Article originally featured on At Today
The Clinician Task Force has published a guide to help occupational therapists (OTs) and physiotherapists (PTs) who want to use telehealth to work with clients requiring complex rehabilitation technology.
Entitled ‘Clinician’s Guide to Use of Telehealth for CRT Service Provision’, the guide reflects on lessons learned throughout the pandemic and the positive outcomes that can be achieved through the use of telehealth services in the provision of complex rehabilitation technology (CRT).
CRT encompasses individually configured manual and power wheelchairs, wheelchair seating systems, and other adaptive equipment. People who might need such assistive technology include those with spinal cord injuries, multiple sclerosis, cerebral palsy and muscular dystrophy. Assistive technology helps these individuals live more independently and improves their quality of life.
The aim of the telehealth guide is for policymakers to take action to make permanent the availability of telehealth from PTs and OTs on a national basis.
Although this guide is aimed at US-based rehabilitation professions working with CRT clients, a lot of the best practice guidance is relevant for professionals in the UK.
“It is meant to be a general guide for the clinician trying to determine if using telehealth is appropriate, and, when it is appropriate, provide general guidance throughout the process for a more successful encounter,” the Clinician Task Force (CTF) explains.
The guide includes information about: applying the use of telehealth to CRT equipment trial and recommendation; what to include in documentation; using telehealth in the follow-up fitting, training and delivery; other ways telehealth can be used to perform outcomes measures; how the guidelines can be applied; and a decision tree to be used as a basic guide for clinicians and suppliers in determining the best utilisation of telehealth.
Additionally, the CTF says that whilst rehabilitation professionals should ideally be in-person when assessing a client’s needs for CRT, telehealth can provide an effective alternative method of assessment when barriers arise.
According to the guide, when the therapist and supplier of the CRT team are unable to be onsite together in-person with the client, the use of telehealth can be a handy resource to bring the team members together, if certain criteria are met.
The guide lays out some considerations for the team in preparing for a successful telehealth visit, which are:
The experience and skill level of each team member must be considered. Communication about expectations for the visit and how to capture various aspects of the assessment must be addressed between the supplier and therapist(s), dependent upon who is onsite and who will be remote.
Determine which telehealth platform will be used and ensure it is permitted by employers and CRT companies alike.
Determine if audio and video capabilities are available and reliable. Establish a back‐up plan in the event of internet connectivity issues.
Ensure all documents are signed and completed by the client consenting for services provided via telehealth, according to individual employer regulations.
Verify that family or caregivers can be present to ensure that the client has physical assistance for transfers or other mobility, as necessary, especially if the therapist will not be the team member present in the home.
During the visit, the remote participants will be reliant on the position of the video feed. Thus, placement of the device is pertinent and someone must be responsible to adjust position of the video equipment during the visit to maintain line of sight.
The guide states that telehealth can be used to assess CRT clients’ needs. It says that this digital technology enables rehabilitation professionals to remotely observe clients in their own primary environments. For instance, through seeing a client in their own home, unmet mobility and equipment needs can be identified, alongside any necessary training.
Safety concerns or environmental modification can also be identified, the CTF notes. Telehealth can therefore provide a comprehensive review of the overall needs in a domestic environment that may be overlooked in a clinic setting.
Furthermore, the guide notes that telehealth enables OTs and PTs to see how the client performs self‐care, activities of daily living, and functional mobility in their own specific environment in order to correctly identify any new CRT.
It adds: “Participation of additional caregivers or family members, who may not be able to be present in the clinic, can provide valuable input regarding how the consumer performs ADLs or how their current equipment impacts their independence.”
Equipment Recommendation and Selection
Through the use of telecare, product trials can also take place at the client’s home or at the supplier’s facility, the guide recommends.
It says that a representative from the supplier should generally be present in-person with the client for equipment trials as the product specialist. Rehabilitation professionals, on the other hand, can be present remotely, using observational skills, interview, or instructional guidance to complete and document objective measures during these trials for additional justification of medical necessity.
The CTF says that when a clinician or supplier is remote during a CRT assessment, a minimum of the following should be documented alongside other standard data:
The reason telehealth was chosen.
The location of all present team members and the consumer.
The address and phone number(s) where the patient is physically located at the time of the telehealth visit.
The client’s agreement to participate and who was present with the consumer.
Any regulations specific to his/her insurance and licensing needs.
The use of PPE and other considerations.
The type of telehealth platform used and any precautions reviewed.
Other specific considerations, as applicable.
The guide also provides some information about what equipment training should be carried out by the supplier: “Training on the care, maintenance and use of the CRT equipment will be done by the supplier. This may include, but is not limited to, programming the electronics, turning the chair on and off, battery maintenance and assembly and disassembly of the equipment.”
Rehabilitation professionals should remotely offer functional training, the CTF advises, such as transfers, positioning, pressure relief program and wheelchair skills with the CRT equipment and any medical considerations.
If further functional training is required, or CRT reviews are necessary in the future, the clinician can establish an open telehealth plan.
Decision tree for using telehealth when working with CRT clients
Rehabilitation professionals can read the guide in full here