Acceptance of telerehabilitation in chronic pain:the patients' perspective

Chronic pain is considered a major public health problem. In addition to the physical and emotional burden that chronic pain brings, it gives rise to significant health care costs. Although conventional rehabilitation programs are effective, the use of telerehabilitation, providing remote care via communication technologies, is expected to offer several advantages over conventional clinic-based rehabilitation because it affords patients to rehabilitate within their own social environment. This can facilitate the care delivery process, increase access of care and improve patients' well-being and quality of life. However, despite the great potential of telerehabilitation, its intended benefits will only be realized when these treatments are accepted and used by patients as fully fledged alternatives to conventional care. Therefore, an understanding of patients' reasons for accepting or refusing relerehabilitation is crucial. The aim of this thesis is to identify drivers and barriers related to patients' acceptance of exercise-based telerehabilitation for chronic pain. This will provide more insight into strategies that may improve telerehabilitation design and as such may facilitate the uptake of prospective telerehabilitation services

Change of patients' perceptions of telemedicine after brief use

Objective: This study aims to investigate whether patients' perceptions regarding a Web-based telemedicine service, for instruction and monitoring of an exercise program, change after brief use. Materials and Methods: Thirty patients were allocated, matched on gender and age, to a control group (10) or an experimental group (20). After basic training, the experimental group was given a 15 min opportunity to use a Web-based telemedicine service. Patients' perceptions regarding the telemedicine service were measured using a questionnaire, based on the Technology Acceptance Model (TAM). This questionnaire was administered to both the control and experimental group before and after the experimental group's intervention. Both groups were compared with respect to any change in perceptions related to the Web-based telemedicine service. Results: The experimental group showed a significantly greater change on the TAM constructs perceived usefulness [F(1,27)=3.40, p =0.08] and perceived ease of use [F(1,27)=5.37, p=0.03] than the control group, who showed no statistically significant change of perceptions. Patients within the experimental group became significantly more positive about the usefulness and ease-of-use of the Web-based telemedicine program after a brief period of use. Conclusions: These findings show that brief use of a Web-based telemedicine service has a significant positive effect on patients' perceptions of this service. Therefore, as patients do not have prior experience with innovative telemedicine services, offering patients a risk-free way to explore and experiment with the service can increase the development of accurate perceptions and user needs. Ultimately, this will increase patients' acceptance of telemedicine. Future studies should investigate the effect of continued usage on patients' perceptions of telemedicin

An exploration of chronic pain patients perceptions of home telerehabilitation services

Objectives  To explore patients’ perceptions regarding prospective telerehabilitation services and the factors that facilitate or impede patients’ intentions to use these services. Design  Using semi-structured interviews, patients reflected on the pros and cons of various scenarios of prospective telerehabilitation services. Patients’ arguments were first arranged according to the Unified Theory of Acceptance and Use of Technology (UTAUT). Next, using inductive analysis, the data for each UTAUT component were analysed and arranged into subthemes. Setting and participants  Twenty-five chronic pain patients were selected from a rehabilitation centre in the Netherlands. Results  Overall, participants considered telerehabilitation helpful as a complementary or follow-up treatment, rather than an autonomous treatment. Arguments mainly related to the UTAUT constructs of ‘performance expectancy’ and ‘facilitating conditions’. Patients valued the benefits such as reduced transportation barriers, flexible exercise hours and the possibility to better integrate skills into daily life. However, many patients feared a loss of treatment motivation and expressed concerns about both reduced fellow sufferer contact and reduced face-to-face therapist contact. Few arguments related to ‘social norms’ and ‘effort expectancy’. Conclusions  The effect of telerehabilitation on healthcare strongly depends on patients’ willingness to use. Our study showed that chronic pain patients valued the benefits of telerehabilitation but hesitate to use it as an autonomous treatment. Therefore, future initiatives should maintain traditional care to some degree and focus on patients’ attitudes as well. Either by giving information to increase patients’ confidence in telerehabilitation or by addressing reported drawbacks into the future design of these services. Further quantitative studies are needed to explore patients’ intentions to use telerehabilitation

Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients’ Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment

Background: Patient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients’ preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients’perspective. In addition, limited evidence is available about the best way to explore patients’ preferences. Therefore, the assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients’ treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: “Intermediate‿ telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment

A multiple stakeholder perspective on the drivers and barriers for the implementation of lifestyle monitoring using infrared sensors to record movements for vulnerable older adults living alone at home: A qualitative study

A variety of technologies classified as lifestyle monitoring (LM) allows, by unobtrusive monitoring, for supporting of living alone at home of vulnerable older adults, especially persons with neurocognitive disorders such as dementia. It can detect health deterioration, facilitate early intervention, and possibly help people avoid hospital admission. However, for LM to redeem its intended effects, it is important to be adopted by involved stakeholders such as informal and formal caregivers and care managers. Therefore, the aim of this qualitative study is to understand factors that drive or impede successful implementation of LM for vulnerable older adults, specifically using infrared sensors to record movements, studied from a multiple stakeholder perspective. An open coding process was used to identify key themes of the implementation process. Data were arranged according to a thematic framework based on the normalization process theory (NPT). All stakeholders agreed that LM could lead to various health benefits for older adults using LM. However, some did not perceive the LM system to be cost-efficient and expressed a need for more flexible health care structures for LM to be successfully implemented. All stakeholders acknowledged the fact that LM requires a transition of care and responsibilities, a clear eligibility strategy for clients, and a clear ambassador strategy for health care professionals, as well as reliable technology. This study highlights the complex nature of implementing LM and suggests the need for alignment within constructs of the NPT among stakeholders about new ways of collaboration in supporting living alone at home