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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 5-11

Application of telemedicine in pediatric physiotherapy


Department of Pediatric Physiotherapy, R V College of Physiotherapy, Bengaluru, Karnataka, India

Date of Submission29-Sep-2020
Date of Decision30-Jan-2021
Date of Acceptance01-Mar-2021
Date of Web Publication19-Aug-2021

Correspondence Address:
Dr. Pallavi B Wajapey
Department of Pediatric Physiotherapy, R V College of Physiotherapy, No. CA 2/83-3, 9th Main Road, 4th Block, Jayanagar, Bengaluru - 560 011, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_49_20

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  Abstract 


Telemedicine in pediatric physiotherapy simply refers to physical therapy services that are provided over a technology platform, rather than by in-person means. Telemedicine can in particular aid underprivileged communities dwelling in remote or underdeveloped areas with scarcely any health services and medical resources. With “social distancing” becoming the norm, we are facing difficulty following up with patients. Therapists are on a lookout for more innovative ways to reach out to their patients and make sure the child's progress is not hampered. Telemedicine is one such opportunity to stay connected with the patients and monitor patient progress. The purpose of this article is to compile and summarize all the scarce and scattered information on telemedicine and its application in pediatric physiotherapy so that researchers can conduct studies on the same and take the work forward from here. Search engines such as Cochrane Library, PubMed, and Google Scholar were explored with specific keywords like telemedicine, pediatric physiotherapy, India. Articles were then skimmed for relevance in the Indian scenario and used for reference. There is a big void in data available for telemedicine in pediatric physiotherapy. Providing telemedicine facilities and services to the huge population can be a daunting task as it involves technical, ethical, and legal issues. It can save the time of the patient and the therapist, provide instant care and assistance to the pediatric population as well as stay available to the increasing number of patients.

Keywords: India, Pediatric physiotherapy, telehealth, telemedicine, telerehabilitation


How to cite this article:
Wajapey PB, Shenoy AB. Application of telemedicine in pediatric physiotherapy. Physiother - J Indian Assoc Physiother 2021;15:5-11

How to cite this URL:
Wajapey PB, Shenoy AB. Application of telemedicine in pediatric physiotherapy. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2021 Dec 3];15:5-11. Available from: https://www.pjiap.org/text.asp?2021/15/1/5/324130




  Introduction Top


Telemedicine, which means “healing at a distance,” has been a well-known technology since 1950, when audio-visual telecommunication links were started to be utilized for the provision of medical services.[1],[2] However, telemedicine is currently in the phase of rapid development and advancement.

The World Health Organization has adopted the following subsequent description: “The delivery of health care services, where distance is a critical factor, by all health-care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”[3]

Telemedicine can in particular aid underprivileged communities dwelling in remote or immature territories with hardly any well-being administrations and clinical assets and regularly have inadequate access to specialties–since it beats separation and time boundaries and structures an extension between human services suppliers and patients. Consultations via live Audio-Visual link or through the store and forward technology are used for routine, less time-critical consultation.[4],[5]

Telemedicine can help in three major areas:

  1. Store and forward data
  2. Remote monitoring
  3. Real-time interaction between patient and doctor.[6]


Tele rehabilitation is playing a serious role in today's scenario. Applications of telehealth in therapy have already got its core that expands throughout patient/client care and consultation as a result of which, it permits physiotherapists (PTs) to communicate with patients and provide the additional necessary care. Telehealth won't replace ancient clinical care; however, it'll allow PTs to produce services throughout a larger capability. Examples:

  • Patients in clinical or hospital settings could be managed from their homes
  • Faster screening, assessment, and referrals will improve care coordination inside cooperative delivery models like care providing organizations or patient-centered medical homes
  • Telehealth facilitates consultation and conjointly in providing clinical education.[7]


Telemedicine allows PTs to dispatch high-quality and convenient care. Contemporary telehealth software makes it trouble-free to support patients as they administer their treatment plan without the necessity for periodic in-office visits.[8]


  Telemedicine in Paediatrics Top


A report published by The American Academy of Paediatrics defined telemedicine in pediatrics as, “the use of electronic communications technology to provide and support health care for infants, children, adolescents, and young adults when distance separates the practitioner from the patient, parent, guardian, or referring practitioner.”[9]

Telemedicine has diverse applications in pediatrics. With the improvement in technology and decrease in cost, instructions, access to care, emergency response, and in diverse settings, conveyance of general and specialty pediatrics has improved through telemedicine. It has ameliorated communication between the essential guardians and the clinical experts thinking about the children, even in community-based practice.

With the large geographical distances and limited resources in India, providing in-person health care becomes challenging. Telemedicine comes into play and importance here as it can cut down the cost and effort especially of rural patients, making it easy for them to obtain consultation and treatment as and when they need without need to travel long distances. Telemedicine thus helps in providing timely and faster access to health care services and likewise decreases expenses related to movement and burden to the guardians and family. It accommodates patients and healthcare professional security amid quick-spreading contaminations and pandemics.

Grammatical error and addition of and- Telemedicine conjointly helps in cases in any place and there's no requirement for the patient to truly observe the medicinal services proficient or visit the emergency clinic, for example, normal, standard registration, or ceaseless checking. Telemedicine encourages the upkeep of records and documentation, subsequently lessening the potential outcomes of passing up any guidance given by the specialist through teleconference. It will increment legitimate security as well.

In telemedicine, advanced technologies are used that make it easier for the patient to follow a better medication regimen and also manage their disease better by making the vital parameters of the patient available to the physician with the help of medical devices such as blood pressure and blood glucose management.[10]

A telemedicine visit may be conducted without exposing workers to viruses/infections inside the instances of pandemics just like the one we're going through now, i.e., COVID-19. Telemedicine exercise can forestall the transmission of irresistible illnesses, bringing down the dangers to both the specialist and patients. Superfluous and avoidable exposure of the individuals engaged with the vehicle of medicinal services can be forestalled by the utilization of telemedicine and patients can be screened remotely. It can give quicker counsel to social insurance experts who probably won't be promptly accessible if it somehow managed to be had face to face. Moreover, it makes accessible extra working fingers to offer physical consideration at the individual well-being establishments.[10]

Telehealth is important in situations where social distancing is needed as well as necessary for children who are immuno-compromised or have a complex chronic illness. Even in situations like these, the children should be able to work toward their goals and improve their functional abilities under the guidance of their usual therapist. Interacting over the screen might motivate the child as most of the children are captivated by screens and find it more difficult to interact with adults

Outside of assessments and adapted interventions, it allows PTs to educate the child as well as the family members, make them aware of how the child interacts with the native environment, and make a few recommendations. It helps the therapist in making the child independent in their home-based exercise program and also in making it easy for them to decide why, where, and how to perform the exercises that were taught in the clinic or through a store and forward video. Practicing activities with the child's equipment and toys in his/her environment mean the therapists and parents are more likely to be able to replicate the activity so that the child can practice it again later and building these activities and strategies into the child's everyday life – which will lead to more opportunities for them to improve than a therapist interaction for a limited time.

During regular hands-on therapy sessions, the child is working directly with the therapist, and hence the dependence on the therapist increases. In a telehealth session, the PT instead becomes a coach and will watch what is happening, identify problem areas watching the videos over and over again, problem-solve together with the parents, and providing direct feedback about supporting, facilitating, or inhibiting certain movements. The therapist, in effect, helps the parents to get better at helping their child.

Recommendations on progressing the activities, evaluation of the child's performance on home-based exercise equipment, and making recommendations on the necessary changes that could be made at home to avoid any kind of architectural barriers that may delay or stop a child from reaching their desired goal of progress and independence.

There are quite a few papers and articles published on Telemedicine in physiotherapy, postoperative hip displacement, ankle injuries, and other orthopedic physiotherapy management that have been discussed in lengths, application of telemedicine in pediatric physiotherapy has remained an untouched area. Compiling and summarizing all the scarce and scattered information on Telemedicine and its application in Pediatric physiotherapy in a single paper so that researchers can conduct studies on the same and take the work forward from here is the main intention of this paper.


  Materials Required in Setting up a Telemedicine Unit Top


A great many people approach essential media communications innovation, similar to phones, web, and Computers. However, numerous telemedicine arrangements require more gear than simply essential types of gear. Increasingly mind-boggling telemedicine arrangements, particularly those utilized by bigger well-being frameworks, as a rule, require a telemedicine truck. It comprises a portable edge and capacity framework to convey cameras, computer screens, consoles, and versatile clinical gadgets. The trucks some of the time seems to be like standing work areas, with PC screens connected at the top and wheels at the base for simple moving. Ordinarily, these trucks are utilized at clinics or other enormous human services frameworks. Now and again, nonetheless, a patient may have a telemedicine station set-up in their own home for simple access. The advisor can screen the kid on the framework and give directions as and when required.[11]

Digital camera

To do video conferencing, you need a webcam at any rate. Some telemedicine suppliers offer top of the line, high-goals advanced cameras for clear video catch, other people offer specific clinical assessment instruments with coordinated cameras that permit social insurance experts to take itemized clinical pictures, for instance, of a patient's ear, at that point share them with an authority at another area. Since this sort of gear is extravagant and frequently requires use by a clinical expert, it is typically utilized for store-and-forward telemedicine arrangements between two health-care professionals.

Telemedicine software

While most telemedicine plans are moving to the cloud, some telemedicine providers notwithstanding everything require the procurement of an item system that ought to be presented on an authority's computer. These item game plans may require additional riggings like data amassing hardware or servers. All items moreover should be checked for comparability against restorative administration provider's computer working systems.

Mobile medical devices

Portable clinical gadgets are frequently utilized by both specialists, other medicinal services experts, and patients to catch clinical information and send it to a clinical expert in another area. For instance, a youngster who has a seizure during treatment can be recorded and sent to a nervous system specialist for cross consultation.

There are tons of innovative, sophisticated telemedicine equipment out there. However you do not need most of this equipment to get started. Remember that more equipment does not just mean a higher price tag, it means more time and training for staff. Basic equipment can be used for one on one consultation, if more number of participants is expected then a sophisticated tool becomes necessary.[12]


  Guidelines under the Health Insurance Portability and Accountability Act Top


Health Insurance Portability and Accountability Act (HIPAA) – HIPAA), a US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals, and other healthcare providers.[13]

In terms of telemedicine, providers looking to remain compliant with the law should look for the following features in any telemedicine technology that they consider:

Fully encrypted data transmission, peer-to-peer secure network connection, and no storage of video.[12]

The privacy rule

It defines and governs the use and disclosure of Protected Health Information (PHI). Providers and their associates who are covered by HIPAA must develop and stick to procedures that protect and secure PHI whenever it is received, handled, transferred, or shared. The rule guides that only the minimum health information necessary to care for the patient to be used or shared.

The security rule

It is shorthand for the Protection of Electronic PHI. It sets the standards for securing patient data that is stored or transferred by electronic methods. It outlines three areas of protection required for compliance; administrative, physical, and technical. The rule establishes security standards for each.

Covered entities

The HIPAA privacy and Security rules apply to certain “covered entities.” They include healthcare service providers, medical clearinghouses, and insurers, including some employer-sponsored health plans.[14]


  Health Insurance Portability and Accountability Act and Telemedicine Top


The same requirements for patient privacy and confidentiality that apply for in-person visits, apply to visits conducted over video. The provider has an identical responsibility to protect patient information. The storage of electronic files, videos, and images needs to be approached with the same caution as one would take with physical documents.

Consumer-grade services such as Skype, Facetime, WhatsApp call, do not support HIPAA compliant video conferencing because they are not encrypted.[14] Therefore, they should never be used for purposes that use PHI.

Many healthcare organizations have been pleasantly surprised at the ease with which the HIPAA guidelines on telemedicine can be complied with, and even more pleasantly surprised at the cost– with there being no need to invest in expensive hardware or complicated software, or drain the organization × s IT resources. The HIPAA guidelines on telemedicine make it quite clear what measures should be introduced to secure the integrity of electronically PHI (ePHI). With there being significant advantages to implementing a secure messaging solution, it is only a question of time before all covered entities providing a telemedicine service are communicating ePHI at distance with secure messaging.[14]


  Guidelines for Technology Platforms enabling Telemedicine by the Indian Medical Council Top


The thought process of these tips is to offer reasonable counsel to clinical specialists so everyone administration and models of care utilized by method of specialists and healthcare workers are embraced to consider the utilization of telemedicine as a major aspect of customary practice. They will assist the medical practitioner in pursuing a sound course of action to provide effective and safe medical care founded on current information, available resources, and patient needs to ensure patient and provider safety.

It presents standards and conventions concerning doctor influenced individual relationship; inconveniences of legitimate obligation and carelessness; evaluation, the administrators and treatment; capable consent; intelligibility of care; referrals for emergency organizations; clinical bits of knowledge; protection and security of the patient real factors and trade of information; suggesting; and reimbursement; prosperity guidance and coordinating. These rules will give data on different parts of telemedicine remembering data for innovation stages and devices accessible to clinical specialists and how to coordinate these advancements to give social insurance conveyance. It moreover enlightens how development and transmission of voice, bits of knowledge, pictures and information ought to be used close by different clinical essentials, shows, rules, and techniques for the openness of care. Where clinically proper, telemedicine is a protected, viable, and an important methodology to help tolerant consideration. Like some other innovation, the innovation utilized for telemedicine administrations can be manhandled. It has a few dangers, downsides, and confinements, which can be moderated through proper preparation, authorization of principles, conventions, and rules.[10],[15]

These guidelines are designed to serve as an aid and tool to enable Registered Medical Practitioners (RMP) to effectively leverage Telemedicine to enhance healthcare service and access to all.

This specifically covers those technology platforms which work across a network of RMPs and enable patients to consult with RMPs through the platform

  • Technology platforms (mobile apps, websites, etc.) providing telemedicine services to consumers shall be obligated to ensure that the consumers are consulting with RMPs duly registered with national medical councils or respective state medical council and comply with relevant provisions
  • Technology platforms shall conduct their due diligence before listing any RMP on its online portal. The platform must provide the name, qualification, and registration number, contact details of every RMP listed on the platform
  • -In the event some noncompliance is noted, the technology platform shall be required to report the same to the Board of Governors (BoG), in supersession to MCI who may take appropriate action
  • Innovation stages dependent on Artificial Intelligence/Machine Learning are not permitted to guide the patients or endorse any drugs to a patient. Just an RMP is qualified for advice or endorses and needs to straightforwardly speak with the patient in such a manner. While innovations, for example, Artificial Intelligence, Internet of Things, propelled information science-based choice emotionally supportive networks, and so on could help and bolster an RMP on quiet assessment, conclusion, or the executives, the last solution or guiding must be straightforwardly conveyed by the RMP
  • Technology platform must ensure that there is a proper mechanism in place to address any queries or grievances that the end-customer may have
  • In case any specific technology platform is found in violation, BoG, MCI may designate the technology platform as blacklisted, and no RMP may then use that platform to provide telemedicine.[16]
  • Softwares that are Telemedicine friendly offers many benefits that increase the overall efficiency and productivity within a medical practice. Some of them are:
  • Enhanced record keeping: Physical therapy and documentation software solutions allow easier upkeep of patient's medical records. Regardless of whether the remedy is for checking a solitary body part or for a thorough exercise based recuperation routine, the arrangement keeps up records in a sorted way
  • Makes it simpler to read: As a large portion of the clinical specialists is famous for their unintelligible penmanship, automated exercise-based recovery programming venture may bolster patients, accomplices, and staff without inconvenience to see the specialist's notes
  • Faster billing: As billing is not viewed as the most efficient activity in clinical practice, telemedicine programming empowers experts to perform quick billing, and henceforth, limit the overall time to complete a job
  • Complete documentation: Since a lot of notes and musings are engaged with a patient's single visit, it is essential to record all the subtleties precisely. An exercise-based recuperation arrangement supports all intents and purposes filling the whole existing apart from everything else information and makes the properly formed records quickly open to a clinical collection of a healthcare professional at any time
  • Automation of tasks: A physical therapy software solution automates several tasks (such as prescription management and documentation) that otherwise consume too much time if manually done by the staff. The solution streamlines all the procedures and processes of the medical practice to enable the staff to provide high-quality care to patients
  • Faster sharing of records: Paper data are despatched and gotten through a copy inside the mail or fax to and from some other area. On the elective hand, electronic realities and distinctive computerized data can be partaken in a far quicker and simpler way by the method of the utilization of a non-intrusive treatment programming program
  • Better quality control: A physical therapy solution helps manage the overall quality of service in medical practices. The appropriate response furthermore upgrades clinical execution by supporting real advisors in the anticipation system and improving the outstanding of influenced individual consideration and stays away from loss of data. Since paper realities consistently face the peril of having harmed, strange, or lost, a physical cure answer empowers safely to store the entirety of the realities on-line
  • Easy scheduling management: When all the records are stored digitally, all scheduling tasks become simpler to manage. With a physical therapy solution, medical practitioners can easily track and manage all their patients without being concerned about complex-to-navigate paper records
  • Enhances decision-making: As the physical therapy solution serves as an excellent source of information, it augments the decision-making process during patient assessments. Physical therapy solutions offer best-practice approaches and prescriptions based on the patient's key symptoms and complaints.


The vast majority of the telemedicine programming gives cloud-based innovation to emergency clinics and wellbeing frameworks. They take into account the two patients and human services associations. Essential highlights incorporate E-mail conferences, online arrangements the board; E-mail updates, EHR synchronizing, and telemedicine. These products are intended to handily bolster any treatment and recovery practice just as mind-boggling multi-claim to fame gatherings.[17]

To list a few international software those have a rating of 3 or 4 out of a total rating of 5-AdvancesMD, WebPT, Systems4PT, TheraPlatform, OptimisPT, APTA Connect, BestPT, TherapyRehab Plus, to name a few.

Specifically in India, Telemedicine software's those are available are-Apollo PT Practice Management, Raintree Practice Manager, Kareo, Carecloud, Ready Set Connect, Cure. Fit, Portea, Practo, etc.


  Advantages of Telemedicine in Paediatrics Top


Telehealth allows us to enhance the in-person care we provide by extending our reach outside the clinic.[18]

Focal points of the utilization of telemedicine would incorporate expanded access for the restoratively underserved, improved access for the provincial and downtown youngster, upgraded care through quicker and more exact evaluation than can be given by telephone consultation, and diminished expense to the social insurance framework and the patient's family, less time away from work for guardians; and less swarming in emergency departments.[19]

The most common utilization of telemedicine in pediatrics is the utilization of teleconferencing facilities to interface patients to pediatric subspecialists. There is a developing number of reports that propose that this is practical and very much acknowledged by patients. The capacity of pediatric subspecialists to give telemedicine care in territories currently served distinctly by grown-up clinical experts should build the alternatives and nature of administrations accessible to patients. Studies despite everything should be performed to show that subspecialty conference by telemedicine improves access for youngsters situated in rustic territories and that such projects are monetarily manageable without award support.[20],[21],[22],[23]

Health-care workforce studies need to be performed to evaluate assumptions about the effectiveness and penetration of telemedicine into Pediatric practice.

In 2009, Cason examined the benefits of an early intervention telerehabilitation program and revealed that the families were highly satisfied with the telerehabilitation visits that supplemented their monthly traditional OT sessions. In the same year, Heimerl and Rasch described a telerehabilitation program that has been successfully implemented by the University of New Mexico's Centre for Development and Disability with families of children ages birth through 2 years.[24],[25]

Home telerehabilitation frameworks are financially savvy if the intercession is simply used to screen or assess patients during restorative treatment. The likelihood to keep in contact with telematic advances permits patients with genuine pathologies, for example, serious intellectual deficiencies, to perform physiotherapy at home without making tiring excursions.[26],[27]

Mobile based or E-rehabilitation helps to set daily, weekly or monthly goals with therapist. Games improving overall mobility, balance, bilateral coordination, fine motor skills, and non-motor components such as speech and voice, quality of life, and satisfaction of therapy can be obtained.[28],[29]


  Disadvantages of Telemedicine Top


As far as detriments, an issue could be the loss of human contact (eye to eye cooperation) with the specialist. Furthermore, for every patient, framework administrators are required to advance the teletherapy as per the sort of malady, and at times, this is preposterous because of significant expenses. The doubt concerning patients because of remote cooperation with their doctors or rehabilitators ought not to be thought little of and constrained adaptability in the utilization of the different clinical gadgets suitable to patients' varying needs. Difficulties incorporate an absence of control of the patient's condition, which impacts unwavering quality and capacity to see/hear the patient.[30]


  Conclusion Top


Pediatric telemedicine programs are breaking barriers between children and the care they need.

There is no clear-cut determination or one-size-fits-all solution regarding telepractice for pediatric services, even in an unusual situation such as the one we are now facing. The regulations are fluid and change quickly. More consistent use of telemedicine in Pediatric physiotherapy will benefit the implementation of new projects. Telehealth does not have an enormous group of proof for clinicians to allude to for best practice; along these lines, progressed clinical dynamic is essential to decide how to best and securely adjust practice utilizing video.

A great deal relies on the case, specific considerations of each context/situation, clinical reasoning, and the individual determination by the practitioner of whether telepractice is appropriate. No matter what service delivery model your employer or organization is trying to establish, PT is ultimately responsible for the legal and ethical delivery of physiotherapy services.

Telehealth is only a device for encouraging best practice and care in the nonintrusive treatment and ought not to copy any baseless administrations. If telehealth administrations are not improving the nature of care or improving patient results, they ought not to be utilized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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