JMIR Publications

ABSTRACT

Background:

The Hospital Authority is the statutory body providing rehabilitation services to citizens of Hong Kong. With aging population and ever growing service demand, there is huge service gap in ambulatory rehabilitation service. Service bottleneck renders clients not able to receive prompt rehabilitation service and adequate service intensity.For example, around 30% of stroke clients served in HA are below 65 years. The rehabilitation day facility has limited placements; and geriatric day hospital is designed predominately to accommodate clients over 65 and has very few capacities for younger clients. Consequently, a large proportion of younger clients are either discharged without rehabilitation support or occasionally referred to AHOP. In 2013, only 15% and 26% of younger stroke cases received day and outpatient rehabilitation services respectively. The HA began to development tele-rehabilitation service aiming primarily to bridge the service gap. The Tele-rehabilitation (TR) platform is rollout for use to Physiotherapy, Occupational Therapy and Speech Therapy and is receiving positive feedback. With the outbreak of COVID-19, the three Allied Health professions experience huge service disruption. Service volume decrease remarkably form 50% to 70%. By early February 2020, the TR platform has been used heavily to alleviate the effect of service disruption. The aim of this quick review is to describe the design and development process of TR in HA and the use of this platform to provide rehabilitation service to affected clients during Coronavirus outbreak.

Objective:

1. To describe the design and development process of Tele-rehabilitation system of Hospital Authority 2. The use of TR to improve rehabilitation service to clients in Hong Kong 3. The use of TR to serve clients during COVID-19 and the design of TR system that allows rapid expansion to cater for more clients to be served

Methods:

A technology or innovation can only be considered useful if it is accepted and actually used in daily clinical practice. There are several criteria to be considered in predicting whether the users will actually use the technology. The theoretical model of Unified Theory of Acceptance and Use of Technology (UTAUT) is used. The model pointed out the essential domains of: (1) Ease of Use; (2) Perceived Usefulness; (3) Implementation Context; (4) Social Context. The development of the TR platform is taking reference to the different contexts in order to make this product to have satisfactory acceptance and utilization. The whole approach will be user centric and close collaboration with clinical users and clients is maintained in the course of entire project development. Focus group is formed to work closely with PT, OT and ST colleagues. Detailed discussion and deliberation is conducted to ensure that the therapist find the system useful and easy to use. It is iterated by our users that the TR shall: (1) bridge the service gap in ambulatory rehabilitation service; (2) enable the therapists to prescribe suitable exercise to clients; (3) save time of therapist in view of current heavy workload. It is emphasized that clients shall be able to carry out prescribed rehabilitation activities anywhere, anytime by themselves. TR using off the shelf technology is more favorable because it is easily accessible to clients without need to procure and install sophisticated equipment. After thorough discussion, a new prescription platform (Activity Base Prescribing System, ABPS) together with a mobile app (Rehabilitation App) is to be developed. After therapist performs assessment to client, exercise videos and reminders should be able to be prescribed through a prescription platform and client can access the prescription through the mobile app. The prescription platform shall be easily accessible and aligns well with existing clinical workflow of therapists. Concerning the mobile app, it shall be user friendly to elderly and able to capture client’s performance and sequentially feedback to prescribing therapist.

Results:

The ABPS is an integrated prescription platform for different Allied Health profession. The system recognizes professions of logon staff and display relevant content for prescription. Therapist can set various prescription parameter: date, time, frequency, user preferred templates etc. Client's performance is viewable from the platform too. The platform is designed with concept of single platform for multiple clinical conditions. Most importantly, new exercise videos, reminders are able to be added. The Rehabilitation App is designed to be barrier-free to user. A swipe of push notification sent to clients at designated time will enable client to access training videos. The app is simple, easy to use and all activities prescribe in ABPS will be shown in the App. Altogether 144 training videos are incorporate into the ABPS for therapists' prescription. Upon the outbreak of COVID-19, the TR system is heavily used. Within a month, 41 new PT videos; 8 ST new videos and later 8 OT videos are added. The utilization from the introduction of the system in Oct 2019 till Jan 2020 is 320 per month. The rate soared to 464 in Feb 2020 and 1989 in March 2020. 31.9% of total ST, OT and PT workforce prescribed TR and the age of clients prescribed with TR is younger. Because other than the elderly clients, more clients are prescribed to use this form of rehabilitation. Moreover, the spectrum of condition prescribed also becomes wider. Very high satisfaction rate is feedback from clients.

Conclusions:

Before the outbreak of COVID-2019, TR has been used to bridge service gap for ambulatory rehabilitation service and is receiving positive feedback from therapists in HA since its introduction. After the outbreak, TR has further demonstrated its usefulness in provision of rehabilitation service to a much wider spectrum of clients. TR has become an indispensable tool to therapists, and clients are showing good acceptance to this mode of rehabilitation service delivery. Figures show that only around 32% of ST, OT and PT workforce has used TR. It is believed that there is huge potential for more therapists to use TR in near future and TR will be a new norm in rehabilitation delivery even after the outbreak. The single prescription platform/mobile app for all design facilitates the speedy expansion of video library and enabled the speedy expansion of service. However, further clinical studies are needed to confirm the clinical effectiveness of TR in Hong Kong. In conclusion, TR in the form of integrated Prescription Platform and Mobile App can be one of the effective means to provide rehabilitation service to clients and has demonstrated its huge potential particularly in the crisis situation of COVID-2019 outbreak.