Telemedicine has arrived to stay
In recent years, thanks to the Internet and the advent of the “Digital Age”, a large number of digital tools have emerged that have revolutionized health care throughout the world (Dixon & Michaud, 2018).
Mobile applications for video consultations, skin sensors to record patient progress or therapeutic exercise apps for injuries rehabilitation are some of the examples that are already implemented in many hospitals and healthcare systems.
It´s very interesting the fact that most of patients have a positive perception of Digital tools in their health care. A recent survey carried out in 2019 by the Pew Research Center in the United States concluded that almost 24.85 million people (approximately 52% of adults in the United States) saw the implementation of Telemedicine and New Technologies in their medical services as something positive. (Kataria & Ravindran, 2019).
As a result of this technological revolution within health fields, new terms have also emerged to describe this form of work such as Telerehabilitation. This is defined in the literature as “a series of tools, procedures and protocols that seek to provide the rehabilitation process remotely” (Pastora-Bernal, Martín-Valero, Barón-López, Moyano, & Estebanez-Pérez, 2018).
This new way of considering the patient’s recovery process has many benefits, especially when we talk about the implementation of therapeutic exercise programs, which is basic and fundamental in all types of processes. Of these, we can highlight:
1. The ability to optimize our time as therapists: A great number of musculoskeletal pathologies will be solved in an optimal way with a personalized exercise program adapted to their evolution. New technologies allow the professional to prescribe individualized therapeutic exercise programs for each patient and the correct monitoring of the patient. This allows the professional or therapist to focus its efforts on patients with a worse prognosis or who require a face-to-face management of their dysfunction.
2. Increased patient treatment time: one of the keys to recovering from a large number of musculoskeletal and neurological processes is the high intensity and large number of repetitions to achieve changes both at the peripheral level and at the level of the central nervous system. Thus, various applications allow the possibility of managing these variables and give the patient the possibility of continuing their treatment beyond the face-to-face sessions at any time of the day, seven days a week.
3. Reduced displacement: It will be a key option for those patients who live far from hospitals or in areas with poor connections, as a remote monitoring and rehabilitation process is possible. Work with apps of exercise prescription, video calls, image taking to see the evolution of a wound, etc. With this technologies we can also save a large amount of indirect costs in transportation, promote an optimal recovery in disadvantaged populations and improve the care process of these patients.
4. Prescription of a CORRECT Therapeutic Exercise Program: These digital tools have the capacity of prescribing individualized therapeutic exercise to the patient that adapts to his/her evolution. This, together with a correct and reliable control of the performance and adherence to treatment are fundamental to guarantee the success of the treatment.
5. Information and data storage: the capacity to monitor various objective patient parameters clearly improves clinical processes, assists the practitioner’s decision-making and can enable this data to be used for future research and clinical trials. (Hammond & Prior, 2016)
6. Improving the therapeutic alliance with our patient and promoting their adherence to treatment: the use of new technologies can be a more than effective way of managing patients’ lack of adherence to treatment. The existence of a control panel where we can manage how the patient performs his/her exercises is already a reality, and allows us to objectify the patient’s involvement. (Cole, Robinson, Romero, & O’Brien, 2019)
If you want to read more about this topic, we share with you a link to a summary thread we made of a Review on New Technologies, mHealth and Rheumatology
What examples can we find in the Evidence about Telerehabilitation?
We leave you with several examples that give you an idea of the great potential of these digital tools:
Towards an adaptive upper limb rehabilitation game with tangible robots (Ozgur et al. 2019)
In this article, the authors propose a management of upper limb pathologies through a series of coordination and proprioception games, based on the game “Pacma”.
This interesting idea is based on the use of robots that act as the “ghosts” of the game, which travel the board following pre-established paths. On the other hand, the patient grabs an object that will be moving around the board, with the aim of taking all the “apples” possible without being caught by the “ghosts”.
Especially interesting is the fact that complexity is adapted based on the patient’s capabilities. Thus, the researchers were able to increase complexity based on, for example, a greater number of repetitions.
Although this tool has shown promising results in healthy subjects, more studies in patients are required in order to apply it to clinical practice.
Postoperative care via smartphone following carpal tunnel release (Tofte et al. 2018)
These authors report their experience with the use of a mobile app in post-surgical patients with endoscopic or open release of a STC. This app has the following functionalities:
-Videos for bandages Care and their removal.
– Videos to remove your own suture from the surgery
– Photographs to document the appearance of the scar at all times.
– Evaluation of the symptoms caused by the Median Nerve.
– Registration of the ROM and physical examination of the hand
All this information was received remotely by the healthcare professional (Hand Surgeon) to allow a proper follow-up.
Datas obtained were very similar to those recorded in a face-to-face manner, suggesting the great potential of these technology-based interventions in saving direct and indirect resources related to post-surgical care.
Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial (Blanquero et al., 2019)
Within the world of Hand Therapy and telerehabilitation, our Scientific team published in 2019 this article through the work of our ReHand tool for Tablet. It was published in one of the most important international journals in rehabilitation and physiotherapy, the “Journal of Physiotherapy”.
In this clinical trial, subjects surgically treated with recent Carpal Tunnel Syndrome Surgery were included, and were distributed in two groups, experimental (working with ReHand) and control (conventional paper exercise program).
In conclusion, a significant improvement was observed in the recovery of functional ability in those patients treated with ReHand, suggesting a faster recovery after this intervention. The key to this greater effectiveness is suggested to be the sensorimotor approach of the exercises incorporated in ReHand, through feedback-driven exercising by touching the touch-screen of the Tablet device, adapted to the pain-free range of motion and the evolution of the patient.
Finally, this tool allowed the research team to rigorously monitor the experimental patients’ compliance with the program, thanks to the fact that all the exercises were performed on the Tablet.
The Digital Revolution is here to stay
Nowadays, scientific literature abounds with works that show the results of the advantages of incorporating new technologies to different areas of clinical practice. Thanks to this, healthcare systems and hospitals have already successfully implemented digital tools.
As a final reflection, we must point out that it is in our hands as health professionals to lead the implementation of these types of solutions to ensure that their approach covers our needs and those of our patients.
Pablo Rodríguez Sánchez-Laulhé
Alejandro Suero Pineda
Jesús Blanquero Villar
Blanquero, J., Cortés-Vega, M. D., García-Frasquet, M. Á., Sánchez-Laulhé, P. R., Nieto Díaz de los Bernardos, M. I., & Suero-Pineda, A. (2019). Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial. Journal of Physiotherapy, 65(2). https://doi.org/10.1016/j.jphys.2019.02.008
Cole, T., Robinson, L., Romero, L., & O’Brien, L. (2019). Effectiveness of interventions to improve therapy adherence in people with upper limb conditions: A systematic review. Journal of hand therapy : official journal of the American Society of Hand Therapists, 32(2), 175–183.e2. https://doi.org/10.1016/j.jht.2017.11.040
Dixon, W. G., & Michaud, K. (2018). Using technology to support clinical care and research in rheumatoid arthritis. Current Opinion in Rheumatology, 30(3), 276-281. https://doi.org/10.1097/BOR.0000000000000485
Hammond, A., & Prior, Y. (2016). The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review. British medical bulletin, 119(1), 49-62. https://doi.org/10.1093/bmb/ldw024
Kataria, S., & Ravindran, V. (2019). Emerging role of eHealth in the identification of very early inflammatory rheumatic diseases. Best Practice & Research Clinical Rheumatology, (xxxx), 101429. https://doi.org/10.1016/j.berh.2019.101429
Ozgur, A. G., Faucon, L. P., Maceira-Elvira, P., Wessel, M. J., Johal, W., Ozgur, A., … Dillenbourg, P. (2019). Towards an adaptive upper limb rehabilitation game with tangible robots. IEEE International Conference on Rehabilitation Robotics, 2019-June, 294-299. https://doi.org/10.1109/ICORR.2019.8779429
Pastora-Bernal, J. M., Martín-Valero, R., Barón-López, F. J., Moyano, N. G., & Estebanez-Pérez, M. J. (2018). Telerehabilitation after arthroscopic subacromial decompression is effective and not inferior to standard practice: Preliminary results. Journal of Telemedicine and Telecare, 24(6), 428-433. https://doi.org/10.1177/1357633X17706583
Tofte, J. N., Anthony, C. A., Polgreen, P. M., Buckwalter, J. A., Caldwell, L. S., Fowler, T. P., … Lawler, E. A. (2018). Postoperative care via smartphone following carpal tunnel release. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X18807606