A newly published paper studied the characteristics of patients who have used telerehabilitation for their wheelchair assessments, versus patients who had in-person evaluations.
The paper — Telerehabilitation for New Wheelchair Evaluations: A Retrospective Study of Patient Characteristics — was published in June in the International Journal of Telerehabilitation.
The study’s authors were Chelsea McClammer, OTDS, BS, department of occupational therapy, Whitworth University; Elizabeth A. Choma, PT, DPT, department of physical therapy, Whitworth University; Richard M. Schein, Ph.D., MPH, department of rehabilitation science and technology, school of health and rehabilitation sciences, University of Pittsburgh; Mark R. Schmeler, Ph.D., OTR/L, ATP, department of rehabilitation science and technology, school of health and rehabilitation sciences, University of Pittsburgh; Gede Pramana, Ph.D., department of rehabilitation science and technology, school of health and rehabilitation sciences, University of Pittsburgh; Jake Gliniak, department of occupational therapy college of health professions, Medical University of South Carolina; and Corey Morrow, Ph.D., MOT, OTR/L, department of occupational therapy college of health professions, Medical University of South Carolina.
The study was a retrospective cohort analysis using the Functional Mobility Assessment (FMA) and Uniform Dataset (UD).
Identifying the characteristics of telerehabilitation seating assessment users
Noting the importance of a proper prescription for an assistive mobility device (AMD), as well as the significance of working with a therapist and a supplier who are qualified and experienced in seating and mobility provision, the study noted, “Without proper fitting of a device, consumers risk being prescribed an inappropriate device that could negatively impact their health with use over time and result in unmet mobility needs. These negative effects may include unnecessary expenses, injury and duplication of effort, all leading to the possibility of device abandonment and wasted resources.”
The paper also noted that a number of factors — from a lack of transportation to a lack of family support, financial limitations or medical situations, such as the COVID-19 pandemic — can make an in-person seating clinic appointment impossible.
Enter the telerehabilitation option.
In the first week of March 2020, as states began preparing to shut down due to COVID-19, “telehealth increased by about 400% and continued to rise throughout the pandemic,” the paper said. “Telerehabilitation is emerging as a viable option for the delivery of rehabilitation (Chen et al., 2020; Iodice et al., 2021) that may improve patient recovery outcomes, reduce economic burden, and minimize access disparity for rural and low-income patients.”
But while other studies “have suggested an overall high level of satisfaction with AMD evaluations via telerehabilitation (Ott et al., 2020) and similar effectiveness when compared to in-person evaluations (Schein et al., 2010; Bell et al., 2020),” there remains “a lack of understanding regarding which individual characteristics are conducive to telerehabilitation use for device evaluation,” the paper said. “Therefore, the objective of this study was to provide a descriptive analysis of demographic and clinical characteristics of PwD [people with disabilities] who have previously had an AMD evaluation via telerehabilitation.”
What the study revealed
Researchers examined past information contained in the FMA and UDS, “a nationwide registry of PwD with a referral for an AMD evaluation with occupational therapists, physical therapists, and ATPs contributing from over 30 clinics. The FMA/UDS was developed in part to allow for the large data analysis of AMD users to determine which devices and service delivery models are most effective in improving patient satisfaction with mobility and reducing secondary health risks like falls and pressure sores.”
FMA/UDS data collection began in 2019 and is ongoing, with the last information used in this study being recorded in December 2023. Seating suppliers and clinicians collaborate on patient intake forms during AMD evaluations.
“The intake form includes a binary yes/no question that indicates if the evaluation occurred using telerehabilitation (Schmeler et al., 2019),” the paper said. “All adult (18 years or older) PwD were extracted from the FMA/UDS for analysis in this study.”
Among the data that researchers studied “that could lead to more targeted telerehabilitation delivery for AMD evaluation from the FMA/UDS were age, gender, and insurance/payer type.” Researchers also noted primary diagnoses, types of mobility devices used prior to the seating evaluation, and patients’ satisfaction with their current mobility status.
In total, 11,953 PwD made up the cohort. The telerehabilitation group had 1,669 patients in it, with the remaining 10,284 patients being in the in-person group.
Researchers learned that the mean age in the telerehabilitation group was 71.9 years, versus a mean age of 61.4 years for the patients in the in-person group.
The three most common diagnoses in the telerehabilitation group were unspecified neuromuscular disease (19%), osteoarthritis (16.2%), and stroke (13.4%). For patients in the in-person evaluation group, the three most common diagnoses were unspecified neuromuscular disease (10.6%), osteoarthritis (9.7%), and stroke (9.7%).
The most common payer types for telerehabilitation patients were Medicare Managed Care (35.5%); Medicare (21.3%); and private insurance HMO (17.9%). For patients in the in-patient group, the most common payer types were Medicare (32.1%); Medicare Managed Care (19.6%); and Medicaid (15.8%).
The FMA has 10 questions — on subjects (“subcategories”) such as daily routine, reaching, transferring, personal care, and indoor/outdoor mobility — that patients can score from 1 (“completely disagree”) to 6 (“completely agree”). The highest possible score is 60.
“The average FMA score before a wheelchair evaluation for the telerehabilitation group was 22.1, while the average score for the in-person group was 29.5,” the paper said. “All FMA subcategories were significantly higher in the in-person group.”
In the end, researchers reported a higher instance of telerehabilitation usage among patients “with progressively acquired disabilities, and those with lower satisfaction measured by the baseline FMA scores with their current means of mobility.” In addition, adults aged 65 years and older had higher rates of telerehabilitation usage in the time period of this study, possibly because of “health and safety concerns during the COVID-19 pandemic” and seniors’ efforts to socially distance.
What these results could mean for the future
Funding sources’ policies, the paper noted, supported greater telerehabilitation usage in recent years.
“In the wake of the COVID-19 pandemic, telerehabilitation use surged because Medicare and private payers eased payment restrictions,” the paper said.
Researchers also found that people in the telerehabilitation group “had lower FMA scores, indicating a low satisfaction with mobility.”
The potentially good news: “People with lower satisfaction with their mobility may have difficulty accessing outpatient seating/mobility clinics and see telerehabilitation as a viable option for their wheelchair evaluation needs.”
Researchers acknowledged the unequal sample sizes — telerehabilitation vs. in-person assessments — and noted that clients’ assessment experiences may have been different depending on whether or not they were in an actual clinic while being evaluated.
“However, the assessment protocol was standardized and used certified, trained ATPs [assistive technology professionals] for consistency and best practice,” researchers said.
Because the data was collected during the COVID-19 pandemic, researchers said it, “may not be generalizable.”
Still, they concluded, “This project is impactful, as it will support larger comparative effectiveness studies contrasting the telerehabilitation to in-person AMD evaluations for different patient populations. Larger comparative effectiveness studies will also steer research, influence reimbursement policy, and facilitate translational research directly impacting occupational/physical therapy practice for AMD services via telerehabilitation.”
Certainly, telerehabilitation proved itself well enough during the last few years to deserve more use and investigation going forward, researchers said.
“With the expansion of telerehabilitation services, best practices for wheelchair provision should be explored for different ages, diagnoses, and device types.”
The study was developed under a corporate research agreement between the University of Pittsburgh and VGM & Associates, with funding also provided through the Learning Health Systems Rehabilitation Research Network, supported by the National Institutes of Health.
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