part of the future of rehabilitation medicine. It has the benefit of being a “green” form of healthcare because of the saved mileage. Moreover, with a high patient and provider satisfaction rate, there will be a significant amount of work for academic physiatrists with respect to medical student, resident and fellow training.

Existing research is available to guide those physiatrists with limited telehealth experience. A few studies showing positive outcomes associated with telehealth include reduction of hospitalization readmissions, mortality, and possible cost effectiveness using telerehabilitation.2 Practical COVID-19 use cases for telehealth for inpatient rehabilitation hospitals (IRF) include: converting appointments to video visits with providers that were previously not credentialed or had privileges to practice at the IRF; providing a platform for providers to video into quarantined patient’s rooms for check-ins and visits to minimize exposure to healthcare providers and conserve critical patient protective equipment (PPE); providing a conduit for patients to connect with family and friends if personal devices are unavailable; obtaining subspecialty consults to freestanding IRFs; and conducting team meetings, family education and training. Outpatient COVID-19 use-cases for physiatrists include subspecialty PM&R follow-up for medication and rehabilitation management; follow up of secondary conditions; chronic pain managed with opioids; high-cost image follow up; and patient education.

While it seems a long way away, the COVID-19 pandemic will end, and the field of PM&R will have exponential experience and data for future research that should focus on appropriate use cases and efficacy for conditions treated by physiatrists along with outcome measures. Hopefully we will only see one pandemic in our medical careers, but we must use this experience to train and teach future physiatrists about the power of telehealth. COVID-19 is today’s moment but there will be others. We must also study the effect of telehealth on slowing climate change and expanding access to vulnerable patient populations who will be affected by climate change.

Let’s all do our part to help people stay safe, stay home and receive the rehab care they need. We must use this moment. We can’t afford to wait.

References

  1. Cheville AL, Moynihan T, Herrin J, Loprinzi C, Kroenke K Effect of Collaborative Telerehabilitation on Functional Impairment and Pain Among Patients With Advanced-Stage Cancer: A Randomized Clinical Trial. JAMA Oncol. 2019 May 1;5(5):644-652. doi: 10.1001/jamaoncol. 2019.0011.
  2. Totten AM, Womack DM, Eden KB, et al. Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews. Technical Brief No. 26. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 16-EHC034-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2016. Available at www.effectivehealthcare.ahrq.gov/reports/final.cfm. Accessed November 22, 2016.