Purpose. To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities.Method. Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale.Results. Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, r...

A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation

The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.

Alternative models of cardiac rehabilitation: a systematic review

We conducted a literature review of telerehabilitation interventions on cardiac patients. We searched for studies evaluating some form of telerehabilitation in cardiac patients. A total of 116 publications were screened initially, of which 37 publications were eligible for further review. We assessed study strength, based on the level of evidence and the quality of the intervention. The majority of the articles (70%) represented the highest level of evidence. Most interventions were of good (46%) or fair (51%) quality. Most studies evaluated the efficacy of the telerehabilitation interventions (84%), while 38% reported on feasibility and acceptance. Most studies did not include safety and/or cost-benefit analyses. Most telerehabilitation interventions (90%) employed only one or two core components of cardiac rehabilitation (CR). Of the CR core components, physical activity was most frequently evaluated. Telerehabilitation appears to be a feasible and effective additional and/or alternative form of rehabilitation, compared to conventional in-hospital CR. Evaluations of telerehabilitation programmes taking into account patient safety and health economics are now required.

A review of telerehabilitation for cardiac patients

Background: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation. Objective: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits. Methods: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student’s t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs). Results: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient’s home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant ( P =.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P =.002; ≥50 km: $90<$152, P <.001). Conclusions: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient’s home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient’s home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic. Trial Registration: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4). [J Med Internet Res 2015;17(3):e83]

Cost analysis of in-home telerehabilitation for post-knee arthroplasty.

We systematically reviewed the evidence on the effectiveness of telerehabilitation (TR) applications. The review included reports on rehabilitation for any disability, other than mental health conditions, and drug or alcohol addiction. All forms of telecommunications technology for TR and all types of study design were considered. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each TR application had been successful, whether reported outcomes were clinically significant, and whether further data were needed to establish the application as suitable for routine use. Sixty-one scientifically credible studies that reported patient outcomes or administrative changes were identified through computerized literature searches on five databases. Twelve clinical categories were covered by the studies. Those dealing with cardiac or neurological rehabilitation were the most numerous. Thirty-one of the studies (51%) were of high or good quality. Study results showed that 71% of the TR applications were successful, 18% were unsuccessful and for 11% the status was unclear. The reported outcomes for 51% of the applications appeared to be clinically significant. Poorer-quality studies tended to have worse outcomes than those from high- or good-quality studies. We judged that further study was required for 62% of the TR applications and desirable for 23%. TR shows promise in many fields, but compelling evidence of benefit and of impact on routine rehabilitation programmes is still limited. There is a need for more detailed, better-quality studies and for studies on the use of TR in routine care.

Evidence of benefit from telerehabilitation in routine care: a systematic review.

In-hospital rehabilitation can improve recovery of patients after surgery, but also contributes to the high costs of the German health system. A telemedicine-based rehabilitation used in the home as an alternative to in-hospital rehabilitation was evaluated in a pilot study. In an open trial, 170 patients performed a 3-month ambulatory rehabilitation after cardiac surgery. There were two groups (group 1 [n = 70] and group 2 [n = 100]). Group 1 participated in conventional in-hospital rehabilitation. Group 2 received ambulant rehabilitation using telemedicine. Physical performance, quality of life, (measured with a questionnaire), complications and costs were assessed and compared between the two groups. Maximal physical performance (MPP) was assessed at 6 and at 12 months after cardiac surgery. It was significantly increased by 46–54 watts in both study groups compared to their baseline value. Moreover, physical and psychological quality of life had increased in both study groups compared to baseline valu...

New East-Westfalian Postoperative Therapy Concept: a telemedicine guide for the study of ambulatory rehabilitation of patients after cardiac surgery.

Stationare Rehabilitationsmasnahmen nach operativen Eingriffen fordern den Genesungsprozess, tragen jedoch auch zum Kostendruck im deutschen Gesundheitssystem bei. In einer Pilotstudie sollte deshalb die Moglichkeit einer telemedizinsch betreuten ambulanten Rehabilitation als Alternative zur stationaren Rehabilitation beurteilt werden. In einer offenen Studie fuhrten 100 Patienten nach herzchirurgischem Eingriff eine telemedizinisch betreute ambulante 3-monatige Rehabilitation und 70 Patienten eine stationare 3-wochige Rehabilitation durch. Korperliche Leistungsfahigkeit (Spiroergometrie), Lebensqualitat (Fragebogen), Komplikationen und Kosten der Rehabilitation wurden miteinander verglichen. Beide Gruppen hatten ihre Wattleistung am Fahrradergometer 6 und 12 Monate nach dem Eingriff im gleichen Ausmas um 46–54 W im Mittel gesteigert. Die korperliche und psychische Lebensqualitat stiegen ebenfalls in beiden Gruppen im Mittel an. Der Anstieg war jedoch nur in der ambulanten Gruppe in allen Bereichen signifikant. Daruber hinaus traten in der ambulanten Gruppe weniger Angina-pectoris-Anfalle als in der stationaren Gruppe auf (p < 0,01). Die Kosten lagen bei der ambulanten Rehabilitation um ca. 59% niedriger als bei der stationaren Rehabilitation. Eine telemedizinisch betreute ambulante Rehabilitation steigert die korperliche Leistungsfahigkeit ebenso wie eine stationare Rehabilitation, erhoht die Lebensqualitat und ist gleichzeitig sicher und kostengunstig. Die Ergebnisse dieser Studie zeigen, dass der Aufbau einer ambulanten Anschlussheilbehandlung anstelle einer stationaren Rehabilitation bei Patienten mit herzchirurgischem Eingriff durchaus sinnvoll sein kann.

Neues Ostwestfälisches Postoperatives Therapiekonzept (NOPT)

BACKGROUND AND PURPOSE In-hospital rehabilitation can improve recovery of patients after surgery, but also contributes to the high costs of the German health system. Therefore, the possibility of a telemedically monitored rehabilitation at home as an alternative to an in-hospital rehabilitation was evaluated in a pilot study. PATIENTS AND METHODS In an open trial, 100 patients performed an ambulatory rehabilitation after heart surgery under coverage of telemedical monitoring for 3 months. 70 patients performed a regular conventional in-hospital rehabilitation for 3 weeks. Physical performance, quality of life (questionnaire), complications, and costs were assessed and compared between the two groups. RESULTS 6 and also 12 months after surgery, maximal physical performance was significantly increased by 46-54 W in both study groups compared to their baseline value. Moreover, physical and psychological quality of life had increased in both study groups compared to baseline values. However, only in the ambulatory group all items had increased with statistical significance. Fewer insults of angina pectoris were reported during follow-up in the ambulatory group compared to the in-hospital group (p < 0.01). Total costs of the rehabilitation were 59% lower in the ambulatory group compared to the in-hospital group. CONCLUSION An ambulatory rehabilitation improves physical performance, quality of life, and is safe and cheap. The data of this study indicate that rehabilitation at home can be established instead of an in-hospital rehabilitation for patients after heart surgery.

New Eastern Westfalian Postoperative Therapeutic Concept (NOPT). A telemedically guided study for ambulatory rehabilitation of patients after cardiac surgery

Elmar Wienecke

Papers

New East-Westfalian Postoperative Therapy Concept: a telemedicine guide for the study of ambulatory rehabilitation of patients after cardiac surgery.

Neues Ostwestfälisches Postoperatives Therapiekonzept (NOPT)

New Eastern Westfalian Postoperative Therapeutic Concept (NOPT). A telemedically guided study for ambulatory rehabilitation of patients after cardiac surgery