Online Tutoring on Telemedicine

Literature review

The scope of telemedicine has been increasing rapidly day by day due to rapid advancement in the computer technologies in general and telemedical devices in specific. Maximizing performance and quality of life through a patient-centered team approach are basic principles in the practice and recovery of physical medicine and rehabilitation. There are various factors such as time, money, location, use of technology that restricts the patients in health care nowadays. Many elements such as location, time, finances, and access to technology, that restrict the experiences of a patient with health care today. A patient’s success in maintaining their health, indeed, relies on a variety of social and physical indicators, such as transportation availability, social mobility, and social assistance. In terms of services, Telehealth has widened its reach, dealing with telerehabilitation, telecare, tele-consulting, telemedicine and remote non-clinical facilities. These are all methods of care delivery that increase access to health care and can support and encourage patient-centered care.

Telehealth has facilitated the delivery of care to advantage telecommunications devices in order to provide medical care outside the traditional face-to-face medical confrontation. Health care delivery can include a combination of history, modified physical examination, diagnostic testing, assessment, and management for a patient using telehealth. Telehealth treatment for patients and longitudinal care encompasses behavioral medicine, drugs, patient education, and shared decision-making. Medical care and effective decision-making can be delivered either synchronously or asynchronously (Tenforde et al., 2017).

In June 2016, the Agency for Health Research and Quality described research that gives the strongest evidence for telehealth, including telerehabilitation (Totten et al., 2016). Systematic reviews stated by the authors of this report show reasonable scientific proof and potential benefit of delivering telerehabilitation care for cardiovascular disorders and other widely treated conditions in PM&R. Research shows very powerful evidence for telehealth programs in terms of remote monitoring, connectivity, and counseling for chronic health conditions, including cardiovascular disease and diabetes. Few outcomes of the telehealth are, it reduces the rate of patients’ admission in hospital, decreases mortality rate and also save cost with the help of telerehabilitation (Tenforde et al., 2017). Telehealth capability is rapidly changing and encouraged by technological growth; although, the basic principle for telehealth delivery requires a method of communication between the involved parties through which information is shared. Data exchange can take many forms, including written, audio, visual, or haptic (data from patient technology contact). Technologies such as e-mail, cellular text, traditional phone lines, video conferencing, cameras, 3D motion sensors, sensors, global positioning systems, nanotechnology, and virtual reality all provide another type of data exchange.

 

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The exchange of data may be in numerous forms, including written, audio, visual, or haptic (data obtained from patient contact with technology). Technologies such as e-mail, cellular texting, traditional phone lines, videoconferencing, cameras, 3-dimensional motion sensors, sensors, global positioning systems, robotics, and virtual reality each offer a different type of data exchange. Telehealth delivery relies on both the patient’s acceptance and exposure to the technology. Users will need to want to use telerehabilitation technology, including hardware access and software installation capabilities along with troubleshooting support. It is very important for user to know about the technology which facilitate them and also adopt in right manner. For example, patients may need guidance on how to use video conferencing software or applications that how appropriately to start the conference and share the display (Pramuka & van Roosmalen, 2009). Long-distance communication can be easily achieved by videoconferencing, email and text. Today, robots, robotic arms, or drones can be run at a distance. The course of human action has been substantially changed and all credit goes to these developments (Ackerman, Filart, Burgess, Lee & Poropatich, 2010)

There are different types of telerehabilitation treatments along with their relative intensity and duration that have been published (Peretti, Amenta, Tayebati, Nittari & Mahdi, 2017). Telerehabilitation can be regarded as one of the branches of telemedicine. Though this field is significantly new but in recent times, its scope is rapidly growing in developed countries. Telerehabilitation typically lowers the costs of both health care providers and patients compared to traditional hospital or individual rehabilitation. Another benefit of telerehabilitation is that, this latest technological advancement also works in those remote areas where traditional rehabilitation services may not reach easily. Change in demographics and increased public health budget allocation have improved new rehabilitation practices over the last two decades (Rogante, Grigioni, Cordella, & Giacomozzi, 2010). Therefore, this new mode of treatment, save much time, money and resources in comparison with the traditional rehabilitation.  Telerehabilitation refers to the use of IT to offer remote assistance, examination and information to persons with physical and/or mental impairments. Implementing telerehabilitation is an economic solution for delivering rehabilitation services to change the lifestyle of patients (Jafni, Bahari, Ismail & Radman, 2017)

Innovation and technological advancements entail providing useful products and services to enhance citizens’ quality of life. The field of telemedicine has revealed progress in recent times in the control, monitoring and assessment of different clinical conditions (Flodgren, Rachas, Farmer, Inzitari, & Shepperd, 2015). In the field of rehabilitation, multiple studies and state-of-the-arts from informatics view and different areas of application (Peretti et al., 2017), demonstrate the effectiveness and benefits of using remote rehabilitation or tele-rehabilitation (Rybarczyk, Kleine Deters, Cointe & Esparza, 2018). Telerehabilitation aims to reduce the time and cost of providing services for rehabilitation. The main objective is to improve the quality of life of patients (Medina, Acosta-Vargas & Rybarczyk, 2019)

 

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Telerehabilitation was designed to take care of patients and return them to hospitals and health healthcare professionals to reduce hospitalization times and costs after the acute phase of a disease. Telerehabilitation enables acute disease diagnosis by substituting the conventional face-to-face approach in the patient-related relationship with the rehabilitator (Carey et a., 2007). It can cover situations in which it is complicated for patients to reach traditional rehabilitation infrastructures located far away from where they live.

Controlled rehabilitation studies have shown that fast management of an injury or illness is critical to attaining satisfactory outcomes in terms of improving the self-efficacy of a patient. A rehabilitation program should therefore begin as soon as possible, be as comprehensive as possible, expand and continue throughout the recovery phase. A major factor is the time of initiation, which should start as soon as possible in general. In most cases, patients at home may be capable of performing the initial stages of rehabilitation after an illness or injury occurs, even if they need appropriate and extensive therapy. For these purposes, telerehabilitation was designed to achieve the same results as regular rehabilitation with a physiotherapist in a hospital or face-to-face (Parmanto & Saptono, 2009)

The first scientific publication on telerehabilitation is dated 1998 and the number of articles on the topic has increased over the past few years, possibly due to people’s changing needs and the emergence of exciting new communication and computer innovations technologies. While working on telerehabilitation, Peretti et al. (2017) studied the number of patients treated with telerehabilitation between 1998 and 2008 and the study shows a notable rise in the number of patients treated with telerehabilitation between 2002 and 2004. Following a corresponding reduction in total, the number of patients facilitated by telerehabilitation risen from 2007, undoubtedly due to the support of new technologies and the overcoming of the initial skepticism to which each new technology is exposed (Peretti et al., 2017).

The primary purpose of telerehabilitation is physiotherapy (Mani, Sharma, Omar, Paungmali & Joseph, 2017) and neural rehabilitation is used to monitor the progress of stroke patients in recovery (Jagos et al., 2015). Telerehabilitation methods use robotics and gaming techniques to mimic virtual reality and rehabilitation for neurological conditions (Burdea et al., 2012). Telerehabilitation has very often been affiliated with other non-rehabilitative technologies, such as remote monitoring of cardiovascular parameters, along with electrocardiogram (ECG), blood pressure and oxygen saturation in chronic disease patients. Such innovations belong to another type of telemedicine called telemonitoring, which in recent years has been widely developed and used. Several researches have concentrated on the economic aspects of using telerehabilitation to minimize hospitalization costs.

Telerehabilitation systems have the potential to provide physiotherapy assistance to various groups of people, such as the older people, disabled and sick, enabling their contact with care providers and trying to improve the quality of life (Anton, Berges, Bermúdez, Goñi & Illarramendi, 2018). Numerous studies show the therapeutic efficiency of telerehabilitation systems and virtual interaction-based tests have shown that they can be as beneficial as traditional treatments. Several studies indicate the therapeutic usefulness of telerehabilitation systems and tests based on virtual interaction have shown that these can be as effective as traditional treatments. However, since the termination of traditional therapy sessions is relatively frequent due to boredom or lack of interest, the motivational aspect of telerehabilitation programs is an important consideration.

In this context, multiple studies have found that game-based telerehabilitation based on Virtual Reality (VR) is considered as entertaining and participating and can boost the rehabilitation intensity and satisfaction of the patient. The benefit of telerehabilitation services is that healthcare professionals have quick access to patient records obtained through the internet and phone call. In order to provide more effective health therapies, data collected through sensors during telerehabilitation sessions can be further analyzed. Eventually, for both physiotherapists and patients, telerehabilitation becomes significantly more time-efficient, even if travel time for routine therapies is removed. A basic telerehabilitation system has at least one camera that allows a physiotherapist to see the patient and monitor the therapy directly (videoconferencing). Sensors that can track the patient’s movements include more complex systems. Existing methods for telerehabilitation are oriented towards the treatment of many diseases.

Most countries around the world regarded health as a very significant sector in terms of both government spending and the generation of employees. The same is true in Australia, where the health sector has been very important. The Australian government is spending the second-largest budget on health care. For contrast, the health sector is also Australia’s biggest employer (Blount & Gloet, 2015). Australia is spending 9.3% of its GDP on education, slightly above the OECD average, and is expected to reach 13% by 2030 (Health at a Glance, 2019). Over the past 25 years, health spending has tripled, and telehealth is progressively seen as a means of tackling the rising costs of delivering health care. In the Australian context, in 2012, the Department of Health assigned $A20.6 million to nine telehealth projects with the aim of examining how telehealth services could be used at home, especially for aging, palliative care and cancer treatment (Dods et al., 2014). Moreover, the adoption of ICT has made healthcare delivery possible in Australia gradually and segmented. One of the limitations of implementing universal ICT-qualified healthcare is that it lacks access to consistently fast connectivity which normally occurs in metropolitan areas rather than in rural and remote areas and this is the case with Australia (Pietrzak, Pullman, Cotea, Nasveld & Warfe, 2013).