JMIR Publications

ABSTRACT

Background:

Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence is needed to establish the effectiveness of rehabilitation technologies, understanding of how to effectively integrate technology into clinical practice is also limited. Currently, the implementation of rehabilitation technology is inconsistent, with low uptake amongst clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy centre in 2022, offering a unique opportunity to conduct research within a clinical setting, generating practice-based evidence to inform future technology implementation efforts and research in the field.

Objective:

To investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting.

Methods:

An observational cohort study in an Australian-based rehabilitation organisation with inpatient, outpatient and community settings. Allied health clinicians (n=119) within the organisation had access to use advanced technologies with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 different advanced technologies; including robotic, virtual reality (VR), sensor-based and functional electrical stimulation devices. Clinicians received training for each device in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from 1 July 2022 to 30 June 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient/community, community), goals of technology therapy sessions and therapy dosage achieved (minutes active, number of repetitions and meters walked).

Results:

Physiotherapists (65%), occupational therapists (33%) and allied health assistants (2%) used advanced technology 4,208 times with 269 patients over 12 months. The majority of patients had stroke, spinal cord injury or brain injury diagnoses (71%). Devices were typically used to target impairment and activity-limitation related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons and upper limb robotic VR devices. On-site outpatient/community services were the dominant users of advanced technology (94%). Clinicians most commonly used devices for patients with stroke (47%) and the greatest variety of devices for patients with stroke and spinal cord injury. The use of lower limb robotic devices was greater in inpatient services (51%, versus outpatient/community services, 41%) (X2(1)=6.63, P=.01) and for patients with spinal cord injury (50%, versus all other conditions, between 24-31%) (X2(5)=16.77, P=.005).

Conclusions:

Advanced technology can be incorporated into rehabilitation practice. The type and amount of device use differed between patient populations and rehabilitation settings. Device selection to match the rehabilitation context and tailored strategies, such as clinician training, supported clinician use of advanced technology. Further practice-based research is required to provide additional guidance on implementation and to establish effectiveness of advanced technology usage.