Covid-19 pandemisinde fizyoterapistlerin telerehabilitasyon uygulamaları bariyer ve fasilitatörlerinin incelenmesi

Year 2022, Volume: 9 Issue: 2, 108 - 117, 19.07.2022

Eren Timurtaş Mine Gülden Polat

https://doi.org/10.15437/jetr.1096192

Abstract

Amaç: Telerehabilitasyon, rehabilitasyon hizmetlerinin bilgi ve iletişim teknolojisi aracılığıyla uzaktan sunumu olarak tanımlanmaktadır. COVID-19 pandemisi ve artmış bulaş riski fizyoterapi kliniklerinde telerehabilitasyon kullanımını zorunlu hale getirmiştir. Çalışmamızın amacı COVID-19 pandemisi sırasında fizyoterapistlerin telerehabilitasyon uygulamalarındaki bariyer ve fasilitatörlerinin belirlenmesiydi.
Yöntem: Çalışmamız Ekim-Aralık 2021 tarihleri arasında İstanbul ilinde kliniklerde telerehabilitasyon uygulayan 99 (%46,9) kadın, 112 (%53,1) erkek, yaş ortalaması 29,9±6,7 yıl, çalışma süresi ortalaması 6,9±6,7 yıl olan toplam 211 fizyoterapist ile gerçekleştirildi. Fizyoterapistlerin telerehabilitasyon uygulamaları ile ilgili tutum ve davranışları Theoretical Domains Framework (TDF) kılavuzu yönergelerine göre hazırlanan 31 madde ile sorgulandı. Veri analizinde tanımlayıcı istatistikler, açıklayıcı faktör analizi kullanıldı.
Bulgular: Çalışma tanımlayıcı kesitsel tipte tasarlanmıştır. TDF kılavuzuna göre belirlenen maddelerin faktör analizi sonucunda 6 boyutta 25 madde belirlendi. TDF anketi açıklayıcı faktör analizi sonucunda KMO örneklem yeterliliği değeri 0,863 puan ile “çok iyi” olarak değerlendirilirken, Cronbach alfa değeri 0,91 olarak belirlendi. Fizyoterapistlerin telerehabilitasyon uygulamalarına yönelik tutumuna etki eden en güçlü fasilitatör 3,81±0,91 ortalama ile “Telerehabilitasyon uygulamaları toplum sağlığına fayda sağlar.” en güçlü bariyer ise 2,11±1,19 ortalama ile “Telerehabilitasyonun nasıl uygulandığı konusunda eğitim aldım” maddesiydi.
Sonuç: TDF teorik çerçevesinde hazırlanan ölçeğin telerehabilitasyon uygulamalarının fizyoterapistler tarafından tutum ve davranışının değerlendirilmesinde önemli bir araç olacağı düşünülmektedir. TDF kılavuzu ile hazırlanan ölçeğimiz aracılığıyla belirlenen beceriler, hedefler, çevresel kaynaklar ve sosyal etkilere yönelik bariyerlerin saptanması telerehabilitasyon eğitimlerinin içeriğinin belirlenmesine katkı sunacaktır.

Keywords

Telerehabilitasyon, Fizyoterapist, COVID-19 pandemisi

Investigation of barriers and facilitators in telerehabilitation applications of physiotherapists in the COVID-19 pandemic

Abstract

Purpose: Telerehabilitation is defined as the remote delivery of rehabilitation services through information and communication technology. The aim of our study was to determine the barriers and facilitators in telerehabilitation practices of physiotherapists during the COVID-19 pandemic.
Methods: The study was designed in descriptive cross-sectional type. Our study included 99 (46.9%) women and 112 (53.1%) men with a mean age of 29.9±6.7 years and mean working time of 6.9±6.7 years, who applied telerehabilitation in clinics in Istanbul between October and December 2021. The study was carried out with a total of 211 physiotherapists. The attitudes and behaviors of physiotherapists regarding telerehabilitation applications were questioned with 31 items prepared according to the Theoretical Domains Framework (TDF) guideline. Descriptive statistics and explanatory factor analysis were used in the data analysis.
Results: As a result of the factor analysis of the items determined according to the TDF guideline, 25 items in 6 dimensions were determined. As a result of the explanatory factor analysis of the TDF questionnaire, the KMO sample adequacy value was evaluated as “very good” with a score of 0.863, while the Cronbach alpha value is determined as 0.91. The strongest facilitator affecting the attitude of physiotherapists toward telerehabilitation practices, with an average of 3.81±0.91 “Telerehabilitation practices benefit public health.” the strongest barrier is the item “I received training on how to apply telerehabilitation” with an average of 2.11±1.19.
Conclusion: The scale prepared within the TDF framework will be an important tool in the evaluation of attitudes and behaviors by physiotherapists. The skills, targets, environmental resources and barriers to social impacts determined through our scale prepared with the TDF guideline will contribute to the determination of the content of telerehabilitation training.

Keywords

Telerehabilitation, Physiotherapist, COVID-19 pandemic

References

• 1. Brennan D, Tindall L, Theodoros D, et al. A blueprint for telerehabilitation guidelines. Int J Telerehabil. 2010;2:31-34.
• 2. Galea MD. Telemedicine in rehabilitation. Phys Med Rehabil Clin N Am. 2019;30:473-483.
• 3. Calton B, Abedini N, Fratkin M. Telemedicine in the time of coronavirus. J Pain Symptom Manage. 2020;60:e12-e14.
• 4. Turolla A, Rossettini G, Viceconti A, et al. Musculoskeletal physical therapy during the COVID-19 pandemic: is telerehabilitation the answer? Phys Ther. 2020;100:1260-1264.
• 5. Cottrell MA, Galea OA, O’Leary SP, et al. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31:625-38.
• 6. Marzano G, Ochoa-Siguencia L, Pellegrino A. Towards a new wave of telerehabilitation applications. The Open Public Health Journal. 1(1):1-9.
• 7. Sarfo FS, Ulasavets U, Opare-Sem OK, et al. Tele-rehabilitation after stroke: an updated systematic review of the literature. JJ Stroke Cerebrovasc Dis. . 2018;27:2306-2318.
• 8. Ownsworth T, Arnautovska U, Beadle E, et al. Efficacy of telerehabilitation for adults with traumatic brain injury: A systematic review. J Head Trauma Rehabil. 2018;33:E33-E46.
• 9. Frederix I, Vandijck D, Hens N, et al.. Economic and social impact of increased cardiac rehabilitation uptake and cardiac telerehabilitation in Belgium–a cost–benefit analysis. Acta Cardiologica. 2018;73:222-9.
• 10. Md Fadzil NH, Shahar S, Rajikan R, et al. A scoping review for usage of telerehabilitation among older adults with mild cognitive ımpairment or cognitive frailty. International J Int J Environ Res Public Health. 2022;19:4000.
• 11. Niknejad N, Ismail W, Bahari M, et al. Understanding telerehabilitation technology to evaluate stakeholders’ adoption of telerehabilitation services: A systematic literature review and directions for further research. Arc Phys Med Rehabil. 2021;102:1390-403.
• 12. van Ommeren AL, Smulders LC, Prange-Lasonder GB, et al. Assistive technology for the upper extremities after stroke: systematic review of users’ needs. JMIR Rehabil Assist Technol. 2018:29;5:e10510.
• 13. Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12:1-18.
• 14. Yong AG, Pearce S. A beginner’s guide to factor analysis: Focusing on exploratory factor analysis. Tutorials in Quantitative Methods for Psychology. 2013;9:79-94.
• 15. Almojaibel AA, Munk N, Goodfellow LT, et al. Health care practitioners' determinants of telerehabilitation acceptance. Int J Telerehabil. 2020;12:43-50.
• 16. Cottrell MA, Hill AJ, O'Leary SP, et al. Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: a qualitative study. Musculoskelet Sci Pract. 2017;32:7-16.
• 17. Howard IM, Kaufman MS. Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders. Muscle Nerve. 2018;58:475-85.
• 18. Tousignant M, Boissy P, Moffet H, et al. Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial. Telemed J E-Health. 2011;17:376-382.
• 19. Morris C, Barr C, George S, et al. Clinician Perspectives of an Avatar-Directed Scheduling and Memory App. Stud Health Technol Inform. 2018;254:86-97.
• 20. Fleig L, Ashe MC, Keller J, et al. Putting psychology into telerehabilitation: Coping planning as an example for how to integrate behavior change techniques into clinical practice. AIMS Medical Science. 2019;6:13-32.
• 21. World Confederation for Physical Therapy INoPRA. Report of the WCPT/INPTRA Digital Physical Therapy Practice Task Force 2022 [cited 2022 March 30]. Available from: https://world.physio/sites/default/files/2021-06/digital-practice-report-2021-FINAL.pdf.
• 22. Russell TG. Physical rehabilitation using telemedicine. J Telemed Telecare. 2007;13:217-220.
• 23. Korsch S, Herbold D, Wiezoreck M, et al. Förderfaktoren, Barrieren und Barrierenmanagement zur Umsetzung gesundheitsförderlicher Verhaltensweisen von Rehabilitanden mit chronischem Rückenschmerz–Eine qualitative Analyse. Die Rehabilitation. 2016;55:210-216.
• 24. Dantas LO, Barreto RPG, Ferreira CHJ. Digital physical therapy in the COVID-19 pandemic. Braz J Phys Ther. 2020;24:381-383.
• 25. Leochico CFD, Espiritu AI, Ignacio SD, et al. Challenges to the emergence of telerehabilitation in a developing country: a systematic review. Front Neurol. 2020;11:1007.
• 26. Aloyuni S, Alharbi R, Kashoo F, et al. Knowledge, attitude, and barriers to telerehabilitation-based physical therapy practice in Saudi Arabia. Healthcare (Basel). 2020:8:460.
• 27. Inskip J, Lauscher HN, Li LC, et al. Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation. Chron Respir Dis. 2018;15:71-80.
• 28. Telerehabilitation. Guide. July 2020, Version 1. Available from: https://cptbc.org/wp-content/uploads/2020/07/CPTBC_Telerehabilitation-Guide_Final-July-27.pdf