Telemedicine in help of rehabilitation in the conditions of COVID-19

The COVID-19 pandemic has led governments around the world to adopt strict rules that restrict individual freedom and impose social distance in order to prevent the collapse of national health systems [1]. Although these measures are needed in this pandemic, they represent a barrier for healthcare professionals who are usually in close contact with patients in need of physical therapy. One way to provide physical therapy for patients in this period is through telemedicine, which allows provision of remote health services. The effects of telerehabilitation have been studied in a variety of musculoskeletal (MSK) conditions, including lower back pain, lumbar stenosis, osteoarthritis, and neck pain. The list of benefits consists of reduced hospitalization rates, shorter stays in a rehabilitation unit, reduced burden of access to outpatient physical therapy, while improving quality of life, health outcomes and early return to work [2]. The combination of evidence-based methodologies with cost-effective services will be used as a basis for further expansion of vital telerehabilitation services and will increase the reimbursement of health insurance providers. Due to the COVID-19 crisis, medical professionals have enlarged the use of telemedicine, which allows medical information to be spread electronically between people in different locations [3]. The World Confederation of Physical Therapy has issued an opinion on the use of telerehabilitation to improve the access to care and to offer physiotherapists the opportunity to provide care in accordance with a new delivery model [3].

Telerehabilitation is provision of rehabilitation services over information and communication technologies. Telerehabilitation allows patients to interact remotely with healthcare providers and can be used for monitoring and therapy. Fields of telerehabilitation include: physical and motor therapy, occupational therapy, speech-language pathology, audiology, virtual reality, robotic therapy and psychology. Commonly used methods include webcams, video conferences, telephone lines, videophone web pages containing internet applications. Telerehabilitation is often combined with other modalities such as personal therapy. Patient satisfaction is a priority in healthcare. The quality of patient care is measured through The Healthcare Effectiveness Data and Information Set, which estimates various areas of quality, including effectiveness, accessibility, availability and professional experience in care provision [4].

Telerehabilitation offers many new opportunities to provide rehabilitation services in alternative ways and in different clinical settings [5]. Telerehabilitation helps physiotherapists by providing them with continuous feedback and monitoring of their patients. Telerehabilitation allows them to give quality health care; to observe the progress of therapy; to make online consultations in real time; to perform a physical assessment of the condition; to plan a targeted physical therapy program. [6]. At health services level telerehabilitation allows telerehabilitation specialists to:

• 1)adapt the intensity, frequency and duration of rehabilitation programs according to the needs of patients;
• 2)increase the efficiency of care;
• 3)reduce waiting lists, thus increasing the sustainability of services;
• 4)ensure adequate and continuous services for both acute and chronic conditions [6].

Prior to the spread of coronavirus (COVID-19), telerehabilitation was recognized by several countries as an effective addition to the traditional inpatient methods. During the COVID-19 pandemic, many countries regulated telerehabilitation rules to allow patients to continue with their current treatment plan. The Centers for Disease Control and Prevention (CDCP) recently proposed guidelines for outpatient care, such as outpatient clinics, urging them to consider using telehealth services as a method of providing care to reduce the risk of exposure to COVID-19, and potentially lower the number of patients who might otherwise seek help in doctor's offices and because of that can spread the virus. Despite some disadvantages of telerehabilitation, it offers a safe and effective alternative to the traditional personal care, especially during an emergency such as that observed during COVID-19, when precautions must be taken to prevent transmission of the disease. Actually, the American Physical Therapy Association (APTA) House of Delegates sees telerehabilitation as “a well‐defined and established method of health services delivery” (Telehealth HOD P06‐19‐15‐09). The Federation of State Boards of Physical Therapy explicitly states that care provided during face-to-face meetings should also be followed during telerehabilitation visits. In addition, state physical therapy and occupational therapy councils across the country have recently made recommendations to ensure appropriate administrative, clinical, technological, and ethical provisions for implementing telerehabilitation programs in the context of pandemic. For instance, a therapist must obtain informed consent and maintain the confidentiality of the patient and the patient's file. Each therapist must treat within the therapeutic practice and according to the needs of the patient, and Health Insurance Portability and Accountability Act of 1996 (HIPAA) must be followed. The provider must also ensure that the introduced procedures can deal with any medical or clinical emergency that may arise during remote treatment.

Telerehabilitation and online technologies will continue to evolve. Typical services performed during a telerehabilitation visit for physical therapy include assessment, intervention, monitoring, education and training. In the current social distances due to the spread of COVID-19, it is the responsibility of healthcare professionals to adapt to these changes in order to continue to provide care to their patients, while at the same time they reduce the risks to overall health and well-being.

Declaration of Competing Interest

None.