Innovations Using Technology to Closing the Gap between Clinic and Workplace Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Karen Jacobs, EdD, OTR/L, CPE, FAOTA Boston University, Boston, MA Nancy A. Baker, ScD, MPh, OTR/L University of Pittsburg, Pittsburgh, PA Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Imagine the following scenario… Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Learning Objectives • Define telehealth • Discuss models of care in telehealth • Describe a pilot study in tele-ergonomics Arthritis State of the Science Meeting 4 Pentagon City, Virginia | April 7, 2014
Ergonomics “the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design in order to optimize human well-being and overall system performance” (www.iea.cc/01_what/What%20is%20Ergonomics.html ) Arthritis State of the Science Meeting 5 Pentagon City, Virginia | April 7, 2014
Telehealth “…the application of evaluative, consultative, preventative, and therapeutic services delivered through telecommunication and information technologies” (Cason, et al., 2013) Arthritis State of the Science Meeting 6 Pentagon City, Virginia | April 7, 2014
Telehealth Benefits • Reduce inequities in access to health resources by experts remotely to underserved areas • Improve efficiency in delivery of services by eliminating travel time, providing instantaneous access, and improving the coordination of care • Reduce the costs of assessments, interventions, and education • Promote client-centered care, since health professionals can observe clients in their own environments Arthritis State of the Science Meeting 7 Pentagon City, Virginia | April 7, 2014
Methods • Information gathering • POTS • Electronic forms • Webcams/video conferencing • Sensors • Immediate vs stored Pani et al., 2014 • “Direct” or through and intermediary • Considerations • Capacity of technology • Access to technology • Skill of client/therapist Arthritis State of the Science Meeting 8 Pentagon City, Virginia | April 7, 2014
Models of Care in Telehealth Supervision Evaluation Monitoring Consultation Intervention (Richmond, 2013) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Tele-evaluation • Diagnosis or identification of problem areas using telecommunication technologies • Considerations • Type of evaluation (self-report/observational) • Validity of evaluation methods Arthritis State of the Science Meeting 10 Pentagon City, Virginia | April 7, 2014
Evidence: Tele-evaluation Evaluation areas Evaluation Tools • Wheelchair prescription • Functional Reach Test and European Stroke Scale • Barlow, Liu, & Sekulic (2009) • Schein et al., 2008 • Palsbo et al., 2007 • Schein, et al., 2010; • Kohlman Evaluation of Living Skills and • Schein, et al, 2011 the Canadian Occupational • Neurological assessment Performance Measure • Savard et al., 2003 • Dreyer et al., 2001 • Adaptive equipment prescription and • Functional Independence Measure, home modification Jamar Dynamometer, Preston Pinch • Sanford et al., 2007 Gauge, Nine Hole Peg Test, and • Ergonomic assessment Unified Parkinson’s Disease Rating Scale • Baker & Jacobs, 2013 • Hoffman et al., 2008 . Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Example of Tele-evaluation Videoconferencing technology between Assessed Activities of provider and client Daily Living (ADL) Occurred in client’s natural environment (Richmond, 2013) Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Teleconsultation Teleconsultation defined Key Support Studies • Virtual consultation for the • Play performance in purpose of obtaining and children with special needs sharing medical • Wakeford et al., 2002 • Veterans with traumatic information or advice brain injury between: • Girard, 2007 • Expert provider and client; or • Wheelchair seating • Expert provider and local consultations between provider with the client distant and local providers present; or • Schein, et.al, 2008 • Expert provider and local provider without client present Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Example of Teleconsultation Consultation between expert provider and local provider with client present Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Tele-intervention • Interventions using telecommunication technologies • Clinic/Home • Methods to provide guidance • Person (visual/auditory) • Built in reminders • Sensor • Analytics Arthritis State of the Science Meeting 15 Pentagon City, Virginia | April 7, 2014
Evidence: Teleintervention Interventions Key Support Studies Evidence supports the use of • Early intervention services telehealth to deliver interventions in • Cason, 2009, 2011; Heimerl & Rasch, 2009 • Kelso et al., 2009 the areas of: • Older adults • Children and Youth • Bendixen et al., 2007; Harada et al., 2010 • Hori et al., 2009 • Productive Aging • Stroke • Mental Health • Chumbler et al., 2010a; 2010b; Hermann et al., 2010 • Rehabilitation and • Work space modifications Participation • Bruce & Sanford, 2006 • Chronic Diseases • Health and Wellness • Darkins et al., 2008; Steel, Cox & Garry, 2011 • Work and Industry Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Evidence: Telemonitoring Telemonitoring defined Key Support Studies • ADLs (Smartphones) Use of telecommunication technology to: • Tang & Venables, 2000 • Home exercise programs • Monitor a client’s adherence to an • Popescu et al., 2000 intervention program • Chronic disease management • Monitor and facilitate progressive • Darkins et al., 2008 therapy program • Monitor and support client in natural environments (i.e. home, work, community) (Cason, et al., 2013) Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Example of Telemonitoring Monitoring or tracking a client’s therapeutic progress remotely through telecommunication technology Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Evidence: Tele-supervision Supervision Key Support Studies • Tele-supervision requires • Telehealth technologies consideration of: can be used to support students and practitioners • State licensure laws working in isolated or rural • Institution specific guidelines areas, and nontraditional • Professional Societies’ fieldwork placements that Guidelines for Supervision, Roles, and Responsibilities cannot offer on-site During the Delivery of supervision Treatment • Miller et al., 2003 • Professional Societies Code of • Hubbard, 2000 Ethics and Ethics Standards (AOTA, 2009; AOTA 2010; Cason, et al., 2013) Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Example of Tele-supervision Tele-Supervision of student or practitioner Image from http://www.infanthearing.org/telehealth/index.html Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
Exemplar: Tele-ergonomics Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014
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