Lessons learned using telehealth during a pandemic and looking ahead to a brighter future
In the face of the COVID-19 pandemic, faculty and researchers at the School of Physical & Occupational Therapy (SPOT) suddenly found themselves locked down at home. Very quickly, they learned how to continue teaching students on remote platforms and determined how best to pursue and adapt research work to the uncertain timeline ahead. Videoconferencing tools such as Zoom, Microsoft Teams, and WebEx quickly became very useful, allowing professors to teach and visually connect with their students. Clinical education for physical and occupational therapy students in fieldwork settings now had restricted site access, this presented challenges that involved innovative thinking and restructuring by the School’s clinical education teams. Rehabilitation science research projects which involved in-person participation of patients suddenly became impossible to continue.
Still in its infancy, telehealth, the provision of virtual healthcare services using different communication technologies, suddenly became a very feasible method for SPOT students to learn clinical skills virtually.
With the quick and impressive collaboration of community, clinical, academic and institutional partners, the occupational therapy clinical course and physical therapy placements were reorganized, approved and completed using telehealth and other digital methods to meet accreditation and regulatory standards, all while maintaining physical distancing for over 120 students in the rehabilitation programs. Two research labs at the School, The Brain Research and Imaging for Neurorehabilitation Lab (BRAIN LAB) and the Person-Centered Health Informatics Lab (PCHI Lab) obtained funding to pursue projects in their respective areas using telehealth and other virtual health platforms.
Pictured above is a physiotherapy telehealth session. Clockwise from top left are clinical supervisor, Jacques Atallah, PT, William Hardy-Abaloos, PT student, patient performing exercises, and Brandon Azimov, PT student.
How familiar were you with telehealth before the pandemic?
Muriel N. Léveillé, erg (Clinical Supervisor): Before the pandemic, I was just familiar with the term telehealth! I knew certain psychologists using this method in their practice, but at no point did I imagine doing telerehabilitation in physical health.
Kimberly McBain (Occupational Therapy Student): Before March 2020 I did not have any experience with telehealth. Very quickly though, all my occupations transitioned to online telecommunications. I suddenly was taking university classes online, teaching dance classes, and eventually doing a clinical stage for my OT professional degree using a telecommunications platform.
William Hardy-Abeloos (Physical Therapy Student): Personally, I did not have any experience with telehealth before the pandemic. The only exposure I did have was from certain Physiotherapists I follow on Instagram. (social media).
Zachary Boychuck OT, PhD (Post Doc, PCHI Lab): Not very familiar at all, I had just started my postdoctoral fellowship at the PCHI Research Lab, under the supervision of Dr. Sara Ahmed, in January 2020. My PhD research was not at all related to telehealth, and I wanted to develop additional knowledge and skills in an area I perceived to be ‘on the horizon’ in healthcare and research. Right place, right time! COVID-19 necessitated a paradigm shift towards incorporating telehealth into clinical practice.
Marie-Hélène Boudrias PT, PhD (BRAIN Lab): Actually, this was a technology we were looking at 3 years ago to help overcome barriers we were experiencing in recruiting patients for our stroke studies. Although patients wanted to participate, they were unable to participate fully or at all, due to transportation issues of distance, difficult weather, general weakness, or unavailability of transport. At the time, it was difficult to receive support and funding for this type of study, but with the pandemic, it suddenly became possible.
What was one of the biggest challenges you faced when implementing telehealth into your practice, teaching, learning or research?
Muriel N. Léveillé, erg (Clinical Supervisor): I would say that the greatest difficulty was to change my practice habits. I had to consider how to grant access to client files and to the resources we have in paper binders and how I was going to allow my student to facilitate a treatment alone while remaining available for him as needed.
Kimberly McBain (Occupational Therapy Student): For our clinical fieldwork course, I worked with a group of 5 students where we used design software to create a prototype of a telerehabilitation app. I would say one of our biggest challenges was during the group meetings where we could only view one screen at a time, this made creativity and collaboration a challenge. In the end we worked out a creative zoom and app platform schedule and we have decided to continue with the development of the app even after the course finished.
William Hardy-Abeloos (Physical Therapy Student): For sure the biggest challenge was to not be able to physically assess the patients, who were also a little skeptical about receiving care online. However, I have learned from my supervisor the best practices for chronic pain education, exercise prescription and pain management. Using telerehab allowed us to put a bigger emphasis on these and I saw that patients really responded well!
Zachary Boychuck OT, PhD (Post Doc, PCHI Lab): We were just about to launch an innovative study focusing on evaluating the implementation and scalability of telehealth solutions within the context of an Early Supported Discharge (ESD) program for stroke. When COVID-19 shut down the study, the ESD clinicians and administrators contacted us and expressed a keenness and desire to use whatever technology was available to ensure they could continue to provide clients and caregivers with services and support. We worked with the ESD clinical team to scale-down our initial study and ensured they had the necessary hardware and software required to rapidly implement telehealth into their clinical practice. The challenge was to get this done in a timely fashion!
Marie-Hélène Boudrias PT, PhD (BRAIN Lab): There were a few different challenges; we had to change the way we obtain consent, assess internet access in remote areas, explain the actual use of the device and platforms in the context of disability with our stroke patients, and importantly, review patient safety as they perform movements explained to them. In fact, we have modified our study to monitor all of these challenges mentioned as well as the original outcome of measuring motor improvement.
Do you have positive advantages, silver linings you could share?
Muriel N. Léveillé, erg (Clinical Supervisor): Yes, Telehealth eliminates all barriers regarding distance and travel. For example, in a private setting such as ours, telehealth makes it possible to refer clients to specialists who are not at our clinic, distance is really not an issue. In this way, client satisfaction and rehabilitation are optimized.
Kimberly McBain (Occupational Therapy Student): This role emerging placement provided us with the opportunity to learn how wide-reaching the occupational therapy practice can be. Student groups were creating smartphone apps, others were compiling resource lists, and some were even trying to investigate ways to contribute to support the healthcare system during the COVID-19 pandemic. Although initially, students were disappointed to not experience a typical clinical stage, I believe that our cohort, after graduation, will go into the workforce as stronger clinicians. The pandemic opened our eyes to what the loss of occupations can look like globally and how we as healthcare professionals are responsible for responding with our critical thinking and adaptive techniques.
William Hardy-Abeloos (Physical Therapy Student). Something that impressed me was when my supervisor was able to successfully explain a set of exercises for the treatment of vertigo to one of our patients virtually. True satisfaction came when we had our subsequent telerehab session, and the patient reported that the maneuver had worked! It really showed me how clear communication can be very effective.
Zachary Boychuck OT, PhD (Post Doc, PCHI Lab): Working with the ESD clinical team to scale-down our initial study, implement the required technology and ensure the quality of care and services that clients in the ESD program received was not easy to do. The quick and seamless collaboration between all stakeholders, especially considering the ‘under pressure’ nature of the roll-out, was really inspiring to experience.
Marie-Hélène Boudrias PT, PhD (BRAIN Lab): Witnessing the change in society as a whole, as the public and clinicians are able to experience the positive aspects of telehealth as a reliable and valid tool to use within their practice, this has been exceptionally nice to see happen in a fast and efficient manner. Another positive is that I was able to apply and receive funding and support for this study I had previously developed and now be able to continue implementing interventions that are best adapted to the population we are providing to, in the context of my studies, stroke patients.
Do you see yourself continuing to use telehealth in the future?
Muriel N. Léveillé, erg (Clinical Supervisor): Certainly, telehealth facilitates the transfer of knowledge acquired in the clinic to the home. By integrating the client’s session into the private environment, our observations allow for more precise and tailored advice. Also, in recent weeks, I have noticed an increase in the compliance of my clients.
Kimberly McBain (Occupational Therapy Student): Absolutely, and this placement was the perfect opportunity to explore what those opportunities could look like. The ability to reach remote populations as well as populations who are more vulnerable is a critical role as occupational therapists. I foresee myself implementing these types of services into my future practice.
William Hardy-Abeloos (Physical Therapy Student): Yes, it is very convenient, time-efficient and I think patients will appreciate this delivery of care. It was really useful for revision of exercises and patient compliance. I learned a lot about patient interaction, maybe more than if I had been in the clinic where I would be observing more of the hands-on aspects.
Zachary Boychuck OT, PhD (Post Doc, PCHI Lab): Absolutely! Telehealth and telerehabilitation have seen a rapid increase in use, and the overall positive experience of clients and caregivers indicates it is here to stay. Its adoption across healthcare settings and clienteles will likely continue to proliferate. I feel it is important that we support healthcare professionals, clients, and caregivers in adapting to using telehealth optimally. I am excited to be at the PCHI lab where we are working with clinicians of the CIUSSS West-Central and SPOT colleagues on OT and PT students’ and clinical preceptors’ experiences with using telehealth during clinical practicums.
Marie-Hélène Boudrias PT, PhD (BRAIN Lab): Yes definitely, I do hope we continue to use these technologies in the future. It will allow us to recruit and include many more patients who live in rural areas where transportation was a very large and limiting barrier. I also think it will become important for clinicians to include this as a tool within all the tools they use in their practice.
With each discussion, I was impressed with how these healthcare professionals, and future healthcare professionals, negotiated and quickly implemented the use of virtual health technologies within each of their current realities. Keywords that often came up were collaboration, clear communication, and gratitude. I look forward to seeing what the future holds as we all navigate the new reality ahead.
July 15 2020