Telerehabilitation Feasibility in Total Joint Replacement

Despite documented benefits, many Total Joint Replacement (TJR) patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients.   TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72%) and internet (69%) at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication.  Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology.Keywords: Hip replacement, Knee replacement, Telerehabilitation, Telemedicine, Total joint replacemen

The redesign and re-evaluation of an internet-based telerehabilitation system for the assessment of dysarthria in adults

A previous study revealed that reliable assessment of dysarthria was feasible. However, that study also revealed a number of system limitations and suggested that technological enhancements and improvements in study design and clinical assessment protocols were needed before validity and reliability of assessment of dysarthria via telerehabilitation could be confirmed. In the current study, improvements in technology, study design, and clinical assessment protocols were implemented in order to re-examine the validity and reliability of assessing and diagnosing dysarthria via the telerehabilitation medium. The aim of this study was to explore the validity and reliability of assessing dysarthria using both formal standardized and informal assessments via a purpose-built telerehabilitation system. Twenty-four participants with an acquired dysarthria were assessed simultaneously via telerehabilitation and face-to-face (FTF) on a battery of assessments. A custom-built telerehabilitation system enabled real-time telerehabilitation assessment over a 128 Kbps Internet connection. Data analysis included an analysis of strength of agreement between the two methods using percentage agreement and weighted Κ statistics. Inter-rater and intrarater reliability were also examined for both the FTF and telerehabilitation-led assessments. Good strength of agreement was found between the FTF and telerehabilitation assessment methods. High intrarater and inter-rater reliability within both the FTF and telerehabilitation assessment methods supported these findings. Participants reported high overall satisfaction in the telerehabilitation environment. This study describes the improvements made to the telerehabilitation system reported previously and confirms that valid and reliable assessment of dysarthria using both standardized and informal assessments over the Internet is possible using this system

An instrument to measure mobile shower commode usability: the eMAST 1.0. Tables

Data from a preliminary evaluation of the eMAST 1.0s psychometric properties, with a crosssectional sample of Australian MSC users

Clinicians' Perspectives of a Novel Home-based Multidisciplinary Telehealth Service for Patients with Chronic Spinal Pain

Chronic spinal pain conditions can often be successfully managed by a non-surgical, multidisciplinary approach, however many individuals are unable to access such specialised services within their local community. A possible solution may be the delivery of care via telerehabilitation. This study aimed to evaluate clinicians’ perspectives on providing clinical care via telerehabilitation during the early implementation of a novel spinal telerehabilitation service.  Eight clinicians’ were recruited, completing surveys at four separate time points. Confidence in providing treatment via telerehabilitation significantly improved with time (?2(3)=16.22, p=0.001). Clinicians became significantly more accepting of telerehabilitation being a time- (?2(3)=11.237, p=0.011), and cost-effective (?2(3)=9.466, p=0.024) platform in which they could deliver care. Overall satisfaction was high, with technology becoming easier to use (p=0.026) and ability to establish rapport significantly improved with experience (p=0.043). Understanding clinicians’ perspectives throughout the early implementation phase of a new telerehabilitation service is a critical component in determining long-term sustainability.

Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic

Objective: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. Design: Repeated-measures study design. Participants: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. Intervention: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. Main outcome measures: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. Results: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1 = 0.58–0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1 = 0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. Conclusion: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person

Hot and cool executive function and its relation to theory of mind in children with and without autism spectrum disorder

Previous research has clearly demonstrated that Autism Spectrum Disorder (ASD) involves deficits in multiple neuropsychological functions, such as Executive Function (EF) and Theory of Mind (ToM). A conceptual distinction is commonly made between cool and hot EF. In ASD, continued attention has been paid to the cool areas of executive dysfunction. Cool EF has been strongly related to ToM but research has not taken into account the association between hot EF and ToM in ASD. The present study investigates the associations between hot and cool EF and ToM in 56 school-aged children with ASD and 69 controls on tasks tapping cool EF (i.e. working memory, inhibition, planning), hot EF (i.e. affective decision making, delay discounting), and ToM (i.e. mental state/ emotion recognition and false belief). Significant group differences in each EF measure support an executive dysfunction in both domains in ASD. Strong associations between delay discounting and ToM mental state/ emotion recognition are reported suggesting that hot EF makes a unique contribution to ToM above and beyond cool EF in typical development and ASD. This study improves understanding of the profile of higher-order cognitive deficits in children with ASD, which may inform diagnosis and intervention

South Georgia blue whales five decades after the end of whaling

Blue whales Balaenoptera musculus at South Georgia were heavily exploited during 20th century industrial whaling, to the point of local near-extirpation. Although legal whaling for blue whales ceased in the 1960s, and there were indications of blue whale recovery across the wider Southern Ocean area, blue whales were seldom seen in South Georgia waters in subsequent years. We collated 30 yr of data comprising opportunistic sightings, systematic visual and acoustic surveys and photo-identification to assess the current distribution of blue whales in the waters surrounding South Georgia. Over 34000 km of systematic survey data between 1998 and 2018 resulted in only a single blue whale sighting, although opportunistic sightings were reported over that time period. However, since 2018 there have been increases in both sightings of blue whales and detections of their vocalisations. A survey in 2020 comprising visual line transect surveys and directional frequency analysis and recording (DIFAR) sonobuoy deployments resulted in 58 blue whale sightings from 2430 km of visual effort, including the photo-identification of 23 individual blue whales. Blue whale vocalisations were detected on all 31 sonobuoys deployed (114 h). In total, 41 blue whales were photo-identified from South Georgia between 2011 and 2020, none of which matched the 517 whales in the current Antarctic catalogue. These recent data suggest that blue whales have started to return to South Georgia waters, but continued visual and acoustic surveys are required to monitor any future changes in their distribution and abundance