International Journal of Telerehabilitation http://www.telerehab.pitt.edu/ojs/Telerehab <p>The International Journal of Telerehabilitation (IJT) is a biannual journal dedicated to advancing telerehabilitation by disseminating information about current research and practices.</p> <p>IJT accepts original research, systematic reviews on novel topics, case studies, viewpoints, technology reviews, book reviews, and country reports that detail the status of telerehabilitation. IJT accepts manuscript submissions between January 5<sup>th</sup> – March 1st for the Spring issue and July 1<sup>st</sup> – September 30<sup>th</sup> for the Fall issue.&nbsp; All manuscripts receive a first-level review by Editorial Board members.&nbsp; Results of the first-level review are shared with authors immediately upon review completion.&nbsp; Manuscripts receiving favorable first-level reviews are sent for blinded second-level reviews to reviewers (Editorial Board members, Section Editors, and/or invited reviewers with expertise in the subject matter).&nbsp; Authors are notified of second-level review results for the Spring issue in April, and in October for the Fall issue.&nbsp; The Spring issue of IJT is published in June and the Fall issue of IJT is published in December of each year.&nbsp;</p> University Library System, University of Pittsburgh en-US International Journal of Telerehabilitation 1945-2020 <p>Authors who publish with this journal agree to the following terms:</p><ol><li>The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.</li><li>Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.</li><li>The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a <a title="CC-BY" href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution 4.0 International License</a> or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:<ol type="a"><li>Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;</li></ol>with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.</li><li>The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.</li><li>Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.</li><li>The Author represents and warrants that:<ol type="a"><li>the Work is the Author’s original work;</li><li>the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;</li><li>the Work is not pending review or under consideration by another publisher;</li><li>the Work has not previously been published;</li><li>the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and</li><li>the Work contains no libel, invasion of privacy, or other unlawful matter.</li></ol></li><li>The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.</li></ol><p><span style="font-size: 75%;">Revised 7/16/2018. Revision Description: Removed outdated link. </span></p> Feasibility and Perception of a Diet and Exercise Intervention Delivered via Telehealth to Firefighters http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6458 <p><strong>Introduction: </strong>Firefighters have a high risk of cardiovascular incidence due to their poor health, fitness, and dietary habits. The purpose of this study was to examine the feasibility of a diet and exercise intervention within firefighters delivered exclusively via telehealth to help reduce the risks of cardiovascular disease. Additionally, the firefighters’ perception of their health was assessed. <strong>Methods: </strong>Fifteen firefighters participated in a six-week Mediterranean diet and a functional circuit exercise intervention with pre- and post-fitness testing and survey completion. The firefighters had weekly video calls with their telehealth coach. <strong>Results: </strong>Self-assessed health improved with the intervention from an average of 5.9 to 7.9 out of 10. Both weight and BMI significantly decreased with the intervention. Overall, firefighters had high adherence to both portions of the intervention. <strong>Discussion: </strong>Telehealth interventions may be efficacious in improving firefighter fitness levels and overall health as firefighters saw positive health and fitness improvements.</p> <p>&nbsp;</p> Stephanie Donahue Carly McMorrow Andrew A. Almeida Deborah Feairheller Copyright (c) 2022 Stephanie Donahue, Carly McMorrow, Andrew A. Almeida, Deborah Feairheller 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6458 Comparison of Goal Achievement When Transitioning from In-Person Therapy to Teletherapy in the Westchester County Early Intervention Program Due to the COVID-19 Pandemic http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6450 <p>The sudden transition to virtual therapeutic services during the COVID-19 pandemic provided a unique opportunity to explore telehealth as a platform for delivering early intervention (EI) services. Through retrospective chart review of 93 children, we collected the following data: demographics, diagnosed conditions, therapy type, service format, and provider-reported participant goal achievement (1=no progress, 2=little progress, 3=moderate progress, 4=great deal of progress, 5=outcome achieved) over a six-month period before and after transitioning to telehealth. Pre- and post-transition progress scores were compared using the Wilcoxon signed-rank test. Results demonstrated maintained progress among children who transitioned from in-person to virtual services for similar therapy types. Children receiving speech therapy in-person and virtually demonstrated increased achievement (3.00 vs 3.33; p=0.032). Participants receiving a particular therapy post-transition but not in-person attained similar achievement as those who received the same therapy only in-person. Our research suggests that teletherapy may be a viable option for delivering EI services.</p> <p>&nbsp;</p> Inna C. De Leon JennaLynn Philipps Marina Yoegel Joseph Byrnes Jordan S. Kase Copyright (c) 2022 Inna C. De Leon, JennaLynn Philipps, Marina Yoegel, Joseph Byrnes, Jordan S. Kase 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6450 COVID-19 Lessons From The Field: Toward A Pediatric Physical Therapy Telehealth Framework http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6448 <p><strong>Introduction</strong>: Telehealth is an established health service delivery method, yet little is known regarding pediatric physical therapy telehealth. We aimed to evaluate users’ experiences and create a framework for effective delivery. <strong>Methods:</strong> A pediatric physical therapists’ telehealth user survey was conducted. <strong>Results</strong>: Seventy-three respondents varied in years of experience and caseload. Most found telehealth easy to learn and use, and they believed the treatment they delivered was useful. Three main themes for successful treatments emerged and were organized into a framework for effective delivery: (1) caregivers’ involvement; (2) therapist telehealth ‘toolbox’ (sub-divided into: treatment management tools, and therapist-caregivers’ collaboration tools); and (3) telehealth client (child) characteristics. <strong>Conclusion</strong>: This study suggests a new framework for effective pediatric physical therapy telehealth delivery to support best practice, for use by administrators and therapists and recommends directions for further research.</p> Galia Daube Fishman Jeananne Elkins Copyright (c) 2022 Galia Daube Fishman, Jeananne Elkins 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6448 A Mindfulness Program Addressing Sleep Quality and Stress: Transition to a Telehealth Format for Higher Education Students During COVID-19 http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6439 <p>Many higher education students report sleep problems, further exemplified along with stress at the onset of the COVID-19 pandemic. Promising evidence supports the use of mindfulness programming, although synchronous telehealth sessions have not been adequately examined. This exploratory eight-session telehealth mindfulness program utilized a pretest-posttest quantitative design to examine changes in sleep quality and perceived stress for 16 higher education students enrolled at a health professions-focused university. Sleep quality changes were measured using the Pittsburgh Sleep Quality Index (Z=-3.234, p=0.0012, d=-0.808) and perceived stress with the Perceived Stress Scale (Z=-3.102, p=0.0019, d=-0.776), both of which were significant. The results suggest that synchronous mindfulness programming delivered via telehealth has the potential to improve sleep quality and perceived stress in students, however, future studies should consider the use of objective measurements of sleep duration and quality, and a control group.</p> Sara Benham Nabila Enam Samanvita Ivaturi Copyright (c) 2022 Sara Benham, Nabila Enam, Samanvita Ivaturi 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6439 Feasibility of Virtual Assessment of Physical Frailty in Solid Organ Transplant Recipients – A Single Centre, Observational Study http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6447 <p><strong>Objectives: </strong>To describe the feasibility of virtual assessments of physical frailty in solid organ transplant (SOT) recipients using a modified Fried Frailty Index (mFFI) and Short Physical Performance Battery (SPPB), and to describe the prevalence of frailty 12-months post-transplant using virtual assessment. <strong>Methods:</strong> Virtual assessments were performed using an e-questionnaire and a video-call for functional tests. Feasibility variables included: internet quality, video-call duration, presence of a companion, and adverse events. <strong>Results</strong><em>:</em> 34 SOT recipients, median age 62 (46-67), 76% lung recipients, 47% female, were included. The video-call had a median duration of 12 minutes (10-15 min), without adverse events. A companion was present in 23 (68%) video-call assessments. Fifteen SOT recipients (44%) were classified as pre-frail by the mFFI, and none were frail. Three participants (8.8%) were classified as frail using the SPPB. <strong>Conclusion</strong><em>:</em> Virtual frailty assessments can be used as an alternative to in-person assessments in SOT recipients.</p> Manoela de Paula Ferreira Noori Chowdhury Lisa Wickerson Heather Ross Nazia Selzner S. Joseph Kim Lianne G. Singer Sunita Mathur Copyright (c) 2022 Manoela de Paula Ferreira, Noori Chowdhury, Lisa Wickerson , Heather Ross, Nazia Selzner , S. Joseph Kim , Lianne G. Singer , Sunita Mathur 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6447 Implementing Team-Based Post-Stroke Telerehabilitation: A Case Example http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6438 <p>Access to extensive, interdisciplinary rehabilitation following stroke is necessary to optimize recovery. Telerehabilitation is an appropriate model for delivering these services. However, given its relatively recent increase in popularity as a service delivery model, researchers have yet to explore the feasibility of interprofessional coordination and collaboration as a guiding framework for telerehabilitation and the effects of team-based remote service delivery on recovery of body functions and activities. This case example reports the development, implementation, and progression of a post-acute treatment program delivered via telerehabilitation to a woman with left hemorrhagic stroke. As is typical, therapy time alone afforded insufficient practice to exploit neuroplasticity and ensure maintenance and generalization of improved functioning; hence, the team worked collaboratively to encourage interdisciplinary activities outside scheduled treatment sessions. Standardized and informal assessments administered at the start and conclusion of treatment confirmed improved functioning as did the client’s progress toward independent living and return to work. Implications for telerehabilitation practices are discussed. &nbsp;</p> <p><strong>&nbsp;</strong></p> Melissa Anderson Brad Dexter Ana Hancock Nealey Hoffman Steve Kerschke Karen Hux Dipika Aggarwal Copyright (c) 2022 Melissa Anderson, Brad Dexter, Ana Hancock, Nealey Hoffman, Steve Kerschke, Karen Hux, Dipika Aggarwal 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6438 Editors' Note http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6469 <p>.</p> Ellen R. Cohn Jana Cason Copyright (c) 2022 Ellen R. Cohn, Jana Cason 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6469 Supervising Students During a Global Pandemic: Clinical Educators’ Perceptions of a Student-Led Telerehabilitation Service During COVID-19 http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6464 <p><strong>Scope:</strong> 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. <strong>Methodology:</strong> 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. <strong>Conclusions:</strong> 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.</p> Megan H. Ross Andrea Whitehead Lauren Jeffery Nicole Hartley Trevor Russell Copyright (c) 2022 Megan H. Ross 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6464 Quality of Life in Patients With Heart Failure Assisted By Telerehabilitation: A Systematic Review and Meta-Analysis http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6456 <p>Introduction: Heart failure (HF) is a syndrome that implies several physical and emotional changes that compromise quality of life. Telerehabilitation is a strategy developed with the aim of involving and motivating cardiac patients to participate in cardiac rehabilitation in their daily routine at home. Objective: To review the impact of telerehabilitation on the quality of life of patients with HF. Methods: This is a systematic review using the PICO strategy, with a search conducted in the electronic data sources PubMed, LILACS (Latin American and Caribbean Literature in Health Sciences) and SciELO (Scientific Electronic Library Online), with the following descriptors: heart failure, congestive heart failure, chronic heart failure, distance rehabilitation, virtual rehabilitation, telerehabilitation, telemedicine, quality of life and HRQoL, combined by the Boolean operators “AND” and “OR”, including articles between 2011 and 2021. Results: Nine articles were found after reading the abstract and titles; five of these met the inclusion criteria. They showed that telerehabilitation contributes to a better quality of life due to the daily increase in mental, social, and sexual activities, exercise tolerance, improvement of symptoms such as edema, fatigue, and dyspnea and reduction of mortality and readmission rates. Telerehabilitation was effective in improving quality of life in patients with HF (mean difference (MD) = -0,22; CI 95% -0.40 to 0.04. Conclusion: Telerehabilitation was at least as effective as usual care and conventional cardiac rehabilitation in improving the quality of life in patients with HF.</p> André Luiz Lisboa Cordeiro Andrêza da Silva Miranda Halana Melo de Almeida Paulo Santos Copyright (c) 2022 André Luiz Lisboa Cordeiro, Andrêza da Silva Miranda, Halana Melo de Almeida, Paulo Santos 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6456 An Evaluation of Telepractice During the COVID-19 Pandemic for the Treatment of Speech and Language Disorders in Belgium http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6411 <p class="AbstractBodyText">The aim of this article was to evaluate the sudden implementation of telepractice in Belgium during the COVID-19 pandemic. A 38-question survey was completed by 1,222 Dutch-speaking speech-language pathologists (SLPs) from Belgium. Most reported good or very good satisfaction with telepractice and that telepractice can be effectively used with clients of different ages and speech disorders with or without comorbidity. The SLPs reported when telepractice could be used most effectively. They also detailed their difficulties with both technology and client-related issues. Limitations when switching to telepractice included a lack of training and experience, and digital materials.</p> Ronny Boey Stefaan Lefevere Copyright (c) 2022 Ronny Boey, Stefaan Lefevere 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6411 Benefits and Challenges of Telerehabilitation Use By Pediatric Physiotherapists During the COVID-19 Pandemic In Western and Southern India: A Cross Sectional Survey http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6466 <p>As the worldwide COVID-19 pandemic spread, many physiotherapists chose telerehabilitation (TR) to continue delivering therapy. This study was conducted to document the perceived benefits and challenges of TR faced by pediatric physiotherapists in western and southern India.&nbsp; Using the snowball method, electronic survey forms were distributed to 275 pediatric physiotherapists in Western and Southern India; 110 responses were available for analysis. A majority of respondents had experience with TR (n=83, 75.5%), while others had never used TR (n=27, 24.5%). TR was reported to be less effective than in-person therapy for treating children and adolescents during the COVID-19 pandemic. Therapists reported significant difficulties during TR sessions; these included assessing and modifying exercises for children. As the popularity of TR grows, pediatric physiotherapists will need to be aware of the benefits and challenges they will face during TR sessions. Most pediatric physiotherapists believed the interaction between parents and therapists is a requisite for optimal service delivery.</p> Shukra Chivate Mehek Sharma Aamila Shaikh Chandrika Satarkar Copyright (c) 2022 Mehek Sharma 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6466 Telehealth Service Delivery in Medicaid Home- and Community-Based Services for People with Intellectual and Developmental Disabilities http://www.telerehab.pitt.edu/ojs/Telerehab/article/view/6478 <p>Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the largest funding mechanism for Long-Term Supports and Services (LTSS) for people with intellectual and developmental disabilities (IDD) in the United States. This study’s aim was to examine telehealth service provision in Medicaid HCBS waivers for people with IDD. We analyzed fiscal year 2021 Medicaid HCBS waivers for people with IDD and emergency Appendix K authorizations (2020-2022) to examine permanent and temporary use of telehealth respectively. The overwhelming majority of waivers (98.1%) temporarily permitted the use of telehealth service delivery for people with IDD. However, only a fraction (27.6%) permanently included the use of telehealth for people with IDD. The most prevalent types of services that permitted telehealth service delivery were: employment, day, and prevocational services; clinical and therapeutic services; and in-home and residential supports. When developing and implementing telehealth, it is important to consider the needs of people with IDD.</p> Carli Friedman Copyright (c) 2022 Carli Friedman 2022-05-25 2022-05-25 14 1 10.5195/ijt.2022.6478