Physiotherapy Canada最新文献

Background: Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery.

Objective: We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life.

Methods: A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured.

Results: Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule.

Conclusion: Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.

Purpose: Further investigation into the feasibility of using videoconferencing and activity tracking devices to provide high-intensity home-based exercise programmes for people with a moderate or severe traumatic brain injury (TBI) is needed to inform clinical implementation and patient adoption. This study aimed to (1) determine if home-based telerehabilitation exercise programmes were feasible for people with a moderate or severe TBI and (2) better understand the lived experience of people with a TBI and their family partners with this programme.

Methods: A mixed-methods approach consisting of measures of feasibility and semi-structured interviews was used. Five participants with moderate to severe TBI and their family partners completed two high-intensity home-based exercise programmes delivered remotely by a physiotherapist (i.e., daily and weekly).

Results: Telerehabilitation services in home-based settings were feasible for this population. Adherence and engagement were high. Dyads were satisfied with the use of technology to deliver physiotherapy sessions.

Conclusion: Telerehabilitation provides a delivery option that allows people with TBI to spend energy on therapy rather than on travelling. A pre-programme training on key components, such as the use of technology, safety precautions, and communication methods, likely improved the overall feasibility. Further research is needed to better understand the effectiveness of such a programme on balance, mobility, and physical activity levels.

Purpose: To examine Canadian physiotherapists' experiences in adapting their delivery of patient care during the COVID-19 pandemic. We examine the level of strain on the profession and barriers and enablers to virtual care and provide strategies to support future virtual care implementation.

Methods: From May to October 2020, a series of eight cross-sectional survey cycles were distributed every 2-4 weeks through branches and divisions of the Canadian Physiotherapy Association, social media, and personal networks. Descriptive statistics summarized the main findings. Open ended questions were first analyzed inductively using thematic analysis, then deductively mapped to the Capability-Opportunity-Motivation Behavioural (COM-B) Model.

Results: Between 1,820 (cycle 1) and 334 (cycle 7) physiotherapists responded. Median strain level was 5/5 (cycle 1) and dropped to median 3/5 (cycles 5-8). In cycle 1, 55% of physiotherapists had ceased in-person care, while 41% were providing modified in-person care. Of these physiotherapists, 79% were offering virtual care. As modified in-person care increased, virtual care continued as a substantial aspect of practice. Physiotherapists identified barriers (e.g., lack of hands-on care) and enabling factors (e.g., greater accessibility to patients) for virtual care. In-depth examination of the barriers and enablers through the COM-B lens identified potential interventions to support future virtual care implementation, including education and training resources for physiotherapists and communication and advocacy to patients and the public on the value of virtual care.

Conclusions: Canadian physiotherapists exhibited high adaptability in response to COVID-19 through the rapid and widespread use of virtual care. By creating an in-depth understanding of the barriers and enablers to virtual care, along with potential interventions, this work will facilitate future opportunities to support and enhance physiotherapists' delivery of virtual care.