Telerehabilitation utilization within the Veterans Administration healthcare system over the past 6 years
Codi Huebner, SPT and Abigail Stearns, SPT
23 Comments on “Telerehabilitation utilization within the Veterans Administration healthcare system over the past 6 years”
To the best of your knowledge is there a corresponding event that would explain why all three disciplines increased utilization of telerehabilitation in 2013 continued their upward trend?
That is an interesting question, Macey! In the information we received from the VA, we did not find a specific reason for the increase in utilization of telerehabilitation in 2013. When we were researching the background information about telehealth/telerehabilitation, we did find that in 2011 and 2012 the VA received more funding for telerehabilitation. In 2013, the VA group, Amputation System of Care, increased the number of Polytrauma Amputation Network Sites and Amputation Clinic Teams which both utilize telerehabilitation. We do not know if this is the exact cause for the increase in utilization, but it could factor into the upward trend. See citation below for the article referenced.
Webster JB, Poorman CE, Cifu DX. Guest editorial: Department of Veterans Affairs Amputations System of care:5 years of accomplishments and outcomes. Journal of rehabilitation research and development. 2014;51(4):vii-xvi.
Would graphing or statistical reporting of the proportion of telerehabilitation services to traditional services been another way to get a representation of the trends of happening (ie telerehap PT/traditional PT for each year).
Kyle, great question! We did report telerehabilitation as a percentage of total patient encounters at the VA, however it was a very small percentage. Telerehabilitation accounted for 0.20% of total VA patient encounters in fiscal year 2010 and increased to about 0.68% in fiscal year 2015. We had originally intended to compare the two graphically, however due to the significant difference in the two figures, we believed that the graphic representations did not do the comparison justice. This is the reason why they are in two separate separate graphs. As far as getting too far into the statistics, we were unable to due to the nature of our project. Our IRB was for us to look at the data and report what the VA was doing. Thus, we were unable to really get too far into the statistics of things. Hopefully this answers your question!
Thanks for your research on this topic. I believe most state practice acts make it difficult to treat and bill patients when the therapist is not physically present. Do you know of states where telerehabilitation is allowed in their practice act? The usefulness of this method of service delivery is very good for a rural state like South Dakota. Looking at states where this is done more frequently and without restriction from their practice act would be good information to have.
The data collected, came from all 50 states, as seen in Figure 3, however that information also includes OT and SLP telerehabilitation. I was just doing a quick search through the practice acts listed on the APTA website and I found that most states do not mention telerehabilitation or telehealth at all. We did not specifically delve into each state practice act for our research, however it would be good information to know for future research on this topic. I agree South Dakota and other rural states could benefit tremendously from telerehabilitation. One of the reasons we started the research on this topic was to increase awareness to the benefits of this method of service delivery.
What were the primary limitations to your study? Was there any other data that you wished you looked at or had access to in order to benefit your study?
James, one of the largest limitations of our study was the fact that we were unable to access any detailed data about patient encounters. We were unable to determine demographics, where the actual visits occurred (patient in home or in a remote clinic) or what they actually performed during the visits. All of this information would have been beneficial to our study; we would have been better able to understand how the VA is actually utilizing telerehabilitation. However, this does open a lot of doors for future study!
Do you think patients prefer tele-rehabilitation over in-person rehabilitation? That is, would patients find tele-rehabilitation to be more/less beneficial than in-person rehabilitation?
James, great question! Unfortunately, I don’t have a great answer for that. I think that it would realistically be a mix, meaning that some patients may prefer telerehabilitation over traditional visits and vice versa. Some patients may prefer telerehabilitation visits simply because they aren’t able to travel for some reason. Additionally, some patients may be uncomfortable in a clinic and would prefer to be treated in home. If home health was unavailable in their area, this would be perfect for them. Obviously there are things that cannot be performed over video or phone technology, so there is always a risk that a patient would be less than satisfied with their care.
Unfortunately with our research we did not further explore the reasons why telerehabilitation was used more in certain areas of the United States. That is something that would be beneficial for future research to look into. It could be related to population density, but I would agree with you. We also thought it would be more prevalent in rural areas.
Why do you speculate that PT is utilized the most for telerehabilitation compared to OT and SLP, as the majority of physical therapy patients require some sort of tactile cues to perform exercises and intervention correctly and more important safely? Additionally, are PTA’s allowed to perform telerehabilitation?
The VA has specific telerehabilitation programs for amputees. It could be that those programs, such as the Telehealth Amputation Clinics (TACs), have patients who require more physical therapy services than the other professions. OT and SLP could be utilized at TACs, but to me, it seems like PT may be utilized more. We did not look specifically at PTA usage. I would assume it would vary from state to state. If you are curious, the APTA website has a link for each state’s practice act. When I was doing a quick search through them, I found many states do not even mention telerehabilitation or telehealth.
The information we received from the VA did not have the specific forms of telerehabilitation utilized due to the magnitude of data we analyzed. The purpose of our research was to analyze telerehabilitation as a whole and it’s utilization compared to traditional services. We would love to know what forms of telerehabilitation were used as well as the specific diagnoses that were treated using this method of service delivery, however that would be the next step in the research process.
I’m glad to see research looking into the idea of telerehab. I think in the future it will be a great avenue to expand PT services to assist clinicians who may need expert opinion, but also to patients for whom getting to therapy as recommended poses a barrier due to transportation, distance, cost or lack of general accessibility to practitioners with novel practice niches.
I’m glad you feel that way Staci! I feel as thought sometimes people get worried about the logistics of it and get worried that it will take away from therapy. However if utilized correctly and diligently I feel as though this could really benefit populations who may not be able to receive therapy in the traditional sort of way!
I think this form of medicine will continue to become increasingly popular and I am very glad that the VA system is endorsing its use! Well done with this poster. I know that you have limited data from the VA, but anywhere in your research did you find if telerehabilitation is being used for home-assessments? Along the same lines, if telerehabilitation starts being used more, would PTAs, aides, or any kind of certified personnel be required to travel to the patient’s home to assist with interventions or monitor safety during the session?
Jenifer, I don’t recall telerehabilitation being utilized for home assessments, however I think that would be a great application of the technology! Regarding your other question, yes in some situations. In other situations, trained personnel may already be present. One of the ideas behind telerehabilitation is that if a PT isn’t able to be with the patient they could potentially utilize other staff on site to monitor the patient. Of course this is patient specific, meaning that there would certainly be cases in which the patient would not need anyone there to monitor them. So in a shorter answer, it depends! Hope this answers your question Jen!
This question isn’t showing up that it is posting so sorry if you’ve gotten 3 posts!
A lot of emphasis is placed on therapeutic alliance and the effect it has on patient outcomes and satisfaction. Do you think that the telerehab might take away from this therapeutic alliance and the relationship we build with our patients by being with them in person?
Good question Tory! We actually found several studies during our research that had positive results with patient satisfaction. In most situations, the patient is seen in the clinic for the initial evaluation before starting telerehabilitation so the patient can meet the therapist and start building that relationship. Telerehabilitation is typically used as an option for patients when they have to travel a long distance to receive the therapy they need so I think they are then grateful they can still get the treatment they need but save on time and travel expenses. In cases like that, I think telerehabilitation will increase the therapeutic alliance because the patient’s hardship is recognized and they appreciate the therapist making their life easier.
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To the best of your knowledge is there a corresponding event that would explain why all three disciplines increased utilization of telerehabilitation in 2013 continued their upward trend?
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That is an interesting question, Macey! In the information we received from the VA, we did not find a specific reason for the increase in utilization of telerehabilitation in 2013. When we were researching the background information about telehealth/telerehabilitation, we did find that in 2011 and 2012 the VA received more funding for telerehabilitation. In 2013, the VA group, Amputation System of Care, increased the number of Polytrauma Amputation Network Sites and Amputation Clinic Teams which both utilize telerehabilitation. We do not know if this is the exact cause for the increase in utilization, but it could factor into the upward trend. See citation below for the article referenced.
Webster JB, Poorman CE, Cifu DX. Guest editorial: Department of Veterans Affairs Amputations System of care:5 years of accomplishments and outcomes. Journal of rehabilitation research and development. 2014;51(4):vii-xvi.
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Would graphing or statistical reporting of the proportion of telerehabilitation services to traditional services been another way to get a representation of the trends of happening (ie telerehap PT/traditional PT for each year).
LikeLike
Kyle, great question! We did report telerehabilitation as a percentage of total patient encounters at the VA, however it was a very small percentage. Telerehabilitation accounted for 0.20% of total VA patient encounters in fiscal year 2010 and increased to about 0.68% in fiscal year 2015. We had originally intended to compare the two graphically, however due to the significant difference in the two figures, we believed that the graphic representations did not do the comparison justice. This is the reason why they are in two separate separate graphs. As far as getting too far into the statistics, we were unable to due to the nature of our project. Our IRB was for us to look at the data and report what the VA was doing. Thus, we were unable to really get too far into the statistics of things. Hopefully this answers your question!
LikeLike
Thanks for your research on this topic. I believe most state practice acts make it difficult to treat and bill patients when the therapist is not physically present. Do you know of states where telerehabilitation is allowed in their practice act? The usefulness of this method of service delivery is very good for a rural state like South Dakota. Looking at states where this is done more frequently and without restriction from their practice act would be good information to have.
LikeLike
The data collected, came from all 50 states, as seen in Figure 3, however that information also includes OT and SLP telerehabilitation. I was just doing a quick search through the practice acts listed on the APTA website and I found that most states do not mention telerehabilitation or telehealth at all. We did not specifically delve into each state practice act for our research, however it would be good information to know for future research on this topic. I agree South Dakota and other rural states could benefit tremendously from telerehabilitation. One of the reasons we started the research on this topic was to increase awareness to the benefits of this method of service delivery.
LikeLike
What were the primary limitations to your study? Was there any other data that you wished you looked at or had access to in order to benefit your study?
LikeLike
James, one of the largest limitations of our study was the fact that we were unable to access any detailed data about patient encounters. We were unable to determine demographics, where the actual visits occurred (patient in home or in a remote clinic) or what they actually performed during the visits. All of this information would have been beneficial to our study; we would have been better able to understand how the VA is actually utilizing telerehabilitation. However, this does open a lot of doors for future study!
LikeLike
Do you think patients prefer tele-rehabilitation over in-person rehabilitation? That is, would patients find tele-rehabilitation to be more/less beneficial than in-person rehabilitation?
LikeLike
James, great question! Unfortunately, I don’t have a great answer for that. I think that it would realistically be a mix, meaning that some patients may prefer telerehabilitation over traditional visits and vice versa. Some patients may prefer telerehabilitation visits simply because they aren’t able to travel for some reason. Additionally, some patients may be uncomfortable in a clinic and would prefer to be treated in home. If home health was unavailable in their area, this would be perfect for them. Obviously there are things that cannot be performed over video or phone technology, so there is always a risk that a patient would be less than satisfied with their care.
LikeLike
Do you have any idea why telehealth is utilized most in the North East? I would have guessed it would be used more in rural areas.
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Unfortunately with our research we did not further explore the reasons why telerehabilitation was used more in certain areas of the United States. That is something that would be beneficial for future research to look into. It could be related to population density, but I would agree with you. We also thought it would be more prevalent in rural areas.
LikeLike
Why do you speculate that PT is utilized the most for telerehabilitation compared to OT and SLP, as the majority of physical therapy patients require some sort of tactile cues to perform exercises and intervention correctly and more important safely? Additionally, are PTA’s allowed to perform telerehabilitation?
LikeLike
The VA has specific telerehabilitation programs for amputees. It could be that those programs, such as the Telehealth Amputation Clinics (TACs), have patients who require more physical therapy services than the other professions. OT and SLP could be utilized at TACs, but to me, it seems like PT may be utilized more. We did not look specifically at PTA usage. I would assume it would vary from state to state. If you are curious, the APTA website has a link for each state’s practice act. When I was doing a quick search through them, I found many states do not even mention telerehabilitation or telehealth.
LikeLike
Do you know what form of telerehabillitation was used the most? Was it video or just telephone?
LikeLike
The information we received from the VA did not have the specific forms of telerehabilitation utilized due to the magnitude of data we analyzed. The purpose of our research was to analyze telerehabilitation as a whole and it’s utilization compared to traditional services. We would love to know what forms of telerehabilitation were used as well as the specific diagnoses that were treated using this method of service delivery, however that would be the next step in the research process.
LikeLike
I’m glad to see research looking into the idea of telerehab. I think in the future it will be a great avenue to expand PT services to assist clinicians who may need expert opinion, but also to patients for whom getting to therapy as recommended poses a barrier due to transportation, distance, cost or lack of general accessibility to practitioners with novel practice niches.
LikeLike
I’m glad you feel that way Staci! I feel as thought sometimes people get worried about the logistics of it and get worried that it will take away from therapy. However if utilized correctly and diligently I feel as though this could really benefit populations who may not be able to receive therapy in the traditional sort of way!
LikeLike
I think this form of medicine will continue to become increasingly popular and I am very glad that the VA system is endorsing its use! Well done with this poster. I know that you have limited data from the VA, but anywhere in your research did you find if telerehabilitation is being used for home-assessments? Along the same lines, if telerehabilitation starts being used more, would PTAs, aides, or any kind of certified personnel be required to travel to the patient’s home to assist with interventions or monitor safety during the session?
LikeLike
Jenifer, I don’t recall telerehabilitation being utilized for home assessments, however I think that would be a great application of the technology! Regarding your other question, yes in some situations. In other situations, trained personnel may already be present. One of the ideas behind telerehabilitation is that if a PT isn’t able to be with the patient they could potentially utilize other staff on site to monitor the patient. Of course this is patient specific, meaning that there would certainly be cases in which the patient would not need anyone there to monitor them. So in a shorter answer, it depends! Hope this answers your question Jen!
LikeLike
This question isn’t showing up that it is posting so sorry if you’ve gotten 3 posts!
A lot of emphasis is placed on therapeutic alliance and the effect it has on patient outcomes and satisfaction. Do you think that the telerehab might take away from this therapeutic alliance and the relationship we build with our patients by being with them in person?
LikeLike
Good question Tory! We actually found several studies during our research that had positive results with patient satisfaction. In most situations, the patient is seen in the clinic for the initial evaluation before starting telerehabilitation so the patient can meet the therapist and start building that relationship. Telerehabilitation is typically used as an option for patients when they have to travel a long distance to receive the therapy they need so I think they are then grateful they can still get the treatment they need but save on time and travel expenses. In cases like that, I think telerehabilitation will increase the therapeutic alliance because the patient’s hardship is recognized and they appreciate the therapist making their life easier.
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Abby and Codi — Great job answering your poster questions.
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