Innovations Using Technology to Closing the Gap between

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Promoting Activity and Participation Among Persons with Arthritis

Innovations Using Technology to Closing

the Gap between Clinic and Workplace


Promoting Activity and Participation Among Persons with Arthritis

Karen Jacobs, EdD, OTR/L, CPE, FAOTA

Boston University, Boston, MA

Nancy A. Baker, ScD, MPh, OTR/L

University of Pittsburg, Pittsburgh, PA


Imagine the following scenario…


Learning Objectives

• Define telehealth

• Discuss models of care in telehealth

• Describe a pilot study in tele-ergonomics

4

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 5

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)


Telehealth

“…the application of evaluative, consultative,

preventative, and therapeutic services delivered

through telecommunication and information

technologies”

(Cason, et al., 2013)


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

7


Methods

• Information gathering

• POTS

• Electronic forms

• Webcams/video conferencing

• Sensors

• Immediate vs stored

• “Direct” or through and intermediary

• Considerations• Capacity of technology

• Access to technology

• Skill of client/therapist

8

Pani et al., 2014


Models of Care in Telehealth

Evaluation

Consultation

Intervention

Monitoring

Supervision

(Richmond, 2013)


Tele-evaluation

• Diagnosis or identification of problem areas using

telecommunication technologies

• Considerations

• Type of evaluation (self-report/observational)

• Validity of evaluation methods

10


Evidence: Tele-evaluation

Evaluation areas

• Wheelchair prescription

• Barlow, Liu, & Sekulic (2009)

• Schein et al., 2008

• Schein, et al., 2010;

• Schein, et al, 2011

• Neurological assessment

• Savard et al., 2003

• Adaptive equipment prescription and

home modification

• Sanford et al., 2007

• Ergonomic assessment

• Baker & Jacobs, 2013

.

Evaluation Tools

• Functional Reach Test and European

Stroke Scale

• Palsbo et al., 2007

• Kohlman Evaluation of Living Skills and

the Canadian Occupational

Performance Measure

• Dreyer et al., 2001

• Functional Independence Measure,

Jamar Dynamometer, Preston Pinch

Gauge, Nine Hole Peg Test, and

Unified Parkinson’s Disease Rating

Scale

• 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.


Example of Tele-evaluation

Videoconferencing

technology between

provider and client Assessed Activities of

Daily Living (ADL)

Occurred in client’s

natural environment

(Richmond, 2013)




Teleconsultation

• Virtual consultation for the purpose of obtaining and sharing medical information or advice between:• Expert provider and client; or

• Expert provider and local provider with the client present; or

• Expert provider and local provider without client present

• Play performance in children with special needs

• Wakeford et al., 2002

• Veterans with traumatic brain injury

• Girard, 2007

• Wheelchair seating consultations between distant and local providers

• Schein, et.al, 2008

Teleconsultation defined Key Support Studies




Example of Teleconsultation

Consultation between expert provider and local provider with client presentSlide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations



Tele-intervention

• Interventions using telecommunication technologies

• Clinic/Home

• Methods to provide guidance

• Person (visual/auditory)

• Built in reminders

• Sensor

• Analytics

15


Evidence: Teleintervention

Evidence supports the use of

telehealth to deliver interventions in

the areas of:

• Children and Youth

• Productive Aging

• Mental Health

• Rehabilitation and

Participation

• Health and Wellness

• Work and Industry

• Early intervention services

• Cason, 2009, 2011; Heimerl & Rasch, 2009

• Kelso et al., 2009

• Older adults

• Bendixen et al., 2007; Harada et al., 2010

• Hori et al., 2009

• Stroke

• Chumbler et al., 2010a; 2010b; Hermann et al.,

2010

• Work space modifications

• Bruce & Sanford, 2006

• Chronic Diseases

• Darkins et al., 2008; Steel, Cox & Garry, 2011

Interventions Key Support Studies




Evidence: Telemonitoring

Use of telecommunication

technology to:

• Monitor a client’s adherence to an

intervention program

• Monitor and facilitate progressive

therapy program

• Monitor and support client in

natural environments (i.e. home,

work, community)

• ADLs (Smartphones)• Tang & Venables, 2000

• Home exercise programs • Popescu et al., 2000

• Chronic disease management • Darkins et al., 2008

(Cason, et al., 2013)

Telemonitoring defined Key Support Studies




Example of Telemonitoring

Monitoring or tracking a client’s therapeutic progress remotely through

telecommunication technology




Evidence: Tele-supervision

• Tele-supervision requires consideration of:

• State licensure laws

• Institution specific guidelines

• Professional Societies’ Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Treatment

• Professional Societies Code of Ethics and Ethics Standards

• Telehealth technologies can be used to support students and practitioners working in isolated or rural areas, and nontraditional fieldwork placements that cannot offer on-site supervision

• Miller et al., 2003

• Hubbard, 2000

Supervision Key Support Studies

(AOTA, 2009; AOTA 2010; Cason, et al., 2013)




Example of Tele-supervision

Tele-Supervision of student or practitionerImage from http://www.infanthearing.org/telehealth/index.html




Exemplar: Tele-ergonomics


Tele-ergonomics – Pilot Studies

• Purpose

• Establish proof-of-concept for the feasibility of delivering

ergonomics assessments & interventions for computer users

via web-based Tele-CES

22


Tele-ergonomics – Pilot Studies

• Validity of remote assessment of workstations

• Design – Single group pre/post test

• Participants - 30

• Remote assessment compared to live assessment (gold standard)

• Validity of remote delivery of ergonomic intervention

• Design: Single-subject AB design

• Participants: 10

• Implementation of recommendations made through remote ergonomic intervention assessed

23Jacobs, Blanchard, & Baker, 2012; Baker &

Jacobs, 2013

Study 1 – Baker et al., 2013 Study 2 – Jacobs et al., 2012


Tele-ergonomics

• Telerehabilitation Computer Ergonomics System (Tele-CES)

• Using existing previously validated ergonomic instruments

• Input from healthcare professionals and consumers

• Conducted by ergonomically trained health professionals

• Remotely assess the computer workstation

• Generate explicit participant-specific workstation modification recommendations


Tele-CES Assessments: Worker Characteristics

• Demographic

information

• Demographic survey

• Computer Workstation

Checklist

• Self-report assessing

computer use

•

•

25

(Baker, Livengood, & Jacobs, 2013)

R11

Slide 25

R11 You need to mention that this is our pilot work on this system and that it involves people with arthritis - Otherwist a lot of these forms don't make sense (why the AIMS for example) Show the BU study as an exemplar of what we are doing to test the system and as an exemplar of what we think we can get out of it. We have the basic system - this is how we adapt to different people/problemsreviewer 1, 9/22/2010


Tele-CES Assessments: Worker Characteristics

• Pain

• Joint Pain Homunculus

(JPH)/Pain Visual Analog

Scale (P-VAS)

• Comfort

• Comfort Visual Analogue

Scale (C-VAS)

26


Tele-CES Assessments: Workstation Use

• Computer Use

• The Computer Problem

Survey (ComPS)

• Computer Usage

• RSIGuard Software

27


Tele-CES Assessments : Workstation Use

• Multiple photographs of

worker in workstation

28


Validity of Tele-CES Assessment

29

00.10.20.30.40.50.60.70.80.91

sens

spec

(Baker et al., 2013)


Recommendations implemented by

participant

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 7 8 9 10 Total

Participant ID

30

(Jacobs et al., 2012)


Recommendations implemented by category

0%10%20%30%40%50%60%70%80%90%100%

31

(Jacobs et al., 2012)


Tele-CES Assessments: Workstation/Worker

Blackboard Learn™

Photographs and video recordings


Tele-CES Assessments: Workstation/Worker


Thank you!


References• American Occupational Therapy Association. (2009). Guidelines for supervision, roles, and responsibilities during the delivery

of occupational therapy services. American Journal of Occupational Therapy, 63, 797–803.

http://dx.doi.org/10.5014/ajot.63.6.797

• American Occupational Therapy Association. (2010). Telerehabilitation. American Journal of Occupational Therapy, 64(Suppl.),

S92–S102. http://dx.doi.org/10.5014/ajot.2010.64S92Baker, N. & Jacobs, K. (2013). The feasibility and accuracy of using a

remote method to assess computer workstations. Human Factors.

• Baker, N., Livengood, H., Jacobs, K. (2013). Reliability and Concurrent Validity of the Computer Workstation Checklist. WORK,

213–221.

• Barlow, I. G., Liu, L., & Sekulic, A. (2009). Wheelchair seating assessment and intervention: A comparison between

telerehabilitation and face-to-face service. International Journal of Telerehabilitation, 1, 17–28.

http://dx.doi.org/10.5195/ijt.2009.868

• Bendixen, R., Levy, C., Lutz, B. J., Horn, K. R., Chronister, K., & Mann, W. C. (2008). A telerehabilitation model for victims of

polytrauma. Rehabilitation Nursing, 33, 215–220. http://dx.doi.org/10.1002/j.2048-7940.2008.tb00230.x

• Bendixen, R., Levy, C., Olive, E., Kobb, R., & Mann, W. (2009). Cost-effectiveness of a telerehabilitation program to support

chronically ill and disabled elders in their homes. Telemedicine and e-Health, 15, 31–38.

http://dx.doi.org/10.1089/tmj.2008.0046

• Bruce, C., & Sanford, J. A. (2006). Development of an evidence-based conceptual framework for workplace assessment. Work,

27, 381–389.

• Cason, J., Hartmann, K., Jacobs, K., Richmond, T. (2013) AOTA Position Paper: Telehealth. American Occupational Therapy

Association: Bethesda, MD.

• Cason, J. (2009). A pilot telerehabilitation program: Delivering early intervention services to rural families. International Journal

of Telerehabilitation, 1, 29–38. http://dx.doi.org/10.5195/ijt.2009.6007


References

• Cason, J. (2011). Telerehabilitation: An adjunct service delivery model for early intervention services. International Journal of

Telerehabilitation, 3, 19–28. http://dx.doi.org/10.5195/ijt.2011.6071

• Cason, J. (2012). Telehealth opportunities in occupational therapy through the Affordable Care Act. American Journal of Occupational Therapy, 66, 131-136.

• Chumbler, N., Quigley, P., Sanford, J., Griffiths, P., Rose, D., Morey, M., . . . Hoenig, H. (2010). Implementing telerehabilitation research for stroke rehabilitation with community dwelling veterans: Lessons learned. International Journal of Telerehabilitation, 2, 15–21. http://dx.doi.org/10.5195/ijt.2010.6047

• Darkins, A., Ryan, P., Kobb, R., Forster, L., Edmonson, E., Wakefield, B., & Lancaster, A. E. (2008). Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14, 1118–1126 http://dx.doi.org/10.1089/tmj.2008.0021

• Dreyer, N. C., Dreyer, K. A., Shaw, D. K., & Wittman, P. P. (2001). Efficacy of telemedicine in occupational therapy: a pilot study.

Journal of Allied Health, 30, 39–42.

• Girard, P. (2007). Military and VA telemedicine systems for patients with traumatic brain injury. Journal of Rehabilitation

Research and Development, 44, 1017–1026. http://dx.doi.org/10.1682/JRRD.2006.12.0174

• Harada, N. D., Dhanani, S., Elrod, M., Hahn, T., Kleinman, L., & Fang, M. (2010). Feasibility study of home telerehabilitation for

physically inactive veterans. Journal of Rehabilitation Research and Development, 47, 465–475.

http://dx.doi.org/10.1682/JRRD.2009.09.0149

• Heimerl, S., & Rasch, N. (2009). Delivering developmental occupational therapy consultation services through telehealth.

Developmental Disabilities Special Interest Section Quarterly, 32, 1–4.


References• Hermann, V. H., Herzog, M., Jordan, R., Hofherr, M., Levine, P., & Page, S. J. (2010). Telerehabilitation and electrical stimulation:

an occupation-based, client-centered stroke intervention. American Journal of Occupational Therapy, 64, 73–81.

http://dx.doi.org/10.5014/ajot.64.1.73

• Hoffman, H. G., Patterson, D. R., & Carrougher, G. J. (2000). Use of virtual reality for adjunctive treatment of adult burn pain

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• Hori, M., Kubota, M., Kihara, T., Takahashi, R., & Kinoshita, A. (2009). The effect of videophone communication (with Skype and webcam) for elderly patients with dementia and their caregivers. Gan To Kagaku Ryoho, 36S, 36–38. Retrieved from www.ncbi.nlm.nih.gov/pubmed/20443395

• Hubbard, S. (2000). A case example of remote supervision. OT Practice, 5, 16–18.

• Jacobs, K., Blanchard, B., & Baker, N. (2012) Telehealth and ergonomics: A pilot study. Technology and Health Care. 445-458.

• Kelso, G., Fiechtl, B., Olsen, S., & Rule, S. (2009). The feasibility of virtual home visits to provide early intervention: A pilot study. Infants and Young Children, 22, 332–340. http://dx.doi.org/10.1097/IYC.0b013e3181b9873c

• Miller, T. W., Miller, J. M., Burton, D., Sprang, R., & Adams, J. (2003). Telehealth: A model for clinical supervision in allied health. Internet Journal of Allied Health Sciences and Practice, 1(2), 1–8.

• Palsbo, S. E., Dawson, S. J., Savard, L., Goldstein, M., & Heuser, A. (2007). Televideo assessment using Functional Reach Test and European Stroke Scale. Journal of Rehabilitation Research and Development, 44, 659–664. http://dx.doi.org/10.1682/JRRD.2006.11.0144

• Pani, D., Barabino, G., Dessi, A., Tradori, I, Piga, M, Mathieu, A. & Raffo, L. (2014). A device for local or remote monitoring of hand rehabilitation for rheumatic patients. Rehabilitation Devices and Systems, 2, doi:10.1109/JTEHM.2014.2299274

• Popescu, V. G., Burdea, G. C., Bouzit, M., & Hentz, V. R. (2000). A virtual-reality-based telerehabilitation system with force feedback. IEEE Transactions on Information Technology in Biomedicine, 4, 45–51. http://dx.doi.org/10.1109/4233.826858


References

• Richmond, T. (2013). Course 1: Introduction to Telehealth for Rehabilitation Professionals Available:

http://www.go2care.com/products.aspx

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Innovations Using Technology to Closing the Gap between