Across the world, telehealth, teletherapy, telemedicine, and telerehabilitation have become the hottest buzz words of the healthcare industry in 2020. Today, patients and healthcare professionals can find bountiful information on the benefits to patients as well as the efficiencies to improve the costs of healthcare via the practice of virtual wellness. In the United States, the therapy world has gained huge support from its national organizations such as American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA), and American Speech Language Hearing Association (ASHA).
Late last year, the APTA itself put out a position statement on the topic stating, “APTA has been a long-time advocate for PTs and PTAs providing services via telehealth — the use of electronic information and telecommunication technologies to remotely provide health care information and services — but COVID-19 has quickly changed the landscape of telehealth and other communication technology-based services.”
Topics related to regulatory changes to advise therapists to pay attention to federal and state regulations including billing and coding practices as well as hardware and software requirements are readily available and encouraged when considering incorporating telehealth in your practice. Articles on the benefits of this technology for seniors and patients with chronic illnesses have been the center of attention, especially. Studies have supported various forms of telehealth and telemedicine in multiple countries and this year even more clinical trials are underway such as “The Effectiveness of Telerehabilitation-Based Exercises in the Elderly” at Istinye University in Istanbul, Turkey.
We see advertisements on the many software platforms that have been either newly developed or reconfigured to meet the needs of this vital resource. Here are a few tips to help your patients learn and feel comfortable living in this virtual world.
1. Practice in Person
Practice with your device and their device while they are in person with you, or, if possible, have someone who can help with their device for the first virtual session. If your company or the facility (e.g., ALF, ILF operator) is providing the device, familiarize your patient with the device (e.g., volume button, power button) as well as the application. If it is their personal device that they will be using, with their permission, familiarize yourself and them with the basic controls of their device before you teach them the application. Log in from their device, and yours, so that they see how it works. Do a practice run to acclimate them to the camera. Have them practice moving themselves as well as the camera. Many people do not know where the camera lens actually is on the device. Don’t forget to show them where it is or put a little sticky note with an arrow next to the camera lens.
2. Watch your language
Remember, everyone has their own level of tech-savviness. Your patient may not understand “app,” “link,” “scroll,” “pull up,” “upload/download,” “pdf” or even to answer the question “what’s on your desktop?” Therapist frustrations and patient confusion can be alleviated with a quick check on their level of tech terms so that you can adjust what you say and write when providing instructions.
3. Set it up
Set up the device they will be using, with their permission. Quick tips are:
- Download the application.
- Set up digital calendar invites and reminders for one day ahead and one hour before the visit time
- If the platform is web-based, bookmark it on their browser or add it to the home screen or desktop. Show them where to find it.
- On the mobile device, create a contact with your name and phone number and the url/meeting link in the notes section (if it is the same every time). Show them how to get to it.
- If sending an invite via email, show them how to click on the highlighted link from their email or calendar app.
4. Can You See Me? Can you Hear Me?
If the settings of your platform permits, present their microphone and video to “on” upon joining. Show them where to find the microphone and video symbol and how to turn it on or off and how they know IF it is on or off. Show them that the application may ask if they want the computer or phone audio. Let them know what you want them to choose. If they will be using a device other than their phone. It may be less stressful for them to call on their phone and log on from the device. They would need to know how to turn off the computer microphone to avoid that echoing ear-piercing feedback.
5. Writing is Remembering
In simple and clear phrases, have them write the directions on how to log on in their writing if that is their preference. Have them write the list of things they will need for your sessions and where they need to be sitting. If there are materials you need them to have ready (e.g., automatic blood pressure cuff, thermometer, exercise bands, pillows, cane), make sure to remind them ahead of time so that they are not panicking and scrambling to get them at the beginning of the session. Don’t forget to include a reminder to be fully dressed top to bottom!
Additionally, send exercises and your treatment plan ahead of time. Either in email, if they can print it out, or snail mail if you were not able to give to them at your last in-person session. Paper is still a security blanket for many people. Having a paper print in front of them (and perhaps for you as well) may quickly reduce the anxiety level.
6. OK. I think I am in. Now what?
If you had not already established this before the session, help them find a place in their home that is conducive to the therapy you will be providing (e.g., seated at the kitchen table as opposed to the sofa). Help them set up where the camera should be for the session based upon what you will be working on and what you need to be able to see. Guide them on how to adjust the volume of the device if it will be propped away from them. Direct them on where they need the screen-side of their device pointed if you are doing an incision check or need to see a part of their body up close for assessment. Remind them of where the camera eye is on their device.
As with the start of most therapy sessions, especially in the sectors of senior care and chronic conditions, vital signs are key assessments to be taken. Many of these patients will have an automatic blood pressure cuff and thermometer. Therapy companies and insurance companies may be supplying them as well as pulse oximeters for pulse rate and blood oxygen levels. Some therapy companies have recently vested in off-the-shelf digital monitoring devices for monitoring heart rate, oxygen saturation, the number of steps walked, sleep/wake cycles, and nighttime sleep interruptions (a valued measurement for pain management as well as urinary incontinence programs). Starting the session with therapeutic breathing exercises or Progressive Muscle Relaxation techniques can be very effective tools in creating connections with a new patient who is experiencing anxiety utilizing technology or in addressing their pain and stress.
7. Plan for Plan B
Establish what Plan B will be ahead of the first video session. If video isn’t working or if you can’t hear them but they can hear you, what are they supposed to do? What if there is a poor connection? Let them know of all the things that can go wrong, what you plan to do on your end or what you want them to do on theirs. It may help to give them a clear and concise problem and solution troubleshooting document ahead of time.
For example, many of us have experienced audio issues and the numerous reasons that can cause them. Troubleshooting tips (with screenshots) such as checking to make sure their microphone is on, is their microphone volume high enough, are they too far away from where the mic is on their device, or have they selected phone audio instead of computer audio and need to switch it. Having these tips ahead of time can go a long way in reducing frustrations. Most importantly, tell them not to panic or worry, they can call you or you will call them on the phone if it gets too stressful.
8. Patience and Compassion are Key
Platforms have certainly become more accommodating to reduce the number of steps and clicks it takes to use them. A cognitive screening test is recommended in establishing if they will need in-person support of a caregiver during your sessions, as well. However, many therapists have attested that they were pleasantly surprised by how quickly their senior patients have adapted and even welcomed this technology as many have had to experience using platforms such as Zoom and Google Meet to connect with their loved ones or have had virtual doctor’s visits and nursing wellness checks within the last six months.
There used to be an assumption that patients, especially the elderly, would have a difficult time using this technology. However, as healthcare professionals are becoming more proficient in using technology during this pandemic, so are our patients in many other aspects of their lives.
With patience, praise, and repetition, they can become pros at using telehealth in no time!
APTA Website– APTA position on Telehealth
“The Effectiveness of Telerehabilitation-Based Exercises in the Elderly” from Istinye University in Istanbul, Turkey