Unlocking the power of digital healthcare for rehabilitation and allied health services

Is practitioner hesitancy around the effectiveness of digital healthcare limiting what may be possible in allied health services?  A new whitepaper by Rehab Management, a leading rehabilitation provider, explores the efficacy of telehealth and self-directed digital health interventions.

A key area of change in the health industry due to COVID-19 has been the shift from a face-to-face service delivery culture to the realm of telehealth (this includes video-based and telephone-based delivery mode) and the growing space of digital health interventions, including self-directed care.  While some areas of health have been marching ahead in these areas, resistance still remains for a variety of reasons, including practitioner lack of digital literacy and hesitancy around the effectiveness and efficacy of telehealth services.

In an effort to better explore the benefits of telehealth and self-directed digital health in delivering clinical outcomes in allied health, a new white paper has been developed by Rehab Management, a leading rehabilitation provider with a strong focus on digital innovation, working with many of Australia’s largest organisations. The paper specifically focuses on the allied health areas of occupational therapy, physiotherapy, and psychology.

Michelle Barratt, Rehab Management’s National Innovation and Customer Engagement Manager, says “The barriers for providing and receiving typical face-to-face allied health services have come into sharp focus during the COVID-19 pandemic. However, these challenges are not new; people in remote and regional areas have been experiencing barriers to accessing allied health services for decades. Thankfully, due to the ever-improving quality and accessibility of technology, online-therapy continues to improve as a viable option for receiving and delivering health services. Yet, despite the many benefits, hesitancy in adopting technology continues to exist.”

“At Rehab Management, we wanted to explore the efficacy of telehealth and self-directed digital health interventions in order to provide the sector with clear evidence-based information on what is working and what does not work. We felt it was important to make the distinction between telehealth and other digital health interventions. Unlike telehealth, online-therapy modalities such as self-directed web-based modules, smartphone applications and web-based therapy all allow for treatment to be undertaken by individuals without the direct involvement of a clinician,” continued Ms Barratt. “As outlined in the paper, there are many excellent examples to learn and grow from.”

Key points from the whitepaper:

·     Research indicates telehealth as a delivery modality produces similar clinical outcomes to in-person allied health services for occupational therapy, physiotherapy, and psychology services.

·       As well as indicating telehealth is equally effective as face-to-face treatment, some studies suggest telehealth can provide more efficient and cost-effective outcomes.

o   For example, the ever-present use of technology in individuals’ lives presents a vast opportunity for widespread access to mental health services. A systematic review of the efficacy of online youth mental health services scoped 28 studies from 2000 to 2015 and found module-based interventions were shown to lead to significant improvements in adolescent mental health literacy, support seeking behaviour and psychological wellbeing (Musiat et al., 2014).

·       However, the research indicates clinicians must screen for personal factors and environmental circumstances to determine if telehealth will produce successful clinical outcomes in each particular case.

o   For example, there are many clinical triage considerations when determining if an individual is suitable for therapy via telehealth. Language barriers, access to technology, cognitive impairments, vision or hearing impairments, technological literacy, severity of symptoms and urgency of care are all individual client factors that may determine if an individual is suitable for therapy via telehealth (Cottrell & Russell, 2020).

·       To mitigate the risks of providing remote services, clinicians (especially when treating mental health conditions) should also establish a ‘safety plan’ if an individual is deemed appropriate for telehealth – in the instance the individual becomes in need of immediate medical attention.

·       Research indicates that online self-directed treatment is effective in treating both mental and physical health conditions. However, literature suggests that to obtain the most successful clinical outcomes with self-directed therapy, some clinician involvement is required to maintain client engagement and improve program adherence. Clinician involvement with self-directed therapy appears to present most commonly in the form of weekly text messages and emails to the app or module user.

o   For example, a year-long randomised control trial assessed the efficacy of an internet-platform-based arthritis self-management program in slowing or reducing negative effects of osteoarthritis. The platform consisted of a discussion board, exercise logs, medication diaries individualised exercise programs, and an ‘Arthritis Help Book’ (which included all program content). The internet-based program was designed to replicate small-group programs that usually take place within the community. The study concluded that the internet-based arthritis self-management program was as effective as community groups in slowing or reducing negative effects of osteoarthritis over a one-year period (Lorig, Ritter, Laurent, & Plant, 2008)

“As outlined in the whitepaper, current research overwhelmingly identifies both telehealth and self-directed digital health interventions as effective and valid forms of assessing and treating both mental and physical health conditions, within certain parameters for the different modalities of occupational therapy, physiotherapy, and psychology. However, mitigating risks associated with allied health delivery, no matter the delivery mode, is critical for maintaining effective services. As the digital health space continues to grow it would be beneficial for the field to see increased emerging research around digital health intervention in prevention, health optimisation, positive psychology, and strengths concepts such as resilience-building and flourishing,” finished Ms. Barratt.

A copy of the whitepaper is accessible here