背景:尽管COVID-19大流行导致需要康复的患者迅速实施和扩大远程医疗,据记录,远程康复的总体扩展速度较慢。
目的:本研究的目的是了解在COVID-19大流行期间实施远程康复的经验,以及从加拿大和国际康复专业人员的角度使用多伦多康复Telerehab工具包。
方法:该研究采用了定性的描述性方法,包括电话或视频会议支持的访谈和焦点小组。参与者包括康复提供者以及使用多伦多康复Telerehab工具包的医疗保健负责人。每个参与者都参加了半结构化面试或焦点小组,持续约30-40分钟。使用主题分析来了解提供远程康复和实施多伦多康复Telerehab工具包的障碍和促成因素。研究小组的三名成员独立分析了一组相同的成绩单,并在每组之后开会讨论他们的分析。
结果:共有22名参与者参加,纳入了7次访谈和4个焦点小组.参与者的数据是从两个加拿大人(艾伯塔省,新不伦瑞克省,和安大略省)和国际网站(澳大利亚,希腊,和韩国)。共有11个地点出席,其中5个专注于神经康复。参与者包括医疗保健提供者(即,医师,职业治疗师,物理治疗师,语言病理学家,和社会工作者),管理者和系统领导者,以及研究和教育专业人士。总的来说,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”的两个子主题,设备,和“空间”和“领导和组织支持”;(2)由于远程康复而开发的创新;(3)工具包作为实施远程康复的催化剂;(4)改进工具包的建议。
结论: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和领导人的角度来看。这些发现包括适当基础设施的重要性,设备,和空间;组织或领导支持在采用远程康复方面的关键作用;并利用资源来实施它。重要的是,我们研究的参与者将工具包描述为中介网络机会的重要资源,并强调了转向远程康复的必要性,尤其是在大流行的早期。这项研究的结果将用于改进工具包的下一次迭代(Toolkit2.0),以促进安全,可访问,以及对未来有需要的患者进行有效的远程康复治疗。
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.