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Question: How does physiotherapy delivered by real-time, video-based telerehabilitation compare with in-person delivery for the outcomes of attendance, adherence and satisfaction?, Design: Systematic review of randomised control trials indexed in PubMed, CINAHL, Embase, Cochrane and PEDro on 12 March 2024., Participants: Adults aged > 18 years., Intervention: Physiotherapy delivered via real-time video telerehabilitation., Outcome Measures: Attendance, adherence and satisfaction., Results: Eight studies were included for attendance (n = 1,110), nine studies for adherence (n = 1,190) and 12 studies for satisfaction (n = 1,247). Telerehabilitation resulted in attendance at treatment sessions that was 8% higher (95% CI -1 to 18) and adherence to exercise programs that was 9% higher (95% CI 2 to 16) when compared with in-person physiotherapy. Satisfaction was similar with both modes of delivery (SMD 0.03 in favour of telerehabilitation, 95% CI -0.23 to 0.28). The level of certainty assessed by GRADE ranged from very low to low, primarily due to inconsistency and high risk of bias., Discussion: Attendance at appointments among participants assigned to telerehabilitation was somewhere between similar to and considerably higher than among control participants. Adherence to self-management with telerehabilitation was better than with in-person delivery, although with some uncertainty about the magnitude of the effect. Reported satisfaction levels were similar between the two modes of treatment delivery. Given the significance of attendance, adherence and satisfaction for successful outcomes, telerehabilitation offers a valuable alternative mode for physiotherapy delivery., Conclusion: Real-time telerehabilitation has potentially favourable effects on attendance at treatment appointments and adherence to exercise programs, with similar satisfaction when compared with traditional in-person physiotherapy., Registration: PROSPERO CRD42022329906., (Copyright © 2024 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Background: Telerehabilitation whether perceived as less effective than in-person care for musculoskeletal problems. We aimed to determine if physiotherapy video conferencing consultations were non-inferior to in-person consultations for chronic knee pain., Methods: In this non-inferiority randomised controlled trial, we recruited primary care physiotherapists from 27 Australian clinics. Using computer-generated blocks, participants with chronic knee pain consistent with osteoarthritis were randomly assigned (1:1, stratified by physiotherapist and clinic) in-person or telerehabilitation (ie, video conferencing) physiotherapist consultations. Participants and physiotherapists were unmasked to group assignment. Both groups had five consultations over 3 months for strengthening, physical activity, and education. Primary outcomes were knee pain (on a numerical rating scale of 0-10) and physical function (using the Western Ontario and McMaster Universities osteoarthritis index of 0-68) at 3 months after randomisation. Primary analysis was by modified intention-to-treat using all available data. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12619001240134., Findings: Between Dec 10, 2019, and June 17, 2022, 394 adults were enrolled, with 204 allocated to in-person care and 190 to telerehabilitation. 15 primary care physiotherapists were recruited. At 3 months, 383 (97%) participants provided information for primary outcomes and both groups reported improved pain (mean change 2·98, SD 2·23 for in-person care and 3·14, 1·87 for telerehabilitation) and function (10·20, 11·63 and 10·75, 9·62, respectively). Telerehabilitation was non-inferior for pain (mean difference 0·16, 95% CI -0·26 to 0·57) and function (1·65, -0·23 to 3·53). The number of participants reporting adverse events was similar between groups (40 [21%] for in-person care and 35 [19%] for telerehabilitation) and none were serious., Interpretation: Telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain., Funding: National Health and Medical Research Council., Competing Interests: Declaration of interests KLB receives personal fees from Wolter Kluwers for production of knee osteoarthritis clinical decision support. RSH and KLB report grant funding paid to University of Melbourne from the National Health & Medical Research Council, Australian Research Council, Medical Research Future Fund, and Medibank for research. The University of Melbourne receives royalties from FutureLearn for the e-learning programme developed to train clinicians as part of this trial. RSH is an Editorial Board member for Journal of Physiotherapy. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Purpose: During the COVID-19 pandemic, hospital physiotherapy departments transitioned to telerehabilitation to ensure continuity of care for patients. The purpose of this study is to determine the key elements to successful, rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments in response to COVID-19., Methods: This study used a qualitative design. Physiotherapists who delivered telerehabilitation consultations during the COVID-19 restriction period in two Brisbane public hospital physiotherapy departments were eligible to participate in semi-structured interviews. Data were analysed thematically., Results: Twenty-five physiotherapists (22-60 years of age; 68% female) with 1-40 years of clinical experience provided insights into their perceptions of the rapid uptake of telerehabilitation in the provision of clinical care. Physiotherapists worked across musculoskeletal outpatient (72%), inpatient, community, paediatrics and pelvic health departments. Qualitative analyses in relation to the physiotherapist perceptions of the key elements of rapid transition to telerehabilitation, revealed four key themes underpinning success: (1) 'it requires a whole team approach', (2) 'technology issues will be encountered and can be overcome', (3) 'optimise the situation while understanding the differences' and (4) 'modifying your approach doesn't imply inferior quality of care'., Conclusion: Rapid implementation of telerehabilitation in a hospital setting is possible, and is facilitated by organisational, administrative and management support, willingness of physiotherapists to adopt, shared learning experience, quality software and connection, availability of equipment and space and optimised systems and processes. Key factors facilitating successful telerehabilitation consultations include effective communication, demonstration, involving a third party to help, and clients who are well prepared and willing to engage., (© 2022 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.)

Introduction: Geographical barriers and impaired physical mobility among people with Parkinson's disease (PD) hinder their timely access to speech pathology services. We compared the costs of delivering a speech treatment via in-person consultation versus telerehabilitation., Methods: We used data from a non-inferiority randomised controlled trial delivering the Lee Silverman Voice Treatment (LSVT LOUD®), where patients with dysarthria associated with PD were assigned to either the urban in-person group ( N  = 16) or the urban online group ( N  = 15), supplemented with a non-randomised group (regional online; N  = 21). We compared costs over a one-month treatment period from a health-system perspective and a patient perspective., Results: The mean treatment costs of both urban online ($1076) and regional ($1206) treatments tended to be slightly higher than urban in-person ($1020) from a health-system perspective. From a patient perspective, the mean treatment cost was $831 in the urban in-person group, $247 in the urban online group and $200 in the regional group., Discussion: LSVT LOUD® may be delivered via telerehabilitation at a slightly higher cost than in-person delivery from a health-system perspective, but it is cost saving from a patient perspective. Telerehabilitation is an economically beneficial alternative for the delivery of the LSVT LOUD® programme in PD patients with speech disorders.

The continuous development in telecommunication tech-nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech-nological advances, along with the demographic and social characteristics of each country, have made the implementa-tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea-nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.

Introduction: Clinical guidelines recommend multidisciplinary non-surgical management for most musculoskeletal spinal conditions. Access to such services continues to be a barrier for many individuals residing outside metropolitan regions. The primary aim of this study was to determine whether clinical outcomes achieved via telerehabilitation are as good as those achieved via in-person care., Methods: A non-randomised pilot clinical trial was undertaken where eligible patients chose to access treatment either via telerehabilitation or in-person (control group). Outcome measures for pain-related disability, pain severity and health-related quality of life were recorded at baseline, 3-, 6- and 9-months. Secondary outcomes included patient satisfaction and technical disruptions., Results: Seventy-one patients were recruited (telerehabilitation, n  = 51; control group, n  = 20). Patient characteristics did not differ at baseline and clinically meaningful improvements for pain-related disability and health-related quality of life were observed in both groups. Non-inferiority of telerehabilitation could not be claimed for any clinical outcome measure. There were no significant group-by-time interactions observed for either pain-related disability ( p  = 0.706), pain severity ( p  = 0.187) or health-related quality of life ( p  = 0.425) measures. The telerehabilitation group reported significantly higher levels of treatment satisfaction (median: 97 vs. 76.5; p  = 0.021); 7.9% of telerehabilitation appointments were not completed due to technical disruptions., Discussion: Findings indicate patients with chronic musculoskeletal spinal conditions can achieve clinically meaningful improvements in their condition when accessing care via telerehabilitation. Telerehabilitation should be considered for individuals unable to access relevant in-person services; however non-inferiority remains inconclusive and requires further exploration.

Introduction: Physical rehabilitation for total hip replacement patients following hospital discharge is beneficial; however, accessing rehabilitation is often challenging. Telerehabilitation helps negate access issues and is efficacious in total knee and hip replacement patients. This study aims to compare the cost-effectiveness of a telerehabilitation programme delivered remotely into patients' homes versus traditional care for total hip replacement patients following hospital discharge., Methods: A cost-effectiveness (cost-utility) analysis was conducted from the perspective of a health service alongside a two-arm randomised controlled trial comparing telerehabilitation ( n =35) with in-person care ( n =35) following hospital discharge after total hip replacement. The primary analysis used an Incremental Cost-Effectiveness Ratio to compare the cost per Quality Adjusted Life Year (QALY) accrued in the telerehabilitation group versus in-person control using costs and effects data from the randomised trial. A secondary analysis was conducted whereby the time accrued by patients attending rehabilitation sessions (including travel time) was considered the "cost" (i.e. a time burden), rather than cost from the health service perspective., Results: Estimated mean differences in healthcare costs and QALYs gained were detected but were not significant. The estimated mean (95%CI) difference in cost of telerehabilitation versus in-person was -$28.90 (-$96.37 to $40.45), favouring the telerehabilitation group. The estimated mean (95%CI) difference in QALYs gained from telerehabilitation versus in-person was -0.0025 (-0.0227 to 0.0217). The estimated mean (95%CI) difference in time burden favoured less time burden for the telerehabilitation group (-4.21 (-4.69 to -3.74) hours)., Discussion: Telerehabilitation in the total hip replacement population incurred similar costs and yielded similar effects to traditional in-person care. Telerehabilitation significantly reduced the time burden for patients and carers. These findings are valuable for healthcare providers seeking to implement accessible patient-centred rehabilitation services.

Background: Whilst home-based telerehabilitation has been shown non-inferior to traditional centre-based rehabilitation in patients with chronic heart failure, its economic sustainability remains unknown. This study aimed to investigate the cost-utility of a home-based telerehabilitation program., Methods: A comparative, trial-based, incremental cost-utility analysis was conducted from a health care provider's perspective. We collected data as part of a multi-centre, two-arm, non-inferiority, randomised controlled trial with 6 months follow-up. There were 53 participants randomised to either a telerehabilitation program (consisting of 12 weeks of group-based exercise and education delivered into the home via online videoconferencing) or a traditional centre-based program. Health care costs (including personnel, equipment and hospital readmissions due to heart failure) were extracted from health system records, and calculated in Australian dollars using 2013 as the base year. Health utilities were measured using the EuroQol five-dimensional (EQ-5D) questionnaire. Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and utility differences were plotted on a cost-effectiveness plane., Results: Total health care costs per participant were significantly lower in the telerehabilitation group (-$1,590, 95% CI: -2,822, -359) during the 6 months. No significant differences in quality-adjusted life years (0, 95% CI: -0.06, 0.05) were seen between the two groups., Conclusions: Heart failure telerehabilitation appears to be less costly and as effective for the health care provider as traditional centre-based rehabilitation., (Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.)

Purpose : Aphasia group therapy can result in improvements in communication, participation and quality of life (QOL). However, evidence for aphasia group interventions with combined aims across the International Classification of Functioning, Disability and Health (ICF) is limited. TeleGAIN is a holistic aphasia group intervention that can be delivered via telepractice. This study builds on prior pilot work and addresses the need for additional research into the effectiveness of TeleGAIN. The aim of this study was to describe changes in aphasia severity, communication related QOL and participation, for people with chronic aphasia following TeleGAIN. Method : Nineteen participants with aphasia were assessed on a range of outcome measures before and after a twelve-week block of TeleGAIN delivered via web based videoconferencing. Treatment provided opportunities to participate in conversation, engage with others with aphasia and complete functional communication activities. Result : Statistical analyses revealed statistically significant improvements in communication related QOL, increased engagement in communicative activities, and decreased aphasia severity. Conclusion : Results from this study suggest that the online delivery of a multi-purpose group intervention for people with aphasia can result in improved communication, communicative participation, and QOL. It also highlights the potential for intervention provided via telepractice to offer an alternative to face-to-face services.

Purpose: Aphasia group therapy offers many benefits, however people with aphasia report difficulty accessing groups and speech-language pathologists are faced with many challenges in providing aphasia group therapy. Telerehabilitation may offer an alternative service delivery option. An online aphasia group therapy program - Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN) - has been developed according to the guidelines of the Medical Research Council (MRC) framework for complex interventions. The purpose of this paper is to describe the development of TeleGAIN and the results of a pilot trial to determine feasibility and acceptability., Method: The development of TeleGAIN was informed through literature reviews in relevant topic areas, consideration of expert opinion and application of the social cognitive theory. TeleGAIN was then modelled through a feasibility pilot trial with four people with aphasia., Result: TeleGAIN appeared to be feasible and acceptable to participants and able to be implemented as planned. Participant satisfaction with treatment was high and results suggested some potential for improvements in language functioning and communication-related quality of life., Conclusion: TeleGAIN appeared to be feasible and acceptable, however the study highlighted issues related to technology, clinical implementation and participant-specific factors that should be addressed prior to a larger trial.

Background: In rural and remote communities children with motor difficulties have less access to rehabilitation services. Telerehabilitation technology is a potential method to overcome barriers restricting access to healthcare in these areas. Assessment is necessary to guide clinical reasoning; however it is unclear which paediatric assessments can be administered remotely. The Movement Assessment Battery for Children - 2nd Edition is commonly used by various health professionals to assess motor performance of children., Aims: The aim of this study was to investigate the feasibility and concurrent validity of performing the Movement Assessment Battery for Children - 2nd Edition remotely via telerehabilitation technology compared to the conventional in-person method., Methods and Procedures: Fifty-nine children enrolled in a state school (5-11 years old) volunteered to perform one in-person and one telerehabilitation mediated assessment. The order of the method of delivery and the therapist performing the assessment were randomized. After both assessments were complete, a participant satisfaction questionnaire was completed by each child., Outcomes and Results: The Bland-Altman limits of agreement for the total test standard score were -3.15 to 3.22 which is smaller than a pre-determined clinically acceptable margin based on the smallest detectable change., Conclusions and Implications: This study establishes the feasibility and concurrent validity of the administration of the Movement Assessment Battery for Children - 2nd Edition via telerehabilitation technology. Overall, participants perceived their experience with telerehabilitation positively., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery., Objective: To evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS., Design: Qualitative descriptive study design., Methods: Healthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers., Results: Template analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS., Conclusion: This study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Objectives: To describe patient experiences and perspectives of a group-based heart failure (HF) telerehabilitation program delivered to the homes via online video-conferencing., Background: Limited information currently exists on patient experiences of telerehabilitation for HF. Patient feedback and end-user perspectives provide important information regarding the acceptability of this new delivery model which may have a substantial impact on future uptake., Methods: We used mixed-methods design with purposive sampling of patients with HF. We used self-report surveys and semi-structured interviews to measure patient experiences and perspectives following a 12-week telerehabilitation program. The telerehabilitation program encompassed group-based exercise and education, and were delivered in real-time via videoconferencing. Interviews were transcribed and coded, with thematic analysis undertaken., Results: Seventeen participants with HF (mean age [SD] of 69 [12] years and 88% males) were recruited. Participants reported high visual clarity and ease of use for the monitoring equipment. Major themes included motivating and inhibiting influences related to telerehabilitation and improvement suggestions. Participants liked the health benefits, access to care and social support. Participants highlighted a need for improved audio clarity and connectivity as well computer training for those with limited computer experience. The majority of participants preferred a combined face-to-face and online delivery model., Conclusion: Participants in this study reported high visual clarity and ease-of-use, but provided suggestions for further improvements in group-based video telerehabilitation for HF., (Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population., Data Sources: Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions., Review Methods: Two reviewers screened 5913 abstracts where 13 studies ( n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black 'Checklist for Measuring Quality' tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI)., Results: Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I 2 =93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I 2 =58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I 2 =10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI -0.10-0.37, I 2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI -0.27-1.60, I 2 =96%) following intervention., Conclusions: Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.

Question: Is a 12-week, home-based telerehabilitation program conducted in small groups non-inferior to a traditional centre-based program in terms of the change in 6-minute walk distance? Is the telerehabilitation program also non-inferior to a centre-based program in terms of functional capacity, muscle strength, quality of life, urinary incontinence, patient satisfaction, attendance rates, and adverse events?, Design: Randomised, parallel, non-inferiority trial with concealed allocation, intention-to-treat analysis and assessor blinding., Participants: Patients with stable chronic heart failure (including heart failure with reduced or preserved ejection fraction) were recruited from two tertiary hospitals in Brisbane, Australia., Intervention: The experimental group received a 12-week, real-time exercise and education intervention delivered into the participant's home twice weekly, using online videoconferencing software. The control group received a traditional hospital outpatient-based program of the same duration and frequency. Both groups received similar exercise prescription., Outcome Measures: Participants were assessed by independent assessors at baseline (Week 0), at the end of the intervention (Week 12) and at follow-up (Week 24). The primary outcome was a between-group comparison of the change in 6-minute walk distance, with a non-inferiority margin of 28m. Secondary outcomes included other functional measures, quality of life, patient satisfaction, program attendance rates and adverse events., Results: In 53 participants (mean age 67 years, 75% males), there were no significant between-group differences on 6-minute walk distance gains, with a mean difference of 15m (95% CI -28 to 59) at Week 12. The confidence intervals were within the predetermined non-inferiority range. The secondary outcomes indicated that the experimental intervention was at least as effective as traditional rehabilitation. Significantly higher attendance rates were observed in the telerehabilitation group., Conclusion: Telerehabilitation was not inferior to a hospital outpatient-based rehabilitation program in patients with chronic heart failure. Telerehabilitation appears to be an appropriate alternative because it promotes greater attendance at the rehabilitation sessions., Trial Registration: ACTRN12613000390785. [Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T (2017) Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. Journal of Physiotherapy 63: 101-107]., (Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.)

Introduction This study aimed to determine the validity and reliability of video-based telerehabilitation assessments in patients with heart failure. Methods Seventeen consecutive participants (mean age 69 years, SD 12 years and 88% males) undertook assessments of three functional tests via both telerehabilitation and face-to-face approaches, on the same day. The assessment order was randomised and conducted by independent assessors. Outcome measures included functional tests: timed up and go (time), six-minute walk (distance), grip strength (kilograms); system usability scale to rate participant experience with telerehabilitation assessment; and number of technical issues encountered. Validity and inter- and intra-rater reliability of telerehabilitation assessments were examined using limits of agreement, intra-class correlation coefficients (ICC), and paired t-tests. Results The limits of agreement for telerehabilitation assessments were within the clinically acceptable limits for timed up and go and grip strength. Telerehabilitation assessments for all functional tests were strongly associated with face-to-face assessments, with ICCs of between 0.85 and 0.96. Inter- and intra-rater reliability of telerehabilitation assessments for all functional tests were excellent (all ICC > 0.95). The mean (SD) system usability scale score was 85 (15)/100. Some incidences of Internet drop-outs, video freezing and auditory fading occurred. Discussion The use of telehealth for the assessment of functional exercise capacity appears to be valid and reliable in patients with heart failure.

Introduction Lower limb musculoskeletal disorders place a heavy burden on healthcare systems. Appropriate management of these conditions is critical, however access to appropriate physiotherapy services is difficult for those in geographically remote areas or those with mobility or transport difficulties. The aim of this study was to evaluate the accuracy and reliability of an online musculoskeletal physiotherapy assessment of the knee complex using telerehabilitation compared to traditional face-to-face assessment. Methods In a repeated-measures design, 18 subjects who sought treatment for knee pain underwent a traditional face-to-face assessment and a remote telerehabilitation assessment. Telerehabilitation assessments were conducted with participants performing facilitated self-palpation, self-applied modified orthopaedic tests, active movements and functional tasks. Results Primary pathoanatomical diagnoses were in exact agreement in 67% of cases and were similar in 89% of cases. The system of pathology was found to be in agreement in 17 out of 18 cases (94%). Comparisons of objective findings from the two physical assessments demonstrated substantial agreement (kappa = 0.635) for categorical data and binary data (chi-squared = 400.36; p < 0.001). A high level of intra-rater (89%) and moderate level of inter-rater (67%) reliability was evident for telerehabilitation assessments. Discussion Telerehabilitation assessment of the knee complex appears to be feasible and reliable. This study has implications for clinical practice and the development of physiotherapy services to address the burden of lower limb musculoskeletal pain and disability.

Background: Pre-Employment Functional Assessments (PEFA) are increasingly used in an attempt to obtain objective information on a potential employee's functional capabilities. In rural and remote communities, there is typically reduced access to qualified therapists to perform these assessments, in part attributable to the time and costs associated with travelling to training courses. One potential method of providing the relevant training to conduct PEFAs is through the use of technologies such as videoconferencing or internet-based modules., Objective: The purpose of this project is to investigate the effectiveness of training therapists and therapy students in performing JobFit System PEFAs via technology when compared with a face-to-face control group., Methods: Fifty-three participants, consisting of 28 professional physiotherapists and occupational therapists, and 25 final year University of Queensland (UQ) physiotherapy and occupational therapy students, underwent JobFit Systems International PEFA training via one of four intervention groups: face-to-face, realtime videoconferencing, group-based online module and individual online module., Results: Of the 53 participants, 49 achieved the minimum competency level of 75% in post-training competency assessments. No significant difference was found in training levels between intervention groups., Conclusions: The results of this study suggest that technology, such as real-time videoconference and online learning modules, can be used to train both therapists and students in how to perform JobFit System PEFAs.

Purpose: This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated., Method: In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures., Results: Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified., Conclusions: Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.

The evolving telecommunications industry combined with medical information technology has been proposed as a solution to reduce health care cost and provide remote medical services. This paper aims to validate and show the feasibility and user acceptance of using a telerehabilitation system called Kinect Rehabilitation System (KiReS) in a real scenario, with patients attending repeated rehabilitation sessions after they had a Total Hip Replacement (THR). We present the main features of KiReS, how it was set up in the considered scenario and the experimental results obtained in relation to two different perspectives: patients' subjective perceptions (gathered through questionnaires) and the accuracy of the performed exercises (by analysing the data captured using KiReS). We made a full deployment of KiReS, defining step by step all the elements of a therapy: postures, movements, exercises and the therapy itself. Seven patients participated in this trial in a total of 19 sessions, and the system recorded 3865 exercise executions. The group showed general support for telerehabilitation and the possibilities that systems such as KiReS bring to physiotherapy treatment., (© The Author(s) 2015.)

Purpose: To examine the effects of telerehabilitation compared with other delivery models for improving physical or functional outcomes in patients with cardiopulmonary diseases., Methods: A search was completed for English language publications from 1990 to August 2013 across 4 electronic databases and gray literature. Inclusion criteria were: (1) home-based telerehabilitation as a core component; (2) at least 2 exercise sessions; (3) randomized controlled trials; and (4) reporting of physical or functional outcome measures in adult patients with coronary heart disease, chronic heart failure, and chronic respiratory disease. Studies were independently screened by 2 reviewers and graded by a reviewer according to the Downs and Black checklist. A narrative synthesis of the included studies was undertaken., Results: Eleven studies were analyzed. It appears that telerehabilitation is no different to other delivery models for patients with cardiopulmonary diseases, in terms of exercise capacity expressed as distance on the 6-minute walk test and peak oxygen consumption and quality of life. Telerehabilitation appears to have higher adherence rates compared with center-based exercise. There has been similar or no adverse events reported in telerehabilitation compared with center-based exercise., Conclusions: Although telerehabilitation shows promise in patients with cardiopulmonary diseases, compelling evidence is still limited. There is a need for more detailed, high-quality studies and for studies on the use of video-based telerehabilitation.

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials). [ABSTRACT FROM AUTHOR]

Objective: To investigate the self-reported confidence of final year Australian physiotherapy students and recent graduates in their capability to deliver care via videoconferencing. Design: A national cross-sectional survey Participants: Australian physiotherapy students enrolled in their final year of an entry-to-practice physiotherapy program and recent graduates (graduating year 2020 or 2021) from an entry-to-practice physiotherapy program. Methods: Participants were recruited via email invitation from their university, direct invitation during a lecture/tutorial and advertisements on social media. Participants rated their confidence (using 4-point Likert scales) in performing 60 individual core capabilities across seven domains from an international core capability framework developed for physiotherapists delivering quality care via videoconferencing. Data were dichotomised with 'moderately confident' and 'extremely confident' deemed as 'confident' and 'slightly confident' and 'not confident' deemed as 'not confident'. Results: 343 participants from 20 (out of 25) Australian universities offering entry-to-practice physiotherapy programs completed the survey. The most common program participants were enrolled in/completed was a Bachelor of Physiotherapy (61%, n=209). Overall, most (75-100%) participants were confident in the domain 'delivery of telehealth', many (51-74%) were confident in domains of 'patient privacy and confidentiality', 'patient safety', 'assessment and diagnosis', 'care planning and management', and some (25-50%) were confident in 'technology skills' and 'compliance' issues. Conclusion: Findings from this study highlight areas where final year entry-to-practice physiotherapy students and recent graduates may need additional support and training to deliver quality care via videoconferencing. These findings can inform the content of telehealth physiotherapy curricula. [ABSTRACT FROM AUTHOR]

Background: To explore attitudes to telehealth education and experiences incorporating telehealth education into entry‐to‐practice physiotherapy programs in Australia, from the perspective of university educators. Methods: Qualitative design based on a constructivist paradigm and a phenomenological approach. Sixteen university educators (who had a responsibility for telehealth curriculum or oversight of the broader curriculum in an entry‐to‐practice physiotherapy programme at an Australian university) were recruited. Individual semi‐structured interviews were conducted via Zoom. Interviews were recorded, transcribed verbatim, and analysed thematically using an inductive approach. Results: Three themes (with associated subthemes) were identified: (i) telehealth education has a role in contemporary physiotherapy practice (COVID‐19 pandemic was a driver for telehealth education, acknowledgement that telehealth is here to stay and identified areas of focus for telehealth education and training); (ii) telehealth education and training vary substantially (content delivered and assessment of telehealth competency is ad hoc and student exposure to telehealth on clinical placements is inconsistent); (iii) challenges in telehealth education (finding space and time in the curriculum, as well as insufficient knowledge and expertise of staff, are challenges for implementation of telehealth education, however, course and subject development and/or reviews provide opportunities for implementing telehealth education and training). Conclusion: Current content and volume of telehealth education and training in entry‐to‐practice physiotherapy programs across Australia varies substantially. Although educators believe telehealth is an important component of contemporary physiotherapy practice, many barriers exist for including telehealth training into the curriculum. [ABSTRACT FROM AUTHOR]

Objective: To investigate how a rural simulation activity influenced physiotherapy students' rural empathy, and to explore students' perception of the activity. Setting: A metropolitan university in Queensland, Australia. Participants: Second year undergraduate physiotherapy students. Design: A single cohort pre‐test post‐test evaluation was undertaken to evaluate a rural simulation activity. Participants received the rural simulation activity, featuring an immersive video and telehealth simulation with a standardised patient portrayed by an actor. Participants undertook a structured debrief and guided reflection following the simulation. Outcome measures included the Rural Comprehensive State Empathy Scale (R‐CSES) and the Satisfaction with Simulation Experience Scale. Group interviews were undertaken regarding participant perceptions of the activity. Wilcoxon Rank‐Sum tests were used to analyse survey data, and group interview data were subject to thematic analyses. Results: A total of 102 students undertook the activity, with an outcome measure response rate of 92.2% (94/102). Intra‐personal rural empathy increased following the activity as demonstrated by the overall R‐CSES score [pre‐test: 101.5 (90–110.75) vs post‐test 107 (100–120); p = <0.001; r = 0.39]. There was high satisfaction with the experience [mean SSES score = 18/21]. Two themes were generated from the group interview data: (1) effect on perceptions of rural practice and (2) feedback regarding the simulation. Conclusion: A rural simulation activity using an immersive video, standardised patient, and a structured debrief increased physiotherapy students' empathy towards Australians living in rural settings. Students were satisfied with the activity and felt that it improved their understanding of the challenges of rural healthcare. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has necessitated a rapid transition to telehealth for the delivery of many Australian physiotherapy services. Little is known about new-graduate training needs in this method of service delivery. Aim To explore the readiness and specific training needs of new-graduate physiotherapists for telehealth service delivery in Australia. Qualitative individual telephone interviews of new-graduate physiotherapists (n = 16) and two videoconference focus groups of supervisors of new-graduate physiotherapists (n = 7) were undertaken. Thematic analysis was used. Two global themes each with three organizing themes were generated. The two global themes were "support needs for novice practitioners" and "how to best prepare for telehealth." New-graduate physiotherapists and supervisors perceive that pre-professional exposure to, and practical skills training for, telehealth is essential. Elements such as undertaking physical assessments via telehealth, verbal communication, and effective clinical reasoning in telehealth assessment and treatment were highlighted as areas of need. Both stakeholder groups perceived that the rapid transition to telehealth challenged the self-efficacy of new-graduates as they did not have clinical experience to rely on. The preparation, and ongoing support of new-graduates to adopt telehealth in the workplace is considered critical given the shift in Australian healthcare to online platforms. [ABSTRACT FROM AUTHOR]

Scope: In March 2020, COVID-19 restrictions prompted services delivered by student-led clinics in the university sector to transition to telehealth. This provided a unique opportunity to explore the challenges and opportunities faced by clinical educators when supervising students to deliver telehealth. Methodology: Semi-structured interviews were conducted with allied health clinical educators who supervised students on clinical placement who were required to provide services via telehealth. Clinical educators across the disciplines of audiology, occupational therapy, physiotherapy, and speech pathology were asked to reflect on their experiences and perceptions of the rapid transition to a telehealth model for student clinical placements. A content analysis approach was used to analyse qualitative data. Conclusions: From the perspective of clinical educators, student-led telehealth services can effectively meet client needs while achieving student learning outcomes. This study highlights many opportunities for student learning via telehealth in the clinical education environment and the role of the clinical educator in the learning experience. [ABSTRACT FROM AUTHOR]

Background: Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). Maintenance of functional communication and swallowing over time is challenging for the person with PD and their families and may lead to social isolation and reduced quality of life if not addressed. Speech and language therapists (SLTs) face the conundrum of providing sustainable and flexible services to meet the changing needs of people with PD. Motor, cognitive and psychological issues associated with PD, medication regimens and dependency on others often impede attendance at a centre‐based service. The access difficulties experienced by people with PD require a disruptive service approach to meet their needs. Technology‐enabled management using information and telecommunications technologies to provide services at a distance has the potential to improve access, and enhance the quality of SLT services to people with PD. Aims: To report the status and scope of the evidence for the use of technology in the management of the communication and swallowing disorders associated with PD. Methods & Procedures: Studies were retrieved from four major databases (PubMed, CINAHL, EMBASE and Medline via Web of Science). Data relating to the types of studies, level of evidence, context, nature of the management undertaken, participant perspectives and the types of technologies involved were extracted for the review. Main Contribution: A total of 17 studies were included in the review, 15 of which related to the management of communication and swallowing disorders in PD with two studies devoted to participant perspectives. The majority of the studies reported on the treatment of the speech disorder in PD using Lee Silverman Voice Treatment (LSVT LOUD®). Synchronous and asynchronous technologies were used in the studies with a predominance of the former. There was a paucity of research in the management of cognitive‐communication and swallowing disorders. Conclusions & Implications: Research evidence supporting technology‐enabled management of the communication and swallowing disorders in PD is limited and predominantly low in quality. The treatment of the speech disorder online is the most developed aspect of the technology‐enabled management pathway. Future research needs to address technology‐enabled management of cognitive‐communication and swallowing disorders and the use of a more diverse range of technologies and management approaches to optimize SLT service delivery to people with PD. [ABSTRACT FROM AUTHOR]

Chronic spinal pain conditions can often be successfully managed by a non-surgical, multidisciplinary approach, however many individuals are unable to access such specialised services within their local community. A possible solution may be the delivery of care via telerehabilitation. This study aimed to evaluate clinicians' perspectives on providing clinical care via telerehabilitation during the early implementation of a novel spinal telerehabilitation service. Eight clinicians' were recruited, completing surveys at four separate time points. Confidence in providing treatment via telerehabilitation significantly improved with time (Χ²(3)=16.22, p=0.001). Clinicians became significantly more accepting of telerehabilitation being a time- (Χ²(3)=11.237, p=0.011), and cost-effective (Χ²(3)=9.466, p=0.024) platform in which they could deliver care. Overall satisfaction was high, with technology becoming easier to use (p=0.026) and ability to establish rapport significantly improved with experience (p=0.043). Understanding clinicians' perspectives throughout the early implementation phase of a new telerehabilitation service is a critical component in determining long-term sustainability. [ABSTRACT FROM AUTHOR]

Background: Speech-language pathologists (SLPs) have begun to incorporate telepractice methods into clinical service delivery and online intervention for aphasia is recognised as an appropriate alternative to face-to-face services. However, little is known about the SLP experience of telepractice with no known study exploring the provision of aphasia group therapy online. The purpose of this study was to describe the experience of SLPs who provided the online aphasia group therapy, Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN), to people with aphasia (PWA) and their perceptions regarding the outcomes of intervention and feasibility of implementation into clinical practice. Aims: The aim of this study was to describe the experience of SLPs who provide TeleGAIN to people with aphasia including the perceived outcomes of the intervention and treatment procedures. Methods & Procedures: Three SLPs with experience in aphasia rehabilitation delivered at least one 12 week block of TeleGAIN - an aphasia group intervention purposefully developed for delivery via telepractice. Prior to TeleGAIN, SLPs were trained in using the technology required and the goals, activities, and constructs of TeleGAIN. The goals of TeleGAIN for PWA were to 1) create opportunities for communicative success, 2) share personal life history, and 3) provide support for living successfully with aphasia through networking with others. The SLPs provided this intervention to 21 PWA across six groups. Following completion of all treatment blocks, each SLP participated in a semi-structured interview exploring their perceptions of TeleGAIN and the potential for implementation. Interviews were analysed using qualitative content analysis and key categories were identified. Outcomes & Results: SLPs enjoyed providing the online aphasia group therapy TeleGAIN, and considered the intervention to be feasible and worthwhile. SLPs developed a range of strategies to manage the barriers to implementing the online group successfully and promoted those factors that facilitated more efficient and effective group sessions. In addition, benefits for individuals with aphasia, SLPs and SLP services were recognised despite challenges with technology and group dynamics experienced during TeleGAIN. Conclusions: The results from this study suggested that although SLPs may take time to improve their skills and confidence in telepractice, they were successfully able to provide online group aphasia therapy to PWA. The experience of the SLPs in this study suggested that commonly cited barriers to telepractice such as rapport building and technology issues were able to be overcome. SLPs perceived that TeleGAIN offered PWA many communication and psychosocial benefits and may improve SLP service provision. Findings support investigation of the implementation of TeleGAIN into clinical services. [ABSTRACT FROM AUTHOR]

Despite documented benefits, many Total Joint Replacement (TJR) patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients. TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72%) and internet (69%) at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication. Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology [ABSTRACT FROM AUTHOR]

Background: Usability is an emerging domain of outcomes measurement in assistive technology provision. Currently, no questionnaires exist to test the usability of mobile shower commodes (MSCs) used by adults with spinal cord injury (SCI). Objective: To describe the development, construction, and initial content validation of an electronic questionnaire to test mobile shower commode usability for this population. Methods: The questionnaire was constructed using a mixed-methods approach in 5 phases: determining user preferences for the questionnaire's format, developing an item bank of usability indicators from the literature and judgement of experts, constructing a preliminary questionnaire, assessing content validity with a panel of experts, and constructing the final questionnaire. Results: The electronic Mobile Shower Commode Assessment Tool Version 1.0 (eMAST 1.0) questionnaire tests MSC features and performance during activities identified using a mixed-methods approach and in consultation with users. It confirms that usability is complex and multidimensional. The final questionnaire contains 25 questions in 3 sections. The eMAST 1.0 demonstrates excellent content validity as determined by a small sample of expert clinicians. Conclusion: The eMAST 1.0 tests usability of MSCs from the perspective of adults with SCI and may be used to solicit feedback during MSC design, assessment, prescription, and ongoing use. Further studies assessing the eMAST's psychometric properties, including studies with users of MSCs, are needed. [ABSTRACT FROM AUTHOR]

Objective: Recent research supports the proposal that valid and reliable clinical swallow examinations (CSEs) can be conducted via telerehabilitation. However, no studies have explored whether dysphagia severity has an impact on the success of the session or its outcomes. The current study examined how dysphagia severity impacted on either (a) clinical decision making for safety of oral intake or (b) clinician perceptions of CSEs conducted via telerehabilitation. Subjects and Methods: One hundred patients (25 nondysphagics and 25 mild, 25 moderate, and 25 severe dysphagics) were assessed using a telehealth system and methodology reported in prior research. For each assessment, the online and face-to-face (FTF) clinicians simultaneously completed a structured CSE. On session completion, the online clinician indicated level of agreement with two statements regarding the level of rapport and ability to competently assess the patient. Results: In each of the four groups, acceptable levels of agreement were observed between raters for the three primary outcomes (decisions regarding oral/nonoral intake and safe food and fluids) as well as over 90% of the CSE items. Clinicians agreed they could develop good rapport with the majority of patients in all groups. However, for a small but significant (p <0.5) proportion of patents in the severe dysphagic group, clinicians disagreed they were able to satisfactorily and competently assess to the best of their abilities using the telerehabilitation system. Conclusions: Clinical decisions made during and as an outcome of the total CSE were found to be comparable to those made in the FTF environment regardless of dysphagia severity. Clinicians noted some difficulty assessing patients with greater complexity, which occurred in greater numbers in the group with severe dysphagia. [ABSTRACT FROM AUTHOR]

To gain insight into factors which may influence future acceptance of dysphagia management via telerehabilitation, patients' perceptions were examined before and after a telerehabilitation assessment session. Forty adult patients with dysphagia (M =66 years, SD =16.25) completed pre- and post-session questionnaires which consisted of 14 matched questions worded to suit pre- and post-conditions. Questions explored comfort with the use of telerehabilitation, satisfaction with audio and video quality, benefits of telerehabilitation assessments and patients' preferred assessment modality. Questions were rated on a 5-point scale (1 = strongly disagree, 3 = unsure, 5 = strongly agree). Patients' comfort with assessment via telerehabilitation was high in over 80% of the group both pre- and post-assessment. Pre-assessment, patients were unsure what to expect with the auditory and visual aspects of the videoconference, however there were significant positive changes reported post-experience. In relation to perceived benefits of telerehabilitation services in general, most patients believed in the value of telerehabilitation and post-assessment this increased to 90-100% agreement. Although 92% felt they would be comfortable receiving services via telerehabilitation, 45% of patients indicated ultimate preference for a traditional face-to-face assessment. The data highlight that patients are interested in and willing to receive services via telerehabilitation; however, any concerns should be addressed pre-assessment. [ABSTRACT FROM AUTHOR]

Background: Telerehabilitation may be a feasible solution to the current problems faced by people with Parkinson's disease in accessing speech pathology services. Aim: To investigate the validity and reliability of online delivery of the Lee Silverman Voice Treatment (LSVT®) for the speech and voice disorder associated with Parkinson's disease. Method & Procedures: Thirty-four participants with Parkinson's disease and mild-to-moderate hypokinetic dysarthria took part in the randomized controlled non-inferiority laboratory trial and received the LSVT® in either the online or the face-to-face environment. Online sessions were conducted via two personal computer-based videoconferencing systems with real-time and store-and-forward capabilities operating on a 128 kbit/s Internet connection. Participants were assessed pre- and post-treatment on acoustic measures of mean vocal sound pressure level, phonation time, maximum fundamental frequency range, and perceptual measures of voice, articulatory precision and speech intelligibility. Outcomes & Results: Non-inferiority of the online LSVT® modality was confirmed for the primary outcome measure of mean change in sound pressure level on a monologue task. Additionally, non-significant main effects for the LSVT® environment, dysarthria severity, and interaction effects were obtained for all outcomes measures. Significant improvements following the LSVT® were also noted on the majority of measures. The LSVT® was successfully delivered online, although some networking difficulties were encountered on a few occasions. High participant satisfaction was reported overall. Conclusions & Implications: Online treatment for hypokinetic dysarthria associated with Parkinson's disease appears to be clinically valid and reliable. Suggestions for future research are outlined. [ABSTRACT FROM AUTHOR]

Background: Patients with Parkinson's disease face numerous access barriers to speech pathology services for appropriate assessment and treatment. Telerehabilitation is a possible solution to this problem, whereby rehabilitation services may be delivered to the patient at a distance, via telecommunication and information technologies. A number of studies have demonstrated the capacity of telerehabilitation to provide reliable and valid assessments of speech, voice and language. However, no studies have specifically focused on assessing patients with Parkinson's disease. Aims: To investigate the validity and reliability of a telerehabilitation application for assessing the speech and voice disorder associated with Parkinson's disease. Methods & Procedures: Sixty-one participants with Parkinson's disease and hypokinetic dysarthria were simultaneously assessed in an online and face-to-face environment by two speech-language pathologists. The assessment protocol included perceptual measures of voice and oromotor function, articulatory precision, speech intelligibility, and acoustic measures of vocal sound pressure level, phonation time and pitch range. Online assessments were conducted via a personal computer-based videoconferencing system with store-and-forward capabilities, operating on a 128 kbit/s Internet connection. The level of agreement between the online and face-to-face ratings was determined using several different analyses, depending on the parameter. These included per cent close agreement, quadratic weighted Kappa, and the Bland and Altman limits of agreement. Outcomes & Results: Per cent close agreement between the two environments was within a predetermined clinical criterion of 80% agreement for all voice and oromotor parameters, articulatory precision and speech intelligibility in conversation. Levels of agreement between the environments, based on quadratic weighted Kappa, ranged from poor to good for vocal parameters and from fair to very good for oromotor parameters. Bland and Altman limits of agreement analyses revealed comparability between online and face-to-face environments for vocal sound pressure level, phonation time, pitch range, sentence intelligibility and communication efficiency in reading. Intra- and inter-rater reliability scores for all tasks were comparable between the online and face-to-face environments. Conclusions & Implications: For the majority of parameters, comparable levels of agreement were achieved between the two environments. Online assessment of disordered speech and voice in Parkinson's disease appears to be valid and reliable. The telerehabilitation application described in this study provides evidence for the delivery of online assessment for the dysarthric speech disorder associated with Parkinson's disease. [ABSTRACT FROM AUTHOR]

Background and Purpose. Musculoskeletal injuries are the most common source of chronic pain and disability. The ankle joint is the most common of these injuries and without adequate rehabilitation function can be severely impaired. Access to physiotherapy rehabilitation services can be limited due to geographical remoteness and a shortage of services in rural and remote areas. Telerehabilitation is a potential solution to bridge this service delivery gap. The aim of this study was to determine the criterion validity and reliability of conducting a remote musculoskeletal assessment of the ankle joint complex using telerehabilitation technologies compared with a face-to-face assessment. Methods. This study utilized a repeated measures design to assess 15 subjects (mean age 24.5, SD 10.8 years) presenting with ankle pain. Conventional face-to-face assessments were compared with assessments performed via a telerehabilitation system. Results. A similar agreement of 93.3% in patho-anatomical diagnosis and an 80% exact agreement (χ2 = 4.267; p < 0.04) in primary systems diagnosis was found between face-to-face and telerehabilitation assessments. Clinical observations were found to have very strong agreement (k = 0.92) for categorical data and significant agreement (93.3% agreement; χ2 = 234.4; p < 0.001) for binary data. A high level of inter- and intrarater reliability was found for the telerehabilitation assessments. Conclusions. This study demonstrates the criterion validity and reliability of remote musculoskeletal assessments of the ankle joint complex using telerehabilitation. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of studies that have used videoconferencing to assess speech and language skills in people with acquired neurogenic communication disorders. However, few studies have focused on cases of apraxia of speech. In order to perform accurately differential diagnosis via the telerehabilitation medium, it is important that validation of the assessment of apraxia of speech be established as part of the overall evidence base for telerehabilitation communication assessment protocols. Aims: To determine if valid and reliable assessment of apraxia of speech using a standardized assessment tool was feasible via telerehabilitation. Methods & Procedures: Eleven participants with an acquired apraxia of speech were assessed simultaneously via telerehabilitation and face-to-face methods on the Apraxia Battery for Adults — 2 (ABA-2). A custom-built telerehabilitation system developed at the University of Queensland enabled real-time telerehabilitation assessment over a 128 kbit/s internet connection. Data analysis included tests of significant difference between raw scores using the Wilcoxon signed rank statistic and analysis of the degree of agreement between the two methods using weighted Kappa statistics. Inter- and intra-rater reliabilities were also examined for the telerehabilitation-led assessments. Outcomes & Results: Results revealed no significant differences between the subtest scores of the ABA-2 obtained in the telerehabilitation and face-to-face test environments (p = 0.06-0.68). Weighted Kappa statistics indicated moderate to very good agreement (0.59-1.00) between the two environments for the subtests of the ABA-2. The reliability study was hampered by small sample size; however, the data were suggestive of reasonable reliability. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the telerehabilitation environment. The speech-language pathologists (SLP) reported some difficulties assessing participants with severe apraxia of speech via the telerehabilitation system. Conclusions & Implications: This study suggests that valid assessment of apraxia of speech using the ABA-2 over the internet is feasible. The reliability study on the telerehabilitation assessments was encouraging with results suggesting that telerehabilitation assessment using the ABA-2 could be reliable. Findings from the participant satisfaction questionnaire were favourable. However, comments from the SLP suggested that participants exhibiting severe apraxia of speech might be better suited to face-to-face assessment. These findings may have implications for the development of evidence-based guidelines for the use of telerehabilitation in the assessment of apraxia of speech. The authors propose that future research should include larger sample sizes with a range of participant severity levels and be conducted over higher bandwidth connections to explore further the validity and reliability of telerehabilitation assessment of apraxia of speech. [ABSTRACT FROM AUTHOR]

The ability to measure activities of daily living (ADL) and hand function for people with Parkinson's disease via an Internet-based telerehabilitation system would have a significant impact on the equity, accessibility, and management of the condition for patients who live in rural and remote communities. A low-bandwidth computer-based telerehabilitation system, which incorporates videoconferencing with calibrated assessment tools, has been recently developed at the University of Queensland. This study aimed to determine the validity, intra- and inter-rater reliability of the telerehabilitation system in measuring ADL and hand function in 12 people with Parkinson's disease. ADL status was assessed using the motor component of the Functional Independence Measure (FIM) and selected items from the Unified Parkinson's Disease Rating Scale (UPDRS). The Nine Hole Peg Test, Jamar dynamometer and Preston pinch gauge were also used to assess hand function. For half of the participants, an assessor administered assessments in the traditional face-to-face manner while another assessor simultaneously scored the same assessments via the telerehabilitation system. For the remaining participants, the telerehabilitation assessor administered the assessments via the telerehabilitation system while a face-to-face assessor simultaneously scored the assessments. The telerehabilitation system was found to be a valid measure of ADL status and hand function in people with Parkinson's disease and to have a high level of intra- and inter-rater reliability (all ICCs > 0.80). These results suggest that therapists can confidently use a low-bandwidth telerehabilitation system to assess ADL status and hand function in people with Parkinson's disease. [ABSTRACT FROM AUTHOR]

Telerehabilitation in which rehabilitation services are provided at a distance using communication technologies is a new and developing field of telehealth. Primarily developed to provide equitable access to individuals who are geographically remote and to those who are physically and economically disadvantaged, telerehabilitation also has the capacity to improve the quality of rehabilitation health care. Online delivery of rehabilitation enables the rehabilitation therapist to optimize the timing, intensity and duration of therapy that is often not possible within the constraints of face-to-face treatment protocols in current health systems. This chapter outlines the advances made to date in telerehabilitation applications in the fields of physiotherapy, speech-language pathology, occupational therapy, and biomedical engineering and provides evidence for the success of these applications. Applications to date encompass systems ranging from low-bandwidth low-cost videophones, to highly expensive, fully immersive virtual reality systems with haptic interfaces. A number of barriers to the establishment and advancement of telerehabilitation within health care systems have been outlined and include professional issues relating to the inherent hands-on approach of some treatments, licensure laws, professional skill development, patient disability, reimbursement, and the paucity of online assessment and treatment tools and outcomes data. In response, possible solutions to these barriers such as the development and validation of alternative assessment and treatment procedures, involvement in the international policy debate, as well as the resolution of national professional policies which hinder the wider uptake of telerehabilitation technologies, have been outlined. The future of telerehabilitation is promising as a new, yet complex form of telehealth with the capacity to provide a wide range of services specifically designed to suit the needs of the individual. [ABSTRACT FROM AUTHOR]