The use of telerehabilitation has an important role in the future of case management, but a case-by-case approach and better patient education is needed to ensure its continuing efficacy, a new report has concluded.
While it is accepted as a safe and effective means of service delivery for initial triage, immediate needs assessment and subsequent case management and treatment coordination phases – backed by clinical support where needed – the research recommends that a number of factors need to be considered on a patient-by-patient basis to fulfil an effective consultation.
The report, from RTW Plus, was commissioned in response to the huge growth in the use of telerehabilitation and information communication technologies (ICT) during COVID-19 lockdown, in response to the Institute of Registered Case Managers’ guidelines that case managers must utilise a virtual first approach.
The use of remote consultations has been rising for the past two decades, the report notes, but has become often the only avenue available for case managers to consult with patients in recent months, without time to fully prepare some patients in how to use technology.
The research and literature review, led by Dr Devdeep Ahuja and Claire Lowther, finds that telerehabilitation will continue to be a valuable resource into the future, once lockdown restrictions are removed.
It recommends, however, a selection criterion to identify rehab clients who may or may not be suitable for remote case management to ensure safe and effective service delivery and mitigate risks as far as possible.
“Despite the well documented effectiveness of telerehabilitation across the whole spectrum of medical conditions…managing patients at a distance, synchronously by telephone/ video or asynchronously by e-mail/ text messages, can be more challenging than face to face clinical consultation and adds a level of medico-legal risk that can be difficult to measure,” the report states.
The report points to previous studies which have highlighted the use of technology in making it easier for patients to attend appointments, as well as allowing flexibility in how services are delivered.
It also stresses the need for numerous factors to be considered on a case manager, patient and organisational level to ensure patient-centric care is provided.
On a client level, individual support must consider the personal circumstances of the individual, including their age, social class and ability to access Wifi and data, and their technical ability.
“There appeared to be a requirement to provide training and support (perhaps through use of pre-clinical call with an administrator) in the use of technology….assumptions include patients require a level of familiarity, competence and confidence (both in technology and their own health) and an alternative to a face-to-face consultation is only for ‘savvy’ patients – those with access to, and ability to use technology,” says the report.
“This may mean we need to offer more education of telerehabilitation to the client to increase their awareness and to ensure patient-centred outcomes remain paramount.
“With adequate support and guidance, older patients may also be able to access video technology.”
For case managers, the importance of communication and technological skills is highlighted, to ensure the client receives as full a consultation as possible, with the need to continue to produce proper documentation also said to be paramount.
“Sometimes recording of telephonic or remote consultations can be problematic as it may be a client request, quick follow up or may even be done whilst the case manager is travelling. It is imperative that case managers document each clinical consultation.
“If this has occurred while travelling, this should be recorded when it is safe to do so, even for quick follow ups whilst having been driving,” states the report.
On an organisational level, RTW Plus concludes that successful implementation of telerehabilitation also requires proper policies, procedures, rules of engagement and protocols to be put in place, alongside measures to ensure data security.
