Patients undergoing physiotherapy can soon opt to carry
out their rehabilitation activities at home, using wearable sensors
to monitor if they are doing it correctly while being filmed on a
tablet for a therapist to review the session remotely, under a
nationwide pilot of tele-rehabilitation involving 14
institutions.
This option will be rolled out by the Integrated Health
Information Systems (IHiS), the IT arm of the Ministry of Health.
NTUC Health and TOUCH Home Care have already implemented such
sessions while various hospitals as well as SPD, an organization
that helps those with physical disabilities, will do so by the end
of the year.
Speaking at a media briefing for the Smart Health
TeleRehab pilot, National University of Singapore (NUS) Associate
Professor Gerald Koh noted that while the most rehab patients
acknowledged that inpatient rehabilitation was beneficial, only
four in 10 wanted to continue with rehabilitation after they were
discharged.
The main obstacle was the functional barrier they faced
ambulating from home to the rehabilitation centre, said Assoc Prof
Koh. “The very reason why (they) needed rehabilitation is the very
reason why (they) can’t get to the day rehab centre three times a
week,” he added.
Other issues included inconvenience in travelling to
the centre, having no caregiver to accompany them as well as the
high-costs involved, such as when hiring private transport.
The NUS Department of Electrical and Computer
Engineering and the Saw Swee Hock School of Public Health jointly
developed the monitoring system — believed to be the first of its
kind — which includes a set-up comprising of a tablet, a neck and
limb motion sensor, depending on which part of the body the patient
would be exercising with, and a tablet stand.
A patient app accompanying the service is also
available in five languages.
To start the tele-rehab session, the sensors are first
strapped onto the patient. After launching the app, the patient can
start performing the exercises — as prescribed by their therapists
through the app — which will be recorded via the tablet. Each set
of exercise comes with video demonstrations, a counter to keep
track of the number of repetitions completed, audio clips of words
of encouragement to keep the patient going, among other things.
On the therapists’ end, they will receive exercise
charts on how their patient performed during the tele-rehab
sessions. They are also able to adjust the difficulty levels,
repetition, among other things for the patient via the app.
A video conference can be arranged between the patients
and their therapists for further assessment.
Suitable patients for tele-rehab include those who
suffered from stroke, fractures, lower limb joint replacement or
amputations, falls, musculoskeletal conditions among others.
In an ongoing trial started in 2014, Assoc Prof Koh
found that the physical recovery with tele-rehab is as good as the
usual rehabilitation process, which involves only face-to-face
sessions with the therapists.
Another study by IHiS and NUS in 2015 also found that
institutions are 30 per cent more productive when they adopt
tele-rehab systems. For example, a therapist can see 9 patients a
week, up from 6, by working remotely.
Due to the small sample size of the trial, the upcoming
pilot will be used to gather more data on how effective the system
is, patient receptiveness, productivity gains and its cost
efficiency.
The participating institutions would determine the cost
of the system. At TOUCH Home Care, each client would pay S$18 for a
session that involves a therapist’s assessment while at Ang Mo
Kio-Thye Hua Kwan Hospital, the cost will range from S$3 to S$50,
depending on the amount of subsidies each patient receives. This
pilot comes as a national platform for telemedicine was launched
last month to have hospitals and other healthcare institutions
offer consultations remotely.
Senior Minister of State for Health Chee Hong Tat said
the new system could transform how therapy services are delivered
in Singapore. “Patients will benefit from greater convenience, cost
savings and better outcomes. Therapists and therapy service
providers will also benefit from the productivity improvements,” he
added.
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