Adverse events associated with the delivery of telerehabilitation: A scoping review protocol.

OBJECTIVE: This scoping review aims to map the existing research on adverse events during the delivery of telerehabilitation. INTRODUCTION: Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic as a means to deliver rehabilitation services remotely. However, there exists a research gap as there has yet to be any scoping review, systematic review, or meta-analysis published to identify and summarize the current primary research on adverse events related to telerehabilitation as a whole. It is important to understand how adverse events, such as falls during physiotherapy or aspiration pneumonia during speech language pathology sessions, are associated with telerehabilitation delivery. This will help to identify key limitations for optimizing telerehabilitation delivery by allowing for the development of key risk-mitigation measures and quality indicators. It can also help improve the uptake of telerehabilitation among clinicians and patients. This review aims to fill this research gap by conducting a search of published literature on adverse events in telerehabilitation. Anticipated key findings of this scoping review include identifying the characteristics and frequencies of adverse events during telerehabilitation, the patient populations and types of telerehabilitation associated with the most adverse events, and the quality of reporting of adverse events. METHODS: The review follows the Joanna Briggs Institute (JBI) methodological framework and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol has been registered and published on Open Science Framework. A comprehensive search strategy was implemented across multiple databases (MEDLINE ALL, EMBASE, APA PsycINFO, CENTRAL, and CINAHL). All stages (screening, extraction, and synthesis) will be conducted in duplicate and independently, with data extraction following the TIDieR framework, along with authors, year of publication (before or after COVID), population and sample size, and specific mode/s of telerehabilitation delivery. For synthesis, data will be summarized quantitatively using numerical counts and qualitatively via content analysis. The data will be grouped by intervention type and by type of adverse event. INCLUSION CRITERIA: This scoping review will include qualitative and quantitative studies published between 2013 and 2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery (asynchronous, synchronous, or hybrid) will be included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants will be excluded.

Clinicians' Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study.

BACKGROUND: Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented. OBJECTIVE: The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally. METHODS: The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis. RESULTS: A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of "infrastructure, equipment, and space" and "leadership and organizational support"; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit. CONCLUSIONS: Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future.

Implementation of a Pilot Leadership Curriculum for Physical Medicine and Rehabilitation Residents.

ABSTRACT: Medical trainees are expected to achieve leadership competencies by the end of their training. However, there is a lack of standardized postgraduate leadership education. The aims of this study were to evaluate a pilot program consistent with leadership aims of the medical education body and to assess learners' perceived responses to the curriculum. A pilot workshop was developed using Kern's six-step approach to curriculum development for medical education. Topics included leading teams, managing conflict, feedback, goal setting, and time management, as these gaps were identified during a targeted needs assessment. Learning was assessed by preworkshop and postworkshop self-assessments, and the curriculum was evaluated with a postworkshop survey. The workshop was attended by 14 physical medicine and rehabilitation residents and 1 medical student. There was a statistically significant increase in participants' Likert scale confidence scores for the summative areas of leading teams, managing conflict, feedback, goal setting, and time management (P < 0.001). All participants rated the session as 4 or 5/5 on all evaluation domains. In conclusion, a single session targeting stated needs of trainees was successful in increasing perceived competence in areas relevant to clinical leadership. Expansion to include a longitudinal component, with assessment for behavior change for ongoing improvement would be beneficial.

Postconcussion Syndrome: A Diagnosis of Past Diagnostic and Statistical Manual of Mental Disorders.

ABSTRACT: After concussion, a subset of patients have persistent symptoms that are functionally limiting and may be difficult to treat. These symptoms were previously captured in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) under the diagnosis of "Post-Concussion Syndrome." However, in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, postconcussion syndrome has been eliminated. The elimination of "Post-Concussion Syndrome" moves the Diagnostic and Statistical Manual of Mental Disorders further away from congruence with the International Classification of Diseases (ICD-10) with respect to the classification of postconcussion symptomology. Although this change likely had the positive effect of reducing misdiagnoses of symptoms due to other causes, the authors highlight the potential issues surrounding the elimination of postconcussion syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This opinion piece also emphasizes the multiple diagnostic and therapeutic challenges that may result for those involved in the treatment of, or research regarding, concussion patients with persistent symptoms. Future revisions that provide clear clinical diagnostic criteria may be beneficial.

Changes to Rehabilitation Service Delivery and the Associated Physician Perspectives During the COVID-19 Pandemic: A Mixed-Methods Needs Assessment Study.

This project aimed to determine the impact of and needs from physician members of the Canadian Association of Physical Medicine & Rehabilitation during the early response to the COVID-19 global pandemic. The purpose of this project was to develop a framework for addressing the pandemic tailored to the needs of Canadian physiatrists. A convergent mixed-methods design was used for this needs assessment quality project. A total of 136 responses were obtained with an overall response rate of 34%. Three major themes were identified relating to the impact of COVID-19 on physicians: (1) changes to direct patient care, (2) changes to nonclinical aspects of physician's practices, and (3) impacts on personal and family well-being. Three requests for Canadian Association of Physical Medicine & Rehabilitation support during the pandemic were as follows: (1) collaborative sharing of information and resources, (2) advocacy for both patients and providers, and (3) avenues for social connection and wellness. This project provided insight into the impact of COVID-19 and current needs of Canadian Association of Physical Medicine & Rehabilitation physicians. The results were used to develop a solutions framework including guidance on use of virtual care and holding education webinars on high-yield topics. Next steps include a follow-up survey on change in preparedness and member satisfaction with the Canadian Association of Physical Medicine & Rehabilitation response.

Practical Considerations for Implementing Virtual Care in Physical Medicine and Rehabilitation: For the Pandemic and Beyond.

This article outlines a practical approach to quickly implementing virtual care for physiatrists. This skill is relevant not only during times of a pandemic, when face to face care is impossible, but is also valuable when caring for patients who have physical, financial, logistic, or other challenges to on-site care. Key themes covered in this article include selecting appropriate virtual care platforms, consenting patients for virtual care and conducting successful virtual visits. It also reviews strategies for performing virtual physical examinations and engaging learners in virtual care.

The Role of Subsymptom Threshold Aerobic Exercise for Persistent Concussion Symptoms in Patients With Postconcussion Syndrome: A Systematic Review.

In recent years, there has been a shift away from rest until total symptom resolution after concussion, due to the potential adverse consequences of inactivity. Aerobic exercise has been increasingly investigated for the treatment of postconcussion syndrome, whereby symptoms persist beyond 4 wks. The aim of this review was to systematically review the literature on subsymptom threshold aerobic exercise as a treatment for postconcussion syndrome. We conducted systematic literature searches in databases: MEDLINE (Ovid), CINAHL, PubMed, and Embase. After thorough review, 12 articles met the eligibility criteria and were included in the systematic review. The quality of selected studies was low to moderate. Subsymptom threshold aerobic exercise was associated with improvement in symptoms in patients with postconcussion syndrome for all included studies. The most commonly used protocols incorporated 20 mins of exercise at 80% of the heart rate that provoked symptoms, 5-6 days per week, with no adverse events documented. However, there was considerable variation in exercise protocols, and many studies incorporated subsymptom threshold aerobic exercise as part of a broader rehabilitation plan. Evidence supports subsymptom threshold aerobic exercise as a promising treatment for postconcussion syndrome. Further studies are required to delineate the optimal intensity, duration, and frequency of exercise for postconcussion syndrome in a variety of populations.