Mobile Rehabilitation Shows Promise, but Therapists May Benefit from Training and Support
A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Mobile health (mHealth) refers to the delivery of health care services via mobile information and communication technologies, including health-related apps on mobile devices, such as smart phones and tablets, wearable sensors, and other technologies. Examples may include fitness or nutrition apps, or apps enabling patients to share health information with their doctors. A related type of technology, mobile rehabilitation (mRehab) technology, includes software, hardware and services specifically designed to support the clinical rehabilitation needs of individuals with disabilities., such as apps that remind users to complete prescribed exercises or that assist with managing medications. mHealth and mRehab technologies are rapidly growing in popularity, and they may improve access to affordable or remote rehabilitation services. However, patients and providers may be hesitant to begin using mRehab applications. They may be unfamiliar or uncomfortable with the technology, concerned about privacy issues, or worried about missing the personal interactions between patients and their providers. In a recent NIDILRR-funded study, researchers asked rehabilitation providers about their attitudes toward incorporating mRehab into their practices. The researchers wanted to find out whether the providers thought that mRehab would be useful for patients between provider visits or after discharge from a rehabilitation center to maintain or improve their recovery. They also wanted to find out how comfortable and knowledgeable the providers felt about mRehab technologies.
Researchers at the Rehabilitation Engineering Research Center for Community Living, Health and Function (LiveWell RERC) analyzed 505 responses to a survey of rehabilitation providers. The respondents included physical, occupational, speech and recreation therapists, mental health counselors, physicians, and other professionals serving patients with a variety of disabilities. On the survey, the respondents were asked to estimate the percentage of their patients who required additional therapy or intervention after being discharged from a rehabilitation center, and the percentage of their patients who required additional therapy between outpatient therapy visits. The respondents were also asked to rate on a five-point scale their personal comfort with integrating mRehab technologies into their practice, and their personal knowledge of mRehab. Finally, the respondents were asked to identify the biggest barriers to adoption of mRehab technology, and specific ways mRehab technology could support patients after rehabilitation or between outpatient visits.
All of the respondents reported that most of their patients needed additional therapy or intervention, excluding medications, outside the clinical setting. On average, they reported that about 70% of their patients required additional therapy after discharge from a rehabilitation center, and that about 50% of their patients required additional therapy between outpatient visits. Most of the respondents indicated that they prescribed specific exercises and/or interventions for their patients to do between clinic visits.
Regarding the comfort and knowledge level using mRehab technologies, about half of the respondents reported feeling “very comfortable” or “extremely comfortable” integrating them into clinical practice. Further, about a quarter of the respondents reported feeling “very knowledgeable” or “extremely knowledgeable” about mRehab. In addition, about 12% of respondents reported that they had already adopted some online coaching or therapy management platforms for patient education, progress tracking, sending reminders, and other case management tasks.
When asked about the biggest barriers to mRehab adoption, about two-thirds of the respondents indicated that patients’ lack of familiarity with the technology or lack of Internet access could limit their use of mRehab. About one-third of respondents selected cost or reimbursement as a potential barrier. When asked about the ways mRehab could support patients, about two-thirds of the respondents indicated that mRehab could support patient functioning in their homes and communities. In addition, about two-thirds of the respondents agreed that mRehab could be useful to help patients follow through with their prescribed exercises or interventionswith prescribed exercises or other activities between clinic visits or after completion of in-person therapies. About half of the respondents indicated that enabling real-time observation and communication with their patients was a potential benefit.
The authors noted that mRehab technologies may help to supplement traditional rehabilitation, particularly by supporting additional therapies or exercises needed to maintain therapeutic gains between clinic visits or after therapy completion. For example, mRehab applications may be useful to remind patients to perform exercises, to help them track their progress, or to assist remote communication between patients and providers. Despite the potential of mRehab technologies, the majority of the providers in this study reported feeling some discomfort or a lack of knowledge about mRehab. It may be useful to develop training modules for providers to become familiar with emerging mRehab technologies and ways to incorporate them alongside their existing practices.
To Learn More
Examples of mHealth and mRehab technologies from the NIDILRR grantee community include:
- iMHere, an mHealth platform promoting clinician-guided self-care to patients with chronic diseases.
- SCI-Hard, is a game-based app which helps young people with newly acquired spinal cord injury gain skills and knowledge to overcome the challenges of their injury. Available for Android and iOS.
- BreatheWell Wear, an Android Wear app that assists the user in performing deep, slow, diaphragmatic breathing by providing visual and auditory guidance to pace breathing, including a display of the user’s heart rate in real time.
Previous issues of Research In Focus have looked at diverse topics in mHealth and mRehab, including:
- Mobile Health Systems May Benefit People with Physical Disabilities, But Some People May Have Challenges Using Them
- A New Mobile Health System Can Help People with Spina Bifida Take Charge of Their Health
- “Even People Who Cannot Speak Should Be Able to Make Their Voices Heard”: Soliciting User Feedback from People with Severe Speech and Physical Impairments
To Learn More About this Study
Morris, J., Jones, M., Thompson, N., Wallace, T., and DeRuyter, F. (2019) Clinician perspectives on mRehab interventions and technologies for people with disabilities in the united states: A national survey. International Journal of Environmental Research and Public Health, 16(21), 4220. This article is available from the NARIC collection under Accession Number J83074 and through Open Access from the publisher.