Occupational Therapy. Tele-health and tele-occupational therapy

Transcription

1 Tele-health and tele-occupational therapy Occupational Therapy Tele-health, telemedicine, or e-health is the use of information and communication technology (ICT) to deliver health services, expertise and information over distance. Typically, it addresses geographic or scheduling barriers, time, social and cultural barriers. Tele-health encompasses internet or web-based e-health, as well as videobased applications. Applications can be synchronous (real-time) or asynchronous (store-and-forward). 1 Tele-occupational therapy is the remote delivery of occupational therapy services through communication and information technologies. 2 The Canadian Association of Occupational Therapists (CAOT) recognizes that tele-health, and specifically the development of tele-occupational therapy will offer increased opportunities for effective, efficient and accessible occupational therapy services to all Canadians in their homes and communities. The growth and sustainability of tele-occupational therapy will be closely linked to high standards of professional service delivery, further investment to advance the development of ICT and effective partnerships that work together toward successful tele-health delivery systems. 3 Occupational therapists like other health professionals are challenged by Canada's vast geography and uneven population to provide timely access to health services. For individuals who cannot easily access occupational therapy services due to challenges related to geography or time constraints, remote access may be a solution. Through the use of tele-occupational therapy, residents of Canada with occupational performance problems will have more opportunities to increase productivity, decrease lifestyle restrictions, and prevent unnecessary dependency. The report from the Commission on the Future of Health Care in Canada, Building on Values: The Future of Health Care in Canada (2002) recommended a national homecare strategy that would enable residents of Canada to receive more timely quality health services at home, relieve pressure on hospitals, and result in significant savings. 4 Tele-occupational therapy could facilitate these outcomes. Furthermore, the Health Care Renewal Accord of February 2003 adopted the expansion for post-acute homecare and palliative homecare. 5 These are two areas where tele-occupational therapy has been demonstrated as valuable. Canadian Association of Occupational Therapists CTTC Bldg, Colonel By Drive Ottawa, ON K1S 5R1 (800) (613)

2 Tele-occupational therapy effectiveness studies Evidence: Tele-occupational therapy is cost-effective The concept of electronic home visits using for example, a video telephone, can be effective for clients who have chronic conditions. The costsavings in these situations are substantial: $80 to $90 per home visit compared to $20 to $35 per tele-health visit. 6 Evidence: Tele-occupational therapy provides timely access to occupational therapy services. Occupational therapists assist individuals in achieving their goals in the areas of self-care, leisure and productivity (paid or unpaid work) but not everyone has access to these services. This is the case for individuals, such as injured farmers who live in rural areas that are geographically remote from the urban centres where most occupational therapists are located. This also applies to persons, such as those with terminal cancer, who may reside in a major city, but choose to die in their homes and require occupational therapy services in their final days. 7 Evidence: Tele-occupational therapy enhances potential for independent living. With the shift to home and community care, early follow-up allows clients to remain in their homes longer and live more independently. This can be possible by using tele-occupational therapy equipment set up in clients' homes thereby allowing occupational therapists to monitor clients in their own environment and addressing issues such as home safety and assistive technology. 8 Clients can be assessed remotely by occupational therapists that specialize in certain areas of practice, e.g. assistive technology, developmental coordination disorder in children or complex seating assessments for individuals that use wheelchairs. 9,10 Coaching, education and problem-solving to address specific strategies can be provided remotely to clients and their family caregivers by an occupational therapist. Evidence: Tele-occupational therapy reduces travel costs and associated stress Tele-occupational therapy is a relatively new service delivery application. At present, most of the evidence supporting the effectiveness of teleoccupational therapy uses a case study methodology. Lili Liu, PhD, in her Visit for further information about occupational therapy. 2

3 report, "Tele-rehabilitation in Canada", illustrated the outcomes of delivery of occupational therapy service from a distance. 8 Joseph, a 25-year-old man was rushed to the University of Alberta Hospital because he had received multiple tendon and nerve lacerations to his right hand. After surgery to repair his injuries, he returned to his home in Cold Lake, a rural town in Alberta. Joseph was on social assistance so follow-up in Edmonton was difficult due to the cost of travel. He had missed two appointments with Wendy Tilley, an occupational therapist at the University of Alberta Hospital. Therefore, mobilization of his tendons could not be initiated in a timely manner. Tilley sent the treatment protocols by fax to Todd Farrell, an occupational therapist in Cold Lake so that Joseph could receive follow-up service in his hometown. Nine weeks after Joseph's surgery, Farrell wanted to confirm that he was following the protocol specified by the University of Alberta team. In January 2000, Tilley provided a consultation to Farrell. Farrell used video-conferencing in Cold Lake to transmit visual images and sound in real-time, while Tilley used a video-telephone at the University of Alberta to receive the signals and to provide her advice. During the consultation, Tilley was able to evaluate Joseph's tendon tightness and the tendon glide by observing gross hand movements and isolating the flexor tendons. Tilley got immediate feedback from the client as to what he felt when he was asked by the therapists to perform certain movements. ß This scenario illustrates the benefits of tele-occupational with the technologies available today. The client was able to receive follow-up services without the expenses and stress of travel. The occupational therapist in Cold Lake was able to deliver intervention consistent with the protocol specified by the surgeon and his team at the University of Alberta Hospital. The occupational therapist in Edmonton was able to share her expertise and provide care in an efficient manner. 8 Visit for further information about occupational therapy. 3

4 Reference List 1. Miyazaki, M., Liu, L., & Kovacs, L. (1998, May/June). Applications of Telehealth in occupational therapy (Abstract page 53). Paper presented at the 12th International Congress of the World Federation of Occupational Therapists, Montreal, Québec. 2. Miyazaki, M., Liu, L., & McCracken, P.N. (1996, November). The use of "Telehealth" for providing services to geriatric clients in remote communities, and for postgraduate education of health professionals. Proceedings of the Gerontological Society of America's 49th Annual Scientific meeting, Washington, DC. (Also published in The Gerontologist, 36 (special issue I), 231). 3. Canadian Association of Occupational Therapists. (2000) Position Statement on Tele-health and Tele-occupational Therapy. Retreived April 26, Web site: 4. Commission on the Future of Health Care in Canada. (2002) Building on Values: The Future of Health Care in Canada. Government of Canada. Retrieved April 26, Web site: ow_e.pdf 5. Health Care Renewal Accord (2003) Government of Canada. Available on the World Wide Web on April 26, Elford, R. Telehome Healthcare. In: First International Congress on Telehealth and Multimedia Technologies. Edmonton, AB: Telehealth Technology Research Institute, In Lili Liu( 2003). Telerehabilitation - An accessible, affordable alternative. Rehab & Community Care Management, Spring, Myasaki,M. & Lili, L. (2002 September/October) Tele-occupational therapy : Make services more accessible. Occupational Therapy Now. 8. Liu, L, (2000). Telerehabilitation in Canada. Unpublished Paper Visit for further information about occupational therapy. 4

5 9. Fulk, Mary Ann. (2002 September/October) Telehealth innovation project. Occupational Therapy Now. 10. Boudreau, Debra (2002 September/October) Meeting children s health needs in rural Nova Scotia Great Idea: Funding needed. Occupational Therapy Now. Ottawa, ON Additional References Liu, L. (2000). Telerehabilitation - An accessible, affordable alternative. Rehab & Community Care Management, Spring, Rosen, M. (2002 Emerging role of telemedicine in home healthcare for the elderly. RESNA 25th International Conference in Technology & disability: Research, Design, and Practice, Minneapolis, MN. ). Ricker, Joseph H.; Rosenthal, Mitchell; Garay, Edward; DeLuca, John; Germain, Anneliese; Abraham-Fuchs, Klaus; Schmidt, Kai-Uwe. (2002) Telerehabilitation needs: A survey of persons with acquired brain injury. Journal of Head Trauma Rehabilitation, 17, Wakeford,L.( November 2002) Telehealth technology for children with special needs. Occupational Therapy Practice (pages 12-16) Visit for further information about occupational therapy. 5