L28/29: Assessment and Treatment using Digital Technologies Flashcards
1
Q
What is the purpose of the digital health?
A
Track and manage health
2
Q
What are 6 characteristics of digital health?
A
3
Q
What are 11 components of digital health?
A
4
Q
What are 11 components of physiotherapy for digital heath?
A
5
Q
What are different terms for digital technologies?
A
- Telemedicine
- Telerehabilitation
- Telecare
- Virtual care
- Home Telehealth
- Separated Services
- Telepractice
- eHealth
- Electronic Digital
- Hospital Medical Records
- Telehealth
- mHealth
can specify if its home or hospital/practice based
6
Q
What are 4 drivers for change in healthcare?
A
- Ever-increasing cost & demand for health care
- Social & demographic changes
- Changes in healthcare models
- Rapid developments in technology Benefits VS implications
B: information is key
I: privacy could be broekn
7
Q
What is the ever-increasing cost and demand for health care?
A
- Ageing Population- Number in the higher categories is increases = tend to consume more health care (older people)
- # Americans > 65 projected to double by 2060
- Share of population increase from 15-24%
8
Q
What is the proportion of the Australian population aged 65 and over, at 30 June over time?
A
9
Q
What is the Australian population pyramid by Aboriginal and Torres Strait Islander status?
A
10
Q
What is the proportion of people aged 65 and over in selected countries?
A
Large of population = ageing (had one child policy??)
11
Q
What does the ageing population (global phenomenon) look like from 1950, 2005 and 2055?
A
12
Q
What are 4 characteristics in regards to access to services?
A
- 68.7% Australians live in major cities
- 30% regional & rural/remote areas
- Providing services beyond metropolitan areas vexing issue – recruitment & retention
- Access to FTF services difficult for persons with physical &/or communication disability
13
Q
What are the rates of different health behaviour and risk factors in different residential areas?
A
14
Q
What is the relationship between area of habitation and mortality?
A
More remote = higher mortality
15
Q
What are 4 main keys in regards to remote, rural living for the demand for health care?
A
16
Q
What are 4 characteristics of ever-increasing cost and demand for health care?
A
- Access to FTF services difficult for persons with physical &/or communication disability
- Effort required → ↓ physical & cognitive state- Poor access to services + mobility impaired
- Require carer & specialised transport
- Children – competing needs of siblings, parent work schedules
17
Q
What are 4 characteristics of social and demographic changes in terms of health care?
A
- Tomorrow’s elders expectations for retirement likely to be different
- Remain living in own homes – transport issues as capacity to drive ↓
- Will demand technology to support independent lifestyle
- Need services to accommodate this change
18
Q
What is the healthcare transformation?
A
“The bottom line is this: the future of health belongs to patients ‘owning’ their own health, at home, in their neighborhoods and in their communities.”- Patient-centred care
19
Q
What are the 2 health care models?
A
- My Aged Care
- Consumer Directed Care (CDC)
- Have say in how services are provided & by who
- Individualised funding mode
- www.myagedcare.gov.au
- National Disability Insurance Scheme (NDIS)
- Client-centred funding – “choice & control” for client
- Home-based
- Self-managed care
- http://www.ndis.gov.au/
20
Q
What is “my Aged Care”?
A
- Consumer Directed Care (CDC)
- Have say in how services are provided & by whom
- Individualised funding model
- www.myagedcare.gov.au
21
Q
What is “National Disability Insurance Scheme (NDIS)”?
A
- Client-centred funding – “choice & control” for client
- Home-based
- Self-managed care
- http://www.ndis.gov.au/
22
Q
What is important about patient-centred care in the 2 healthcare models?
A
Patient chooses how they want their money to be distributed
23
Q
What are 5 current approaches to service delivery inconsistent with new models of healthcare & disability?
A
- Driven by medical model
- Clinic-based
- Assessment & treatment in artificial environment
- Limited generalisation to ‘real world’
- Funding restrictions
24
Q
What are the 4 rapid increase in capacity to (rapid development in technology)?
A
- Access information & services
- Perform work activity online
- Be entertained
- Engage in social networking
25
What are 5 examples of technology in rehabilitation?
1. Telerehabilitation / videoconferencing
2. Wearables
3. mHealth
4. Virtual Reality
5. Gamification
26
What is audiovisual telehabilitation?
Real-time videoconferencing for the replication of in-person services
27
What are 5 characteristics of dedicated systems?
1. Single purpose
2. High quality videoconferencing
3. Fixed locations (hospitals / health services)
4. Ideal for meetings / talking heads / some clinical
5. Rehabilitation examples Head and Neck Cancer Burns Swallowing Ax Mobility Ax
28
What are 10 pros and cons for audiovisual telehabilitation?
1. Good Standards
2. Good Security
3. Good Multipoint
4. Good Usability
5. Increased Cost
6. Decreased Portability
7. Decreased Homecare
8. Versatility
9. Good Camera Control
10. Good Quality (video /audio)
29
What are 3 types of Hybrid Endpoints?
1. Desktop
2. Laptop
3. Tablet Local end infrastructure
30
What are 2 generic collaboration tools?
1. PC / MAC / Table / Phone
2. Combination of
* Videoconferencing
* Application Share
* Whiteboard
* Voting systems
* Text Chat
31
What are 10 pros and cons in regards to generic collaboration tools?
1. Good Standards
2. Good Security
3. Good Multipoint
4. Decreased Usability
5. Increased Cost
6. Increased Portability
7. Increased Homecare
8. Versatility
9. Decreased Camera Control
10. Quality (video /audio)
32
What are 6 characteristics of real-scale measurement for eHAB?
1. Real-scale measurement
2. Angles / angular displacement
3. Linear distance
4. SPL, pitch
5. Intuitive and clinically based
6. Extensive validation
33
What are 5 characteristics of advanced media tools for eHAB?
1. Display media such as video, images, text
2. Full clinician control (play, pause, scrub, hide)
3. Bandwidth independent
4. Annotate over media
5. Replication of clinical assessments
34
What are 5 fundamentals of technology: store and Forward?
1. Acquisition and storing of clinical information
2. Information forwarded (or retrieved) by another site
3. Data such as vital signs, x-rays, dermatology images
4. Delay between the sending and receiving of information
5. Usually simple technology such as email, web portal
35
What is Store and Forward technology?
Not done in real time --\> information collected --\> transmitted and stored --\> can then access at a later point
36
What are 4 characteristics of real time?
Interacting with patient
* Can between one or many people
1. Two-way real time transmission of clinical information
2. Often video and/or audio with a patient and clinician
3. Interaction can be important for education of diagnosis
4. Technology / connection requirements often higher
37
What are 5 important terms to know for digital health?
1. Bandwidth
2. Latency
3. Jitter
4. Packet Loss
5. Quality of Service
38
What is bandwidth?
Rate that information can be transferred over the connection
39
What are 3 characteristics of bandwidth?
1. Kilobits per second Kbps
2. 1000 Kbps = 1 Mbps
3. For videoconference bandwidth \> 128 Kbps up to 4 Mbps
40
What is latency?
Delay between when information is sent and when it is received
41
What are 3 characteristics of latency?
1. Measured in milliseconds
2. How much traffic and how many traffic lights are on the road
3. Generally latency \< 300-400ms required
42
What is jitter?
Variation in the latency over time
43
What are 3 characteristics of jitter?
1. Can make it hard for the videoconference to maintain quality and synchronisation between video and audio streams
2. Can result in freezing of video frames
3. Poor lip sync, freezing, frames skipping forward..etc
44
What is packet loss?
* Video / Audio data is sent over the network in small packets • Packets can be ‘lost’ in transmission
* High packet loss can result in a ‘jumpy’ videoconference and the audio may cut in and out
* Packets only describes a bit of picture = can have old and new parts of video
45
What are 2 characteristics of quality of service?
1. Idea that bandwidth, latency, packet loss etc can be measured and to some extent be guaranteed in advance
2. Use of ‘traffic shaping’ techniques to prioritise certain traffic (such as video / audio) over others (such as facebook browsing)
46
What are 5 characteristics of growth in telemedicine?
1. About 90% of healthcare executives surveyed report that their organizations have begun developing or already implemented a telemedicine program
2. The number of telemedicine patients will increase from 350,000 in 2013 to 7 million in 2018
3. In 2015, 29 states already required health insurers to pay for telemedicine services and another 26 bills were pending in Congress
4. About 22% of employers with 1,000 or more employees offer telemedicine services and another 37% planned to by the end of 2015
5. Telemedicine makes up nearly one-fourth of the health IT market that was valued at $15.6 billion in 2014 and is expected to increase to approximately $20 billion by 2019
47
What is the aim of Musculoskeletal Diagnostic Accuracy?
Investigate the validity and reliability of telerehabilitation assessment of common musculoskeletal conditions
48
What are 7 characteristics of Musculoskeletal Diagnostic Accuracy eHAB Telerehabilitation system?
1. Specifically developed for rehabilitation
2. Clinically validated
3. Software as a service solution
4. Available on any platform
5. Real scale measurement of the client
6. Advanced multimedia capabilities
7. High quality ‘beyond-bandwidth’ recording
49
What is the Telerehabilitation Procedure for patient interview?
+/- standardised questionnaires
50
What are the 5 Telerehabilitation Procedure for physical examination?
1. Observation
2. Palpation
3. Movement examination
4. Standardised Tests
5. Specific testing of muscular, neural, articular systems
51
What is the effectiveness of face to face in person vs telerehabilitation?
Interpersonal connectivity maintained
Tele VS face to face = same effectiveness
52
How can the palpation in physical exam be done in telerehab?
Eg. put your finger on where it is sore?
Go up and down
Does the tissue feels squishy, hard..etc?
Use word suggestion
53
How can the Movement examination / Standardised testing in physical exam be done in telerehab?
Use connect (X box)
* Can only do in tele, not face to face
54
How can theSpecific Testing in physical exam be done in telerehab?
55
Diagnostic accuracy of telerehabilitation assessment is not _____ to face-to-face reliability studies. In fact, there are _____ level of both inter and intra rater reliability
inferior; high
56
In telereb, Patients (+/- carer- Eg. partners, kids) were able to adequately assist with a remote _____ examination (palpation, orthopedic tests etc..)
physical
57
Technology provided adequate suite of tools to enable most aspects of the _____ to be conducted
Ax
58
Alternate strategies are required for ______ testing and some aspects of manual joint assessment in telerehab.
neurodynamic
59
What are 4 assessment considerations for telerehb?
1. Convention assessment planning procedures should be used
2. Many Ax elements do not require manual examination (e.g. Patient Interview)
3. Manual examination elements
* Is a presenter available?
* Is the presenter trained or untrained?
* Can the patient assist?
* Can the examination be modified?
4. Standardised assessments
* Can elements of the test be accurately reproduced?
* Is copyright permission required?
60
What are 8 telerehab interventions?
1. Education
2. Goal Setting
3. Exercise +/- equipment
4. Motor retraining
5. Movement facilitation
6. Functional restoration
7. Pain Management
8. Manual Therapy
61
Outpatient Telerehabilitation post TKA _____ (is/is not) feasible
is
62
Telerehabilitation produced physical and functional results that were ______ (better in some measures) with those achieved through traditional face-to-face therapy
comparable
63
A _____ level of satisfaction was reported for the telerehabilitation intervention
high
64
The telerehabilitation intervention was \_\_\_\_\_despite participants having a very low level of computer skills and knowledge / interest
successful
65
Is telerehab effective?
* Generally TR found to be as effective as usual care
* More evidence required for stroke
* More evidence required for economics
66
What are wearables?
Uses devices to remotely collect, store and communicate biometric health information (eg. Measure tremor throughout the day ) (Wrist (eg. activity trackers, HR, glucose)
67
What are 2 types of sensors?
68
What can activity trackers measure in wearables?
Activity trackers
* Blood pressure
* HR
* Glucose levels
Where people are mobilising and where they are mobility = categories activity (eg. sitting for an hour, lying on left side..etc)
Can use both side
Can see how management is improving
69
What is the effectiveness for wearables?
Cheaper wearables --\> tend to underestimate
* Not accurate in data
But can see a benefit in change activity
70
What is mhealth?
Mobile health
71
What are 4 characteristics of mHealth?
1. Interactive app for rehabilitation/education (Eg. phone)
2. Store-and-forward and real-time
3. Diagnosis and treatment
4. Information / scheduling
72
What is virtual reality?
Computer-generated environment that can be interacted with in a seemingly real or physical way.
73
What are 7 reasons for using virtual reality?
1. Exposure therapy
2. PTSD
3. Pain Management
4. Surgical Training
5. Phamtom limb pain- Can recreate a limb that is missing
6. Cognitive assessment
7. Social cognition training autism
74
What are the full immersive to "serious" games in VR?
75
What is an example of a Low cost sensor technology suitable for the home environment for VR?
X-box Kinect
76
What are 5 characteristics of VR?
1. Task-oriented Training- Esp. stroke patients
* Challenging- While being still interesting
* Progressive
* Adaptable
2. Direct costs often not reported
3. Emergence of mass production of hardware
4. Few off the shelf rehabilitation products
5. Emerging evidence for efficacy especially with ‘Serious Games’
77
What is benefit of gamification?
Make HEP more interesting --\> increase compliance
78
What is gamification?
79
What is the benefit of sleep trackers?
Eg. can observe sleep cycle (eg. if they have cough --\> wake up in sleep) = can be monitored
