Telerehabilitation for people with physical disabilities and movement impairment: A survey of United Kingdom practitioners (Preprint)

BACKGROUND Telerehabilitation is a feasible and potentially effective alternative to in-person rehabilitation. However, specific guidance, training and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment is limited. OBJECTIVE The aims of this survey of United Kingdom (UK) based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practice in telerehabilitation for physical disabilities and movement impairment. The ultimate aim will be to use the findings to inform a practical toolkit and training package for telerehabilitation use. METHODS UK rehabilitation practitioners were invited to complete an online questionnaire in November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups and via social media. Closed questionnaire items were analysed using descriptive statistics. Qualitative inductive analysis using NVivo was used for free text responses. RESULTS There were 247 respondents, of which 177 (72%) were physiotherapists and occupational therapists. Most (n = 207, 84%) had used video-based consultations, typically supported by telephone and e-mail. Practitioners perceived telerehabilitation positively overall, and recognised benefits for patients including reduced infection risk, convenience and flexibility, and reduced travel and fatigue. Common obstacles were: technology-related (e.g. internet connection); practical (e.g. difficulty positioning the camera); patient-related (e.g. health status); practitioner-related (e.g. lack of technical skills); and organisational (e.g. lack of access to technology). Support from family members or carers was a major facilitator for successful remote consultations. Of the 207 respondents who had used video-based consultations, 103 (50%) had assessed physical impairments using this method, 107 (52%) had assessed physical function, and 121 (59%) had used patient-reported outcome measures. Although practitioners generally felt confident in delivering video-based consultations, they were less confident in undertaking remote physical assessments. They expressed concerns about the validity, reliability and safety of physical assessments carried out remotely. Only 46 of the 247 respondents (19%) had received any training in telerehabilitation or video consultations, with some commenting that they were “feeling their way in the dark”. Practitioners desired training and guidance on: physical assessment tools suitable for remote use; when to use video-based consultations or alternative methods; and governance issues. They also wanted guidance on digital platforms and signposting to digital skills training for themselves and their patients. CONCLUSIONS In response to the COVID pandemic, practitioners rapidly adopted telerehabilitation for people with physical disabilities and movement impairment. However, there are technical, practical and organisational obstacles to overcome, and a clear need for improved guidance and training in remote physical assessments. The findings of this survey will inform the development of a toolkit of resources and training package for the current and future workforce in telerehabilitation.