Telerehabilitation during the COVID-19 pandemic in Sweden: a survey of use and perceptions among physiotherapists treating people with neurological diseases or older adults

Abstract

BACKGROUND : Telerehabilitation, i.e. rehabilitation at a distance using Information and Communication Technology (ICT), is a promising avenue for improving health among people with neurological diseases or older adults who often experience limited access to services. Still, little is known about physiotherapists' use, perceptions and needs with regards to telerehabilitation services.

Aims: To describe physiotherapists use and perceptions of, as well as needs for, telerehabilitation services for the rehabilitation of people with neurological diseases or older adults in Sweden.

Methods: In this cross-sectional study, an author-created survey was sent out to members of the Swedish Association of Physiotherapists including questions about the use and perceptions of existing telerehabilitation services (e.g. telephone, internet-based applications and mobile applications) as well as needs of future telerehabilitation services. The results were presented descriptively as numbers and percentages.

Results: Three hundred seven physiotherapists were included in this study with 139 (45%) treating people with neurological diseases and 168 (55%) treating older adults. Most respondents did not provide telerehabilitation before (74%) or during (51%) the COVID-19 pandemic. Telephone, which was predominantly used for administrative tasks, was the most frequent utilised ICT used by 68% of the physiotherapist using ICTs several days/week. Few respondents used internet-based applications (12%), mobile applications (3%) or SMS services (8%) and videoconferencing (3%). A majority of the respondents were interested in ICT (78%), felt comfortable using ICT (57%) and were interested in learning how ICT can be used in rehabilitation (92%). Still, few respondents perceived that people with neurological diseases or older adults can use existing ICTs for rehabilitation purposes (18%) and that existing reimbursement system within health care facilitates remote rehabilitation (16%). Important functionality of future ICT perceived by physiotherapists covered patient communication (e.g. chat, SMS and video), assessments (e.g. digital surveys and assessment of physical activity) and treatment (e.g. exercise prescription).

Conclusion: While physiotherapists had an overall positive perception to use and willingness to learn about telerehabilitation, few used telerehabilitation services before nor during the COVID-19 pandemic and they also perceived multilevel barriers for implementation, ranging from patients ability to use ICT to existing reimbursement systems within health care. Our findings emphasize the need to strengthen the expertise regarding remote services among physiotherapists.

Keywords: COVID-19 pandemic; Information and Communication Technology; Perceptions; Physiotherapists; Telerehabilitation.

Fig. 1

Use of telerehabilitation among physiotherapists working with individuals with neurological diseases and older adults before and during the COVID-19 pandemic

Fig. 2

Willingness to work with telerehabilitation among A physiotherapists working with individuals with neurological diseases and B physiotherapists working with older adults

Fig. 3

Perceptions of telerehabilitation and digital tools among A physiotherapists working with patients with individuals with neurological diseases B and physiotherapists working with older adults. The results are presented from the physiotherapist views of using digital tools, the perspectives of using digital tools with the patients they treat and their views of digital tools to deliver telerehabilitation

Fig. 4

Physiotherapists’ perceptions of needs of telerehabilitation services with respect to patient communication, assessment and treatment