Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic

Matthew J Miller, Sang S Pak, Daniel R Keller, Deborah E Barnes, Matthew J Miller, Sang S Pak, Daniel R Keller, Deborah E Barnes

Abstract

Objective: The objective was to evaluate implementation of telehealth physical therapy in response to COVID-19 and identify implementation strategies to maintain and scale up telehealth physical therapy within a large urban academic medical center.

Methods: The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework was used to evaluate telehealth physical therapy implementation. Patient-level data were extracted from electronic medical records between March 16, 2020, and May 16, 2020 (implementation phase). Reach was defined as the proportion of physical therapy sessions completed via telehealth. Effectiveness was assessed using a patient-reported satisfaction survey with a 5-point Likert scale. Adoption was defined as the proportion of physical therapists who used telehealth. Implementation was assessed through qualitative analysis of patient and clinician perspectives to identify emergent themes, retrospectively classify strategies used during the implementation phase, and prospectively identify evidence-based strategies to increase telehealth maintenance and scale-up. Maintenance of telehealth was defined as the proportion of patients who indicated they would attend another telehealth session.

Results: There were 4548 physical therapy sessions provided by 40 therapists from March 22, 2020, to May 16, 2020, of which 3883 (85%) were telehealth. Ninety-four percent of patients were satisfied. All physical therapists (100%) used telehealth technology at least once. Retrospectively classified and prospectively identified evidence-based strategies were organized into 5 qualitative themes that supported implementation: organizational factors (policies, preexisting partnerships), engaging external stakeholders (satisfaction survey), champions (clinician leaders), clinician education (dynamic, ongoing training), and process (promote adaptability, small tests of change). Ninety-two percent of patients reported they would attend another telehealth session.

Conclusion: Findings from this study suggest that implementation of telehealth physical therapy during the COVID-19 pandemic was feasible and acceptable in this setting.

Impact: These results can be used to guide future health policy, quality improvement, and implementation science initiatives to expand the use and study of telehealth for physical therapy.

Keywords: Hospital-Based; Implementation Science; Outpatient Physical Therapy; Quality Improvement; Telehealth.

© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Figures

Figure 1
Figure 1
Patient satisfaction survey.
Figure 2
Figure 2
Distribution of in-person and telehealth sessions (new and follow-up) by week during implementation phase (March 22, 2020, to May 16, 2020) and average sessions/week during comparison period (March 22, 2019, to May 16, 2019).

References

    1. Digital Physical Therapy Task Force . Report of the WCPT/INPTRA Digital Physical Therapy Task Force. In: World Confederation for Physical Therapy and International Network of Physiotherapy Regulatory Authorities. 2020.
    1. Nelson M, Bourke M, Crossley K, Russell T. Telerehabilitation is non-inferior to usual care following total hip replacement—a randomized controlled non-inferiority trial. Physiotherapy. 2020;107:19–27.
    1. Paxton RJ, Forster JE, Miller MJ, Gerron KL, Stevens-Lapsley JE, Christiansen CL. A feasibility study for improved physical activity after total knee arthroplasty. J Aging Phys Act. 2018;26:7–13.
    1. Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020. doi: 10.1002/14651858.CD010255.pub3.
    1. Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-rehabilitation after stroke: an updated systematic review of the literature. J Stroke Cerebrovasc Dis. 2018;27:2306–2318.
    1. Helleman J, Van Eenennaam R, Kruitwagen ET, et al. Telehealth as part of specialized ALS care: feasibility and user experiences with “ALS home-monitoring and coaching”. Amyotroph Lateral Scler Front Degener. 2020;21:183–192.
    1. Christiansen CL, Miller MJ, Murray AM, et al. Behavior-change intervention targeting physical function, walking, and disability after dysvascular amputation: a randomized controlled pilot trial. Arch Phys Med Rehabil. 2018;99:2160–2167.
    1. Lee ACW, Billings M. Telehealth implementation in a skilled nursing facility: case report for physical therapist practice in Washington. Phys Ther. 2016;96:252–259.
    1. Middleton A, Simpson KN, Bettger JP, Bowden MG. COVID-19 pandemic and beyond: considerations and costs of telehealth exercise programs for older adults with functional impairments living at home—lessons learned from a pilot case study. Phys Ther. 2020;100:1278–1288.
    1. California Department of Public Health . Order of the State Public Health Officer. 2020. Accessed September 29, 2020. .
    1. City and County of San Francisco Department of Public Health . Order of the Health Officer No. C19-07. San Francisco, CA, USA: City and County of San Francisco Department of Public Health; 2020. Accessed September 29, 2020. .
    1. Centers for Medicare & Medicaid Services . COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. Baltimore, MD, USA: Centers for Medicare & Medicaid Services; 2020. Accessed September 29, 2020. .
    1. Stetler CB, Legro MW, Wallace CM, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;2:1–8.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Published online August 7, 2009. Implement Sci. doi: 10.1186/1748-5908-4-50.
    1. Glasgow RE, Harden SM, Gaglio B, et al. RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review. Published online March 29, 2019. Front Public Health. doi: 10.3389/fpubh.2019.00064.
    1. Harden SM, Smith ML, Ory MG, Smith-Ray RL, Estabrooks PA, Glasgow RE. RE-AIM in clinical, community, and corporate settings: perspectives, strategies, and recommendations to enhance public health impact. Published online March 22, 2018. Front Public Health. doi: 10.3389/fpubh.2018.00071.
    1. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project. Published online February 12, 2015. Implement Sci. doi: 10.1186/s13012-015-0209-1.
    1. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Heal Ment Heal Serv Res. 2011;38:65–76.
    1. City and County of San Francisco Department of Public Health . Order of the Health Officer No. C19-07d. San Francisco, CA, USA: City and County of San Francisco Department of Public Health; 2020. Accessed September 29, 2020. .
    1. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–1139.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
    1. Holtrop JS, Rabin BA, Glasgow RE. Qualitative approaches to use of the RE-AIM framework: rationale and methods. BMC Health Serv Res. 2018;18:177.
    1. Guest G, MacQueen K, Namey E. Applied Thematic Analysis. Thousand Oaks, CA, USA: SAGE Publications, Inc.; 2012.
    1. CDC COVID-19 Response Team . Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019—United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:382–386.
    1. McDonnell ME. Telemedicine in complex diabetes management. Curr Diab Rep. 2018;18:42.
    1. Yamin CK, Emani S, Williams DH, et al. The digital divide in adoption and use of a personal health record. Arch Intern Med. 2011;171:568–574.
    1. Kakkar A, Jacobson BC. Failure of an internet-based health care intervention for colonoscopy preparation: a caveat for investigators. JAMA Intern Med. 2013;173:1374–1376.
    1. Nelson MJ, Crossley KM, Bourke MG, Russell TG. Telerehabilitation feasibility in total joint replacement. Int J Telerehabilitation. 2017;9:31–38.
    1. Nilsen P. Making sense of implementation theories, models and frameworks. Published online April 21, 2015. Implement Sci. doi: 10.1186/s13012-015-0242-0.
    1. Cane J, O’Connor D, Michie S. Validation of the theoretical framework. Published online April 24, 2012. Implement Sci. doi: 10.1186/1748-5908-7-37.
    1. May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Soc Forces. 2009;43:535–554.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren