Table 4.

Steps and Considerations for Developing and Delivering Telehealth Exercise Programs

Phase	Step	Provider-Related Considerations	Participant-Related Considerations
	1. Select telehealth platform	Costs of license and any additional equipment Ease of use – Complexity of initial installation and connecting with participants – Provision of technical support Devices that are compatible with the platform (ie, smart phone, tablet, computer) Quality of visual and auditory output Privacy and security of transmissions Obtainment of HIPAA Business Associate Agreement	Costs of use, including data streaming Internet/cellular and bandwidth requirements and availability Ease of use – Complexity of initial installation and connecting with provider for sessions – Availability of support – Accessibility of features (eg, size of font and buttons) Devices that are compatible with the platform (ie, smart phone, tablet, computer) Quality of visual and auditory output Data security and encryption
Development	2. Develop documentation system	Costs The components of the session that need to be documented Timing of documentation (real time vs post-session) Ease of data input and extraction Integration with electronic health record	Outcomes: – Selection of self-report versus performance outcomes – Opportunity for verbal versus text/typed/interactive response – Balance of synchronous versus asynchronous reporting (within or between sessions)
	3. Identify and obtain necessary resources (personnel and supplies)	Personnel – Qualifications of individual who will run program and/or deliver sessions Supplies – Exercise equipment needed to deliver content – Additional supplies needed to enhance delivery of program (e.g., adjustable stands for communication devices) – Develop procedures for infection control, if equipment will be transferred to subsequent participants	Availability of family or caregivers for setup or participation Environmental setup in participants’ homes (eg, moveable and safe chairs, counters/rails for support) Technology available in participants’ homes (e.g., tablet, laptop) Exercise equipment available in participants’ homes Safety of participants using equipment
	4. Identify recruitment sources and develop recruitment strategies	Define target population Identify individuals who interact regularly with target population (e.g., physical therapists, physicians) Develop resources for recruitment (e.g., flyers)	Characteristics of individuals who may benefit from a home telehealth exercise program Characteristics of individuals who would not be appropriate for a home telehealth exercise program
	1. Evaluate the participant’s functional status prior to and following the program	•Determine location and delivery of assessments: home or clinic? In-person or remote? •Use functional performance measures that will guide delivery (preprogram) and will demonstrate whether/how participant benefitted from program (postprogram)	•Burden with travel to assessments •Impairments that the program will target
Delivery	2. Conduct preprogram training and environmental setup with participant	•Determine location and delivery of training: home or clinic? In-person or remote? •May be helpful to include caregiver/partner in training on use of telehealth technologies •Some participants may benefit from a technology trial run prior to the 1st session •Location in home should be level floor space free of loose objects next to a stable surface (e.g., counter top, back of chair) that can be used for support if needed	•Burden with travel to training •Cognitive status and comfort with technology •Availability of a caregiver/partner •Home setup and flexibility in the setup
	3. Connect with participant via telehealth technology at scheduled session times	•Depending on telehealth platform, updated links may need to be sent for each session •Provider may need to be easily accessible via phone around session start time to troubleshoot connection-related issues on participant’s end •Confirm patient and provider identification prior to starting session •Ensure participant understanding of right to refuse telehealth session •Ensure participant understanding of emergency procedures, in case of fall or other emergent events	•Comfort and ability with technology •Access to reliable internet or cellular services •Ability to keep the battery on device they will use for sessions charged
		4. Start each session by ensuring environment safe and video frame adequate	•Ensure participant within reach of a stable support surface •Ensure participant has exercise equipment (e.g., resistance bands) in reach •Ensure participants’ device is positioned so the provider can see the participant well •Ensure the participant can hear the provider well and adjust volume as needed	•Ability to modify the environment if needed •Safety when retrieving exercise equipment during sessions (e.g., reaching for something on floor) •Availability of a caregiver/partner to assist with session setup
		5. Monitor intensity of selected exercises and progress participant as appropriate	•Monitor intensity consistently throughout session •Progress activities as appropriate to ensure adequate intensity to achieve training effect	•Current medications and health conditions (eg, beta blockers) •Ability to communicate exertion (e.g., may benefit from an RPE scale handout with color-coding and/or pictures to increase understanding of the scale)
		6. Document exercise session content, technological issues, and safety concerns	•Capture information needed to guide future sessions and inform billing (if applicable)	•n/a