35 research outputs found
Ăvaluer la tĂ©lĂ©rĂ©adaptation : la synthĂšse des effets et lâanalyse des changements cliniques et organisationnels
La tĂ©lĂ©rĂ©adaptation, tout comme dâautres champs en tĂ©lĂ©santĂ©, est de plus en plus interpelĂ©e pour la prestation de services. Le but de ce projet de thĂšse est dâenrichir lâĂ©valuation de la tĂ©lĂ©rĂ©adaptation afin que les connaissances qui en dĂ©coulent puissent venir soutenir la prise de dĂ©cision dâacteurs impliquĂ©s Ă diffĂ©rents niveaux en tĂ©lĂ©rĂ©adaptation.
Le premier article prĂ©sente une revue systĂ©matique dont lâobjectif Ă©tait de faire synthĂšse critique des Ă©tudes en tĂ©lĂ©rĂ©adaptation. La revue rassemble 28 Ă©tudes en tĂ©lĂ©rĂ©adaptation, qui confirment lâefficacitĂ© de la tĂ©lĂ©rĂ©adaptation pour diverses clientĂšles dans diffĂ©rents milieux. Certaines des Ă©tudes suggĂšrent Ă©galement des bĂ©nĂ©fices en termes de coĂ»ts, mais ces rĂ©sultats demeurent prĂ©liminaires. Cette synthĂšse critique est utile pour soutenir la dĂ©cision dâintroduire la tĂ©lĂ©rĂ©adaptation pour combler un besoin. Par contre, les dĂ©cideurs bĂ©nĂ©ficieraient aussi de connaissances par rapport aux changements cliniques et organisationnels qui sont associĂ©s Ă la tĂ©lĂ©rĂ©adaptation lorsquâelle est introduite en milieu clinique.
Les deux autres articles traitent dâune Ă©tude de cas unique qui a examinĂ© un projet clinique de tĂ©lĂ©rĂ©adaptation dans lâest de la province de QuĂ©bec, au Canada. Le cadre conceptuel qui sous-tend lâĂ©tude de cas dĂ©coule de la thĂ©orie de structuration de Giddens et des modĂšles de structuration de la technologie, en particulier de lâinteraction entre la structure, lâagent et la technologie. Les donnĂ©es ont Ă©tĂ© recueillies Ă partir de plusieurs sources (groupes de discussion, entrevues individuelles, documents officiels et observation dâenregistrements) suivi dâune analyse qualitative. Le deuxiĂšme article de la thĂšse porte sur le lien entre la structure, lâagent et la culture organisationnelle dans lâutilisation de la tĂ©lĂ©rĂ©adaptation. Les rĂ©sultats indiquent que les diffĂ©rences de culture organisationnelle entre les milieux sont plus Ă©videntes avec lâutilisation de la tĂ©lĂ©rĂ©adaptation, entraĂźnant des situations de conflits ainsi que des occasions de changement. De plus, la culture organisationnelle joue un rĂŽle au niveau des croyances liĂ©es Ă la technologie. Les rĂ©sultats indiquent aussi que la tĂ©lĂ©rĂ©adaptation pourrait contribuer Ă changer les cultures organisationnelles.
Le troisiĂšme article examine lâintĂ©gration de la tĂ©lĂ©rĂ©adaptation dans les pratiques cliniques existantes, ainsi que les nouvelles routines cliniques quâelle permet de soutenir et la pĂ©rennisation de la tĂ©lĂ©rĂ©adaptation. Les rĂ©sultats indiquent quâil y a effectivement certaines activitĂ©s de tĂ©lĂ©rĂ©adaptation qui se sont intĂ©grĂ©es aux routines des intervenants, principalement pour les plans dâintervention interdisciplinaire, tandis que pour les consultations et le suivi des patients, lâutilisation de la tĂ©lĂ©rĂ©adaptation nâa pas Ă©tĂ© intĂ©grĂ©e aux routines. Plusieurs facteurs en lien avec la structure et lâagent ont contraint et facilitĂ© lâintĂ©gration aux routines cliniques, dont les croyances partagĂ©es, la visibilitĂ© de la tĂ©lĂ©rĂ©adaptation, le leadership clinique et organisationnel, la disponibilitĂ© des ressources, et lâexistence de liens de collaboration. La pĂ©rennitĂ© de la tĂ©lĂ©rĂ©adaptation a aussi pu ĂȘtre observĂ©e Ă partir de la gĂ©nĂ©ralisation des activitĂ©s et le dĂ©veloppement de nouvelles applications et collaborations en tĂ©lĂ©rĂ©adaptation, et ce, uniquement pour les activitĂ©s qui sâĂ©taient intĂ©grĂ©es aux routines des intervenants. Les rĂ©sultats dĂ©montrent donc que lorsque la tĂ©lĂ©rĂ©adaptation nâest pas intĂ©grĂ©e aux routines cliniques, elle nâest pas utilisĂ©e. Par contre, la tĂ©lĂ©rĂ©adaptation peut dĂ©montrĂ©e certains signes de pĂ©rennitĂ© lorsque les activitĂ©s, qui sont reproduites, deviennent intĂ©grĂ©es aux routines quotidiennes des utilisateurs.
Ensemble, ces Ă©tudes font ressortir des rĂ©sultats utiles pour la mise en place de la tĂ©lĂ©rĂ©adaptation et permettent de dĂ©gager des pistes pour enrichir le champ de lâĂ©valuation de la tĂ©lĂ©rĂ©adaptation, afin que celui-ci devienne plus pertinent et complet, et puisse mieux soutenir les prises de dĂ©cision dâacteurs impliquĂ©s Ă diffĂ©rents niveaux en tĂ©lĂ©rĂ©adaptation.Telerehabilitation, like other telehealth applications, has been increasingly used to provide health services. The goal of this thesis is to enrich the field of telerehabilitation evaluation such that it can better contribute to informed decision making of those involved in telerehabilitation at different levels.
The first article is a systematic review of telerehabilitation studies and it was conducted in order to provide a critical synthesis of the current telerehabilitation literature. The revue included 28 studies of telerehabilitation, which, overall, confirmed the efficacy of telerehabilitation when used with a variety of clienteles in different settings. Some of the studies also suggest that there may be some cost benefits associated with telerehabilitation although the findings remain preliminary. Such a synthesis of the literature can contribute to some decisions regarding the pertinence of introducing telerehabilitation. However, decision makers also need information regarding the clinical and organizational changes that are associated with telerehabilitation when implemented in a clinical setting.
The next two articles contain the results of a single case study that was centered on a telerehabilitation clinical project implemented in the eastern part of the province of Quebec, in Canada. A conceptual model was developed to guide this study, and it was based on Giddensâ Theory of Structuration and on models of technology structuration, in particular drawing upon the notion of the interaction between structure, agent and technology. Data was collected from several sources (focus groups, interviews, official documents and observation of recordings) and was analyzed using a qualitative analysis approach. The second article in this thesis examined the relationship between structure, agent and organizational culture with respect to telerehabilitation use. The results indicate that differences in organizational culture between the centres are more visible when telerehabilitation is used, which can in some cases lead to conflicts, while in other cases create opportunities for change. In addition, organizational culture also played a role in shared beliefs linked to the technology. Lastly, the results suggest that telerehabilitation could be used to bring about changes in organizational culture.
The third article examined how telerehabilitation became integrated into existing clinical practices, how it contributed to the development of new routines and explored the sustainability of telerehabilitation. The results indicate that some activities, namely interdisciplinary care plans were integrated into clinical routines, while consultations and patient follow-up were not. Several factors related to the structure and agent were found to facilitate or hinder the integration of telerehabilitation into routine practices, including shared beliefs, the visibility of telerehabilitation activities, the clinical and organizational leadership, the availability of resources and the existence of collaborations. Sustainability was also observed when telerehabilitation use became more generalized and novel applications were developed, although this was only found to occur for activities which had integrated into routine practice. The results therefore suggest that when telerehabilitation is not integrated into routine practices, it will not be used, but that, on the other hand, telerehabilitation may be sustainable for activities which are repeated and then integrated into routine day-to-day clinical activities.
Together, these studies put forth findings which can be useful when implementing new telerehabilitation programs. They also help elucidate directions for future research in order to enrich the field of telerehabilitation evaluation so that it may become more pertinent and comprehensive to support decision-makers involved at all levels of telerehabilitation
Telemedicine in palliative care: a review of systematic reviews
Aims. To evaluate the quality of systematic reviews on telemedicine applications in palliative care. Methods. A structured literature review was conducted to identify systematic reviews dealing with telemedicine in palliative care; the AMSTAR â Assessment of Multiple Systematic Reviews â checklist was used to appraise the evidence related to the systematic reviews. Results: 405 records were initially identified; of these 14 were eligible for full-text analysis. In summary, the research strategy allowed the identification of 6 reviews to be included which showed a medium quality (AMSTAR score in between 4 and 7). All the included systematic reviews considered telemedicine applications as a feasible means to be used in palliative care; however, the positive findings are counterbalanced by several critical issues mainly related to the evidence from the primary studies included in each single review. Conclusions. Results of this first attempt to appraise the evidence in the field of telemedicine applications in palliative care highlighted that there is still limited evidence related to this approach. Strengths and weaknesses that impact on the general quality of the reviews were identified and relevant points to be taken into account for future research were suggested
A quality assessment of systematic reviews on telerehabilitation: what does the evidence tell us?
Aims. To evaluate the quality of systematic reviews on telerehabilitation. Methods. The AMSTAR â Assessment of Multiple Systematic Reviews â checklist was used to appraise the evidence related to the systematic reviews. Results. Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i) analysis of the grey literature; ii) a list of the excluded studies and their haracteristics; iii) the identification of possible source of bias and the assessment of its likehood; iv) an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the highscored systematic reviews telerehabilitation resulted at least as effective as usual care: 1) in the short term treatment of mental health related to people affected by spinal cord injury; 2) in rural communities for treating patients affected by chronic conditions; 3) in treating common pathologies (mainly asthma) affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. Conclusions. In the authorsâ knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies
Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic
Purpose: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. Methods: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participantsâ attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. Results: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. Conclusion: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease
Creating a rehabilitation living lab to optimize participation and inclusion for persons with physical disabilities
AbstractWe present an on-going multidisciplinary and multisectorial strategic development project put forth by the Centre for Interdisciplinary Research in Rehabilitation of greater MontrĂ©al (CRIR) in Quebec, Canada and its members, in collaboration with a MontrĂ©al ârenovation-readyâ shopping mall, local community organizations, and local, national and international research and industrial partners. Beginning in 2011, within the context of the Mall as Living Lab (MALL), more than 45 projects were initiated to: (1) identify the environmental, physical and social obstacles and facilitators to participation; (2) develop technology and interventions to optimize physical and cognitive function participation and inclusion; (3) implement and evaluate the impact of technology and interventions in vivo. Two years later and working within a participatory action research (PAR) approach, and the overarching WHO framework of the International Classification of Functioning, Disability and Health (ICF), we discuss challenges and future endeavors. Challenges include creating and maintaining partnerships, ensuring a PAR approach to engage multiple stakeholders (e.g. people with disabilities, rehabilitation and design researchers, health professionals, community members and shopping mall stakeholders) and assessing the overall impact of the living lab. Future endeavors, including the linking between research results and recommendations for renovations to the mall, are also presented
Mobile Videoconferencing for Occupational Therapistsâ Assessments of Patientsâ Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study
Background:
Occupational therapists who work in hospitals need to assess patientsâ home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patientsâ home environments could be an innovative solution to allow better and more appropriate recommendations.
Objective:
The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patientsâ home environments.
Methods:
Occupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patientsâ homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patientâs occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews.
Results:
Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not.
Conclusions:
The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning
Improving the usefulness of evidence concerning the effectiveness of implementation strategies for knowledge products in primary healthcare: protocol for a series of systematic reviews
The literature on the implementation of knowledge products is extensive. However, this literature is still difficult to interpret for policymakers and other stakeholders when faced with choosing implementation strategies likely to bring about successful change in their health systems. This work has the particularity to examine the scope of this literature, and to clarify the effectiveness of implementation strategies for different knowledge products. Consequently, we aim to (1) determine the strengths and weaknesses of existing literature overviews; (2) produce a detailed portrait of the literature on implementation strategies for various knowledge products; and (3) assess the effectiveness of implementation strategies for each knowledge product identified and classify them
A strategic initiative to facilitate knowledge translation research in rehabilitation
While there is a growing body of literature supporting clinical decision-making for rehabilitation professionals, suboptimal use of evidence-based practices in that field persists. A strategic initiative that ensures the relevance of the research and its implementation in the context of rehabilitation could 1) help improve the coordination of knowledge translation (KT) research and 2) enhance the delivery of evidence-based rehabilitation services offered to patients with physical disabilities. This paper describes the process and methods used to develop a KT strategic initiative aimed at building capacity and coordinating KT research in physical rehabilitation and its strategic plan; it also reports the initial applications of the strategic plan implementation
Exploring Powered Wheelchair Users and Their Caregiversâ Perspectives on Potential Intelligent Power Wheelchair Use: A Qualitative Study
Power wheelchairs (PWCs) can have a positive impact on user well-being, self-esteem, pain, activity and participation. Newly developed intelligent power wheelchairs (IPWs), allowing autonomous or collaboratively-controlled navigation, could enhance mobility of individuals not able to use, or having difficulty using, standard PWCs. The objective of this study was to explore the perspectives of PWC users (PWUs) and their caregivers regarding if and how IPWs could impact on current challenges faced by PWUs, as well as inform current development of IPWs. A qualitative exploratory study using individual interviews was conducted with PWUs (n = 12) and caregivers (n = 4). A semi-structured interview guide and video were used to facilitate informed discussion regarding IPWs. Thematic analysis revealed three main themes: (1) "challenging situations that may be overcome by an IPW" described how the IPW features of obstacle avoidance, path following, and target following could alleviate PWUs' identified mobility difficulties; (2) "cautious optimism concerning IPW use revealed participants" addresses concerns regarding using an IPW as well as technological suggestions; (3) "defining the potential IPW user" revealed characteristics of PWUs that would benefit from IPW use. Findings indicate how IPW use may help overcome PWC difficulties and confirm the importance of user input in the ongoing development of IPWs
The Patientâs Perspective of in-Home Telerehabilitation Physiotherapy Services Following Total Knee Arthroplasty
This study aimed at exploring patientsâ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patientsâ perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patientâs experience in telerehabilitation will be essential as programs continue to be developed and implemented