ABSTRACT
Parkinson's disease (PD) is a chronic, neurodegenerative condition resulting in various motor impairments, including speech disorders. However, at the height of the coronavirus disease 2019 pandemic, a patient with PD could not access traditional in-person neurorehabilitation care. This case report highlights the feasibility of telerehabilitation to deliver speech therapy over a distance using available resources in a developing country. We describe a Filipino elderly woman, public speaker, and marriage counselor, seeking teleconsultation for her voice problems (slow and soft) attributed to PD. At that time, most center-based outpatient rehabilitation centers in Manila were closed due to the pandemic, and the patient preferred to stay at home for safety reasons. Hence, she was evaluated and managed remotely by an interdisciplinary team (neurologist, physiatrist, speech-language pathologist) through video calls. Since the ideal rehabilitation set up (in-person evaluation and therapy;use of Lee Silverman Voice Therapy) could not be done, the clinicians had to find practical alternatives, such as remotely administering subjective perceptual voice assessments, objective speech analysis using the Praat™ computer application, and speech teletherapy through synchronous (videocalls, phone calls) and asynchronous (e-mails, text messages, prerecorded exercise videos) techniques. Notable speech improvements were observed by the clinicians, patient, and patient's frequent communicative partners after at least four teletherapy sessions. However, the carry-over of the improvements was affected by the patient's lack of compliance with the prescribed home exercise program. Telerehabilitation using synchronous and asynchronous techniques for speech disorders due to PD was found feasible, beneficial, safe, and practical amid social distancing and low resources in a developing country. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
People who incur injuries and illness affecting their hands and upper extremities demand a specialized approach to rehabilitation that was once available only as an in-person service. With the onset of the COVID-19 pandemic, occupational and physical therapists who provide hand and upper extremity rehabilitation services must adapt and serve the needs of those who require both in-person and virtual delivery systems. The use of traditional in-person and telerehabilitation services will continue to be in demand and require a unique, hybrid approach to encourage both occupation and client-centered practice. The goal of this dynamic approach is to achieve optimal functional outcomes, while empowering the patient with neurological and musculoskeletal conditions affecting the hand and upper extremity during their therapeutic sessions. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Objectives. The objective of this study was to determine the coping strategies and job satisfaction among rehabilitation medical and paramedical staff deployed to different areas at the University of the Philippines Manila-Philippine General Hospital, a designated COVID-19 referral center. Method. This was a cross-sectional study that utilized total population sampling of the medical and paramedical staff of the Department of Rehabilitation Medicine deployed to other areas in PGH and who carried out non-rehabilitation-related clinical work responsibilities during the COVID-19 pandemic. Electronic informed consent was obtained from each participant. Two sets of validated and reliable self-administered online questionnaires, namely, the Brief Coping Orientation to Problems Experienced (COPE) Inventory Tool and Satisfaction of Employee in Health Care (SEHC) Survey, were used to determine coping strategies and work satisfaction, respectively. Descriptive statistics (such as frequencies, percentages, ranges, means) were used to present the data. Results. A total of 50 medical and paramedical staff participated in the study. The participants’ age ranged from 22 to 60 years (mean: 30.2 ± 8.7). The majority were single (84%), women (64%), and with a Bachelor of Science degree. Most of the participants were assigned in the orange zone, which included the COVID ward nurses’ station and donning/doffing areas;with 30% who rotated in the COVID wards. There were three types of coping strategies utilized by the department staff: (1) emotion-focused coping, (2) problem-focused coping, and (3) dysfunctional coping. Problem-focused coping was the most common general strategy (mean COPE score for all problem-focused strategies, 3.1 ± 0.9). Acceptance was the most common specific coping strategy, followed by active coping and a tie among positive reframing, planning, and self-distraction. The work satisfaction rate was at 76.9% ± 13.2. Three out of 4 participants would recommend their workplace to other healthcare workers. Conclusion. The medical and paramedical staff of the Department of Rehabilitation Medicine in a COVID referral center had relatively high job satisfaction despite their health risks and changes in responsibilities among others. The majority utilized functional coping strategies to help them adapt to the work demands. The sources of motivation and values of the staff are areas for future research to help explain their positive outlook about their jobs and generally high recommendation about their workplace in the middle of the COVID-19 crisis. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
The suspension of facility-based rehabilitation services and restricted mobility at the onslaught of the coronavirus disease 2019 (COVID-19) pandemic forced healthcare workers to explore new methods of providing patient care. This case report presents a 40-year-old female who underwent osteotomy with iliac crest bone graft and intramedullary nailing with quadricepsplasty to correct the leg length discrepancy and knee extension contracture that developed secondary to multiple bone injuries sustained in a vehicular accident 17 months before admission. The in-hospital postoperative rehabilitation was prematurely terminated due to the COVID-19 lockdown. The client was discharged with pain and swelling of the right lower limb, knee flexion of 0–25°, and an ankle plantar flexion contracture. She had moderate to severe difficulty in walking, bathing, toileting, and lower garment dressing, needing assistance to complete these tasks. Telerehabilitation was done over three months using both synchronous and asynchronous methods. Gains from the remote program were independence in all the self-care activities with no difficulty in performing them. The patient was able to return to work. Gains in knee and ankle mobility were minimal. Telerehabilitation using available technologies can be used to continue patient care amidst barriers to face-to-face rehabilitation in a low-resource country. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
Background. The Department of Rehabilitation Medicine of the University of the Philippines-Philippine General Hospital (UP-PGH) established its telerehabilitation service program in 2017. The program previously catered to patients in a partner rural community by providing teleconsultation and teletherapy over a distance. With the unprecedented coronavirus disease 2019 (COVID-19) pandemic, the program has expanded its service to outpatients previously managed face-to-face by the department, regardless of location. Objectives. This study aimed to evaluate the usability of the telerehabilitation service program at UP-PGH when it was expanded during the pandemic and to associate telerehabilitation usability ratings with the participant groups, demographic characteristics, and prior telemedicine knowledge and experience. Methods. This cross-sectional study involved the doctors, physical therapists, occupational therapists, psychologists, patients, and patients’ carers, who participated in at least one telerehabilitation session and consented to respond to a digital survey thereafter. Total enumeration sampling of all telerehabilitation participants was employed. The study outcome was the usability of the expanded telerehabilitation program based on the System Usability Scale (SUS) benchmarked at 68. Descriptive and inferential statistics were done at a 95% confidence interval. The participants’ responses to open-ended questions regarding telerehabilitation experience and recommendations were also presented. Results. The participants consisted of 19 doctors, 11 therapists, 37 patients, and 74 caregivers. The majority of the participants were female and lived in urban areas. The primary online telerehabilitation platforms used were Viber™ and Zoom™. The mean of overall SUS scores was below average for health providers [doctors (mean = 61.71), therapists (mean = 67.73)];and above average for end-users [patients (mean 74.56), and carers (mean = 71.89)]. There was a significant difference in the overall SUS scores between doctors (mean: 61.7) and patients (mean: 74.6), p<0.05. In terms of videoconferencing platform, participants reported significantly higher system usability for those who used either Zoom™ (mean: 75.0) or Viber™ (mean: 69.3), as compared to Google Meet™ (mean: 53.1), p<0.05. There was no significant difference in the overall SUS scores across sexes, places of residence, primary telerehabilitation techniques used, prior telemedicine knowledge, and experience. The majority viewed telerehabilitation as a valuable method to provide service during the pandemic, but they were mostly concerned with technical problems, particularly an unstable Internet connection. Conclusion. The expanded telerehabilitation service program of the PGH was perceived as useful by patients and caregivers but not by the health providers. While the program succeeded in providing continued outpatient rehabilitation services during the pandemic, the challenges experienced by its telehealth providers must be investigated and addressed. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
Pelvic sarcomas are rare malignancies that can result in extensive surgeries involving bone and soft tissue resection, which can greatly improve with rehabilitation. However, due to the restrictions brought about by the COVID-19 pandemic, the rehabilitation of patients with pelvic sarcomas was affected. Limited information is also presented in the literature regarding the rehabilitation of patients with lower extremity surgeries undergoing telerehabilitation and during a pandemic. This study presents the rehabilitation process of a 43-year-old woman diagnosed with pelvic round cell sarcoma of the right gluteal area during the COVID-19 pandemic. The patient underwent wide excision, buttockectomy and internal hemipelvectomy, and we measured outcomes using the Tinetti assessment tool (TAT) and Lower Extremity Functional Scale (LEFS). A decreased risk of falls and improved functional performance were recorded using the TAT and LEFS respectively. Telerehabilitation was noted to have a good satisfaction rate among the patient and health workers. Telerehabilitation may be an effective alternative to face-to-face therapy during the COVID-19 pandemic. More studies are needed to look into the conduct of telerehabilitation intervention among patients with bone and soft tissue surgeries. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
Introduction. The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective. This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods. The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results. The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion. The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic. © 2022 University of the Philippines Manila. All rights reserved.