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PHTY2240 MSE > L31/32: Professional and implementation- Considerations > Flashcards

L31/32: Professional and implementation- Considerations Flashcards

1
Q

What are the 4 key practical considerations when embarking on a telerehabilitation session?

A
  1. Environmental considerations
  2. Expectations of technology
  3. Adaptive skills
  4. Online behaviours
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2
Q

What are the 8 practical environmental considerations?

A
  1. Choose an appropriate room for the telerehabilitation sessions’
  2. Characteristics of an appropriate room
  3. Arrange furniture so it is appropriate for service being provided and the client
  4. Appropriate backdrop for video
  5. Acoustic environment
  6. Visual Environment
  7. Appropriate clothing
  8. Positioning
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3
Q

What are the 2 characteristics of “Choose an appropriate room for the telerehabilitation sessions” as practical environmental considerations?

A
  1. Consider both sites (client site and your site)
  2. Privacy considerations- Client will be less aware as they are in a comfortable setting
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4
Q

What are the 3 characteristics of an “appropriate room” as practical environmental considerations?

A
  1. Appropriate size for the number of people participating
  2. Not a common room where other people may interrupt the session
  3. Appropriate infrastructure (network access)
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5
Q

What are the 3 characteristics of “arrange furniture so it is appropriate for service being provided and the client” as practical environmental considerations?

A
  1. Consider both sites
  2. Liaise with the client to set-up their room appropriately.
  3. Ensure furniture is arranged so that the session is optimised and safety is assured
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6
Q

What are the 2 characteristics of “appropriate backdrop for video” as practical environmental considerations?

A
  1. Neutral colours are best
  2. Avoid patterns, shiny/glossy surfaces, stark white
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7
Q

What are the 4 characteristics of “acoustic environment” as practical environmental considerations?

A
  1. Exclude as much background noise as possible
    • Ensure doors and windows are closed
  2. Limit internal noise - phones, clocks ticking, air-conditioning noise etc.
  3. Soft furnishings, carpet, curtains &/or acoustic tiles will optimise the acoustic environment
  4. Use the mute button to avoid distracting clients with unavoidable noise. Acoustics of the room (eg. Don’t want echos)
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8
Q

What are the 4 characteristics of “visual environment” as practical environmental considerations?

A
  1. Ensure lighting is in front of and above all participants NOT behind
  2. Artificial lighting is better than natural lighting as it is more consistent.
  3. Reduce reflected glare by varying the position and intensity of lighting
  4. Reduce shadows by altering the position and intensity of lighting
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9
Q

What are the 3 characteristics of “appropriate clothing” as practical environmental considerations?

A
  1. Wear plain colour that contrasts with the backdrop
  2. Ensure clothing contrasts with resources
  3. Be aware of glare or reflection from participants’ glasses
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10
Q

What are the 4 characteristics of “position” as practical environmental considerations?

A
  1. Consider your position relative to the camera and screen
  2. Talk to the client about their position
  3. May need markers if client needs to move during the session and then return to same position
  4. Check positioning throughout the session
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11
Q

What are 3 practical technology considerations?

A
  1. High speed, stable connectivity is vital to successful telerehabilitation
  2. Test equipment before the session
  3. Technology expectations
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12
Q

What are the 2 characteristics of “high speed, stable connectivity is vital to successful telerehabilitation” as practical technological considerations?

A
  1. If delivering services into the home, determine the connectivity used for the client’s current Internet plan
  2. Connectivity may be intermittently variable and affect auditory and visual clarity Not speed of connection but consistency of connection that is important
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13
Q

What is a characteristic of “test equipment before the session” as practical technological considerations?

A

You may wish to conduct a test session with the client to ensure good connectivity and environmental set up Important to do test connection (same time of day, same day of week) Eg. morning tea = bad connection

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14
Q

What are the 2 characteristics of “technology expectations” as practical technological considerations?

A
  1. Prepare the client’s expectations of technology
  2. Seek feedback from the client about technical issues
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15
Q

What are the 4 characteristics of “prepare the client’s expectations of technology” in the “technology expectations” as practical technological considerations?

A
  1. Discuss variability in connectivity
  2. Provide written and visual instructions for technology
  3. Provide basic troubleshooting information
  4. Have another way to contact the client – e.g. phone Might have drop out for 3-4 secs –> give them this instruction first —> they are aware = more satisfaction compared to if unknown (feel that it is suboptimal service)
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16
Q

What are the 3 characteristics of “seek feedback from the client about technical issues” in the “technology expectations” as practical technological considerations?

A
  1. Especially important during multipoint sessions
  2. Initially check in frequently with the client
  3. Monitor client reactions to determine if there has been a change in auditory or visual signal.

Good communication strategies if something does go wrong (eg. if you cant hear me –> put hand on head)

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17
Q

What are 4 characteristics of “technology expectations” as practical technological considerations?

A
  1. Using technology in a telerehabilitation session is different to in-person use of technology
  2. Technical issues should be expected to occur from time to time and should be reacted to calmly
  3. Arrange for consistently available technical support
  4. Know the most frequently occurring technical problem and possible solutions What to do if cant back to call?
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18
Q

What are 3 practical adaptive skill considerations?

A
  1. Preparation
  2. Flexibility – prepare for the unexpected and react calmly
  3. Defining roles and responsibilities
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19
Q

What are the 8 characteristics of “preparation” in the “technology expectations” as practical adaptive skill considerations?

A
  1. Prepare the session well ahead of time
  2. Provide all scheduling details to client
    • when, how long, who should be present, contact details of clinician, technical support options.
  3. Send reminder about scheduled session
  4. Provide written instructions on use of technology (e.g., connection process)
  5. Tell participant what they need to bring to the session
  6. Plan and prepare the session materials
  7. Practice using materials with technology
  8. Use predictable format for sessions
    • Pre-recorded exercises and their progressions before starting
    • Check have all the resources available before starting
    • ‘Pre-plan treatment and then plan ahead to know how to deliver information (eg. pre-record, demonstration)
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20
Q

What are the 5 characteristics of “flexibility” in the “technology expectations” as practical adaptive skill considerations?

A

prepare for the unexpected and react calmly- Have plan B –> no weight in kitchen –> can use body weight or spouse to provide resistance

  1. Poor connectivity may lead to increased length of session
  2. Poor connectivity may mean you need to repeat instructions
  3. Have more materials/activities available so can change planned activities if needed (e.g. if client forgets their materials)
  4. Have a plan B session prepared
  5. Think about what could go wrong and how to salvage the situation
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21
Q

What are the 5 characteristics of “defining roles and responsibilities” in the “technology expectations” as practical adaptive skill considerations?

A
  1. The client will be expected to take on an active role in telerehab sessions
  2. Clinician will need to develop coaching and guiding skills
  3. Prepare the client for extra demands of telerehab through discussion
    • If done physio before –> need to explain the different roles now (when using telehealth eg. extra roles))
  4. Assigning specific tasks to each participant to facilitate role shift
  5. See RIDBC Guiding Principles for Telepractice for examples
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22
Q

What are 7 good communication skills for practical online behaviours considerations?

A

Delay = might talk over each other –> can use hand signals once finished talking

  1. Clear speech at an appropriate pace and volume
  2. Maintain eye contact during direct interaction by looking at camera
  3. Turn-taking is essential
  4. Reduce extraneous comments
  5. Demonstrate listening by nodding or reflective listening techniques
  6. Maintain constant position and reduce extraneous physical movement
  7. Use hand signals/gesture if appropriate
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23
Q

What are 6 characteristics of practical online behaviours?

A
  1. Good communication skills are essential
  2. Provide clear, specific directions and instructions.
  3. Engage all participants
  4. Rapport should be intentionally established
    • Can sometimes loose small talk when the video starts –> make a conscious effort to engage first (don’t start immediately on physio session )
  5. Develop turn-taking skills of all participants.
    • Longer pauses after speaking may be needed to account for connection delays
  6. Clients should be able to provide feedback on sessions
24
Q

What are 4 characteristics of client selection?

A
  1. Condition
  2. Specific Client Attributes
  3. Location
  4. Technology
25
Q

What is a characteristic of condition specific in client selection?

A

Nature of the required intervention / interaction with the client

26
Q

What are 6 characteristics of “client attributes” in client selection?

A

Elderly can still adapt to technology well

  1. Age (e.g. very young)- Under 5-6 (difficult to keep attention and engagement)
  2. Hearing / Vision
  3. Physical capabilities (interaction with technology, moving cameras)
    • Do they have dexterity?
  4. Cognitive status
    • Head injuries, stoke but there is a threshold
  5. Familiarity with technology
  6. Consent
27
Q

What is a characteristics of “location” in client selection?

A

Connectivity options

28
Q

What are 7 characteristics of “technology” in client selection?

A
  1. Availability
  2. Personally
  3. Loan
  4. Community
  5. Privacy / security
  6. Features – evidence
  7. Training
29
Q

What are 7 safety and risk?

A
  1. A principle consideration
  2. Same consideration as face-to-face interactions • Use clinical reasoning
  3. Remember you cannot physically assist
  4. Training of carers / spouses possible but consider limitations
  5. Adult presence required for children
  6. Remember privacy / confidentiality
  7. Consult practice guidelines
30
Q

What are some strategies you could use to improve the safety of doing a videoconference with an orthopaedic patient in the home?

A
  • Clear immediate surroundings
  • Appropriate footwear (ge. Footwear)
  • Carer present
  • Support (hold on to eg. rail, stable chair –> not a rolling chair)
  • Emergency number and address details available (in case of emergency)
  • Red flag signs and symptoms (if you feel unwell..etc)
31
Q

What are 2 characteristics of privacy, confidentiality and security?

A
  1. Client privacy & confidentiality is part of being a healthcare provider
    • It is paramount in healthcare technologies.
  2. ‘Security is the strategy & privacy is the consequence’
  3. 3 major aspects of security:
    1. confidentiality
      • Not allow patient information to not be shared
    2. integrity
    3. availability
32
Q

What are the 3 major aspects of security?

A
  1. confidentiality
  2. integrity
  3. availability
33
Q

Write a list of considerations you may need to think about with respect to privacy, confidentiality and security when doing a videoconference into the home?

A
  • Location (private room)
  • Secure software
  • Address and phone number kept private
  • Background (make sure that they don’t see or hear other patients)
  • Microphone on desk -> can act as an amplifier
  • Same physio for consistent care
  • Make sure right patient (ask name, client ID) eg. not
34
Q

What are the 3 policies in terms of privacy, confidentiality and security in the USA?

A
  1. HIPAA (1996)
    • Who has access to patient information?
  2. HIPAA Privacy & Security Rules
  3. HIPAA Compliant Hosting
    • What rules are put into place (eg. administration and practice part)
35
Q

What are the 4 policies in terms of privacy, confidentiality and security in the Australia?

A
  1. No HIPAA equivalent
  2. Privacy Act (1988)
  3. Privacy Amendment (Private Sector) Act (2000)
  4. The Australian Government Agencies Privacy Code
36
Q

What is the Australian Government Agencies Privacy?

A

Sets out specific requirements and key practical steps that agencies must take as part of complying with Australian Privacy Principle 1.2 (APP 1.2). It requires agencies to move towards a best practice approach to privacy governance to help build a consistent, high standard of personal information management across all Australian Government agencies. The Code enhances existing privacy capability within agencies, builds greater transparency in information handling practices, and fosters a culture of respect for privacy and the value of personal information. The Code therefore symbolises the commitment of Australian Government agencies to the protection of privacy, and helps build public trust and confidence in personal information handling practices and new uses of data proposed by agencies.

37
Q

What are the 3 legal considerations?

A
  1. Clinical judgement
  2. Scope of Practice
  3. Position Statements
38
Q

What is clinical judgement in legal consideration?

A

‘Given the variability of rehabilitation clients, candidacy and appropriateness for telerehabilitation should be determined on a case-by-case basis with selections firmly based on clinical judgment, client’s informed choice and professional standards of care’

39
Q

What are the 5 characteristics of scope of practice in legal considerations?

A
  1. Aims of the session
  2. Safety of the client
  3. Ability of the client to interact with the practitioner via appropriate technology
  4. The availability of appropriate technology
  5. Benefits vs risks of conducting the session via telerehabilitation
    • Known when something is out of your scope –> know when to refer
40
Q

What are the 4 characteristics of Position Statements in legal considerations?

A
  1. APA
  2. SPA
  3. AA
  4. ?? OTAUS
41
Q

What are 3 characteristics of registration?

A
  1. Practitioners must abide by local laws- Must be registered to practice (eg. national laws)
  2. AHPRA
  3. National registration.
  4. USA
  5. Controlled by State bodies.
    • Can do physio consults to places where registration is not required (eg. vietnam) • If registrations are in place –> unable to provide session
42
Q

What are 6 characteristics of telerehabilitation research?

A
  1. Evidence for the effectiveness of this new mode of service delivery
  2. Discover new ways to provide service
  3. Explore the impact and cost effectiveness (Cost effectiveness –> provide services at a cheaper price) of telehealth services
  4. Explore client and practitioner uptake and satisfaction with services
  5. Understand how to embed telehealth into organisations and health services
  6. Understand the interface between the user and the technology WADE, V.,
43
Q

What are the 4 types for telerehabilitation research?

A
44
Q

What are the number of telerehabilitation papers by years?

A
45
Q

What does the graph for telerehabilitation research by type?

A
46
Q

What is the research translating to practice?

A
47
Q

What are _____

A

Large number of studies

Outcomes which are at least “equivalent” in telerehab

Neurological test and lumbar spine posture = not very effective

48
Q

What are the 4 research efforts be focussed on?

A

Outcomes Research

  1. Research currently focussed on the replication rather than innovation
  2. Interventions should designed with best available evidence
  3. Leverage access, distribution and convenience factors
  4. Methodology and statistics needs to be solid

Technical

  1. Fragmented, few standards
  2. Integration Policy / Guidelines Sustainability • Reported outcomes (clinical / economic) from sustainable TR services
49
Q

What are 5 challenges for telerehabilitation?

A
  1. Professional Issues
  2. Clinician attitude
  3. Training of health professionals
  4. Reimbursement Technology & connectivity
  5. Evidence base
  6. Implementation
50
Q

What are the 5 characteristics of professionals issues for challenges?

A
  1. Clinician attitude
    • Resistance to change – paradigm shift required
    • FTF interaction in clinical setting - “gold standard” Is it?
    • ↑ evidence to show that telerehabilitation can be implemented
  2. Client capacity to adapt to online mode of service delivery
  3. Need to review perceptions about capacity of clients, old & young (& families) to engage in new management protocols & technology
  4. Current & future training of health professionals
    • Workplace
  5. Universities
    • ↑ curriculum focus on technology-enabled practice
    • Clinical experience in use of technology
51
Q

What are 4 types of reimbursement in the challenges?

A
  1. Private sector - Predominantly fee-for-service for allied health
  2. Public health/education – may be available
  3. Medicare
    • No Medicare rebates for allied health services
    • Medical specialists only- Some re-imbursement (rebate)
      • Patient needs to be at least 15 kms from specialist
      • Can be in residential aged care facility
      • Aboriginal Medical Service (AMS), Aboriginal Community Controlled Health Service (ACCHS)
  4. Private health insurance
    • Depends on insurer
52
Q

What are the 2 types of technology as a challenge?

A
  1. Selection of technology to meet service requirements & budget
  2. Connectivity
53
Q

What are 4 characteristics of “Selection of technology to meet service requirements & budget” of technology of the challenge?

A
  1. Desire to replicate healthcare interactions as closely as possible
  2. Difficulty in finding “all-in-one” technology that is fit-for-purpose
  3. Need to consider wide range of synchronous &asynchronous technologies
  4. Rapid changes in technology- positives & negatives
54
Q

What are 3 characteristics of “connectivity” of challenge of the technology?

A
  1. Internet access ↑ rapidly BUT
  2. Current levels of connectivity – significant barrier to service delivery in many areas of Australia
  3. ↓ connectivity more often than not in areas of greatest need
55
Q

What are the 4 characteristics of evidence base of challenge of technology?

A
  1. Need for greater body of evidence in certain disciplines
  2. Growing body of evidence for assessment & intervention validation
  3. More needed around implementation of telerehabilitation in mainstream practice
  4. Economic evaluation – critical component of implementation
    • Cost benefit
      • Client
      • Service provider
      • Society
56
Q

What are the 4 characteristics of implementation of challenge of technology?

A
  1. Embedding telehealth service into traditional models is difficult
  2. Requires planning and an effect Knowledge Translation (KT) process
  3. Requires the involvement and commitment of all stakeholders
  4. Implementation should be structured and informed by a KT framework
57
Q

What are the UQ implementation framework for technology?

A

PHTY2240 MSE (17 decks)

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