F. benvenuti model for telerehabilitation clear project

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F. benvenuti model for telerehabilitation clear project

  1. 1. Model for telerehabilitation services for stroke survivors: experiences of CLEAR project Francesco Benvenuti Dipartimento Riabilitazione-Fragilità AUSL11, Empoli Research brokerage workshop in Lodz 10-11 September 2013
  2. 2. Aims was CLEAR project • To evaluate a tele-rehabilitation service provided through the Habilis platform. • The study was focused on the end users (patients and clinicians): – Satisfaction with the tele-rehabilitation application – Clinical effectiveness of the service – Time investment for providing and receiving the tele-rehabilitation service
  3. 3. Consortium Coordinatore Signo Motus Designers SITUS (IT) UPM (ES) RRD(NL) Clinici AUSL11 (IT) FPING (SP) RCR (NL) MUW (PO) Gruppo validazione ISS (IT) IE-UAB (ES) TIC –Salut (ES) RETOS (IT) CSIOZ (PO) MENZIS (NL) Coordinator Signo Motus Clinical Centers AssessorsDesigners
  4. 4. Cinical studies COPD ,  Chronic back pain,  Whiplash Cognitive disorders Acquired Brain Injury Osteoarthritis of hip or knee before and after total joint replacement Upper limb paresis  after stroke
  5. 5. Telerehab vs. Conventional Treatment Effectiveness Similar or superior Safety Similar Customer satisfaction Good/very good Time investment for clinicians and patients Reduced CLEAR Results
  6. 6. Different rehabilitation treatment scenarios Partial replacement Time augmentation Conventional Addition Conventional rehab sessions Tele-rehab sessions
  7. 7. Stroke Epidemiology • Incidence: 220/100000 • Survival: • 1 year: 60-75% • 3 years: 40-68% • 10 years: >35% • Prevalence: 600-800/100000 • Severely disabled: 35-40%
  8. 8. Recovery plateau What we observe…. Rehabilitation Rehabilitation Rehabilitation Rehabilitation Time from stroke Acute & Subacute Chronic
  9. 9. What we learn….. Recovery plateau Time from stroke Acute & Subacute Chronic Aims of CLEAR project in AUSL11: •To extend rehabilitation in the subacute phase of the disease •To maintain/improve function in the chronic phase
  10. 10. Methods Hospital Home Kiosk3 times/week 2 times/week Treatment duration 3 months
  11. 11. Kiosks installed HOSPITALs & KIOSKs LOCATION Hospitals Montelupo F.no
  12. 12. Clinical results Safety No significant ACEs associated to the treatment program have been observed in both groups
  13. 13. Clinical results Effectiveness: analysis at individual level Improved (>10%) Unchanged (0-9%) Worse (<0%) Chi2 test P=0.00011 Chi2 test P=0.01924 Nine Hole Peg Test 0% 20% 40% 60% 80% 100% Usual care group Treatment group Motricity Index 0% 20% 40% 60% 80% 100% Usual care group Treatment group
  14. 14. Clinical results Logistic Regression Analyses OR 95%CI Female Gender 2.30 1.58 3.34 UL Paresis (Motricity Index) 0.94 0.92 0.96 Spasticity (Ashworth scale) 0.67 0.58 0.78 Adherence 2.39 1.77 3.21 Predictors of effectiveness OR 95%CI Home-kiosk distance 0.85 0.78 0.91 No help needed to go to kiosk 10.88 6.27 18.88 Predictors of Adherence
  15. 15. Clinical results Patients’ Satisfaction Satisfaction questionnaire: scores post-intervention n=160 Component Low (score 1-2) Average (score 3-5) High (score 6-7) Ease of use 3% 89% 8% Usefulness 11% 51% 38% Attitude 1% 96% 3% Social Norm 2% 60% 38% Self-efficacy 10% 90% 0% Intention 3% 78% 19% Satisfaction 2% 53% 45% 78% found the exercise program useful for them 70% patients found the Habilis platform well implemented 75% would recommend the Habilis service to others Average patient grading of the Habilis service 7.4 (SD 1.8)
  16. 16. Clinical results Time investment Home-Kiosk-Home Median (min-max) Home-Hospital-Home Median (min-max) Single treatment session travel distance (km) 5.8 (0.4-43.6) 22.2 (0.6-68.0) 3-months travel distance for 22 treatment sessions (km) 127.6 (9.2-959.2) 488.4 (13.2-1496.0) 3-months travel cost for 22 treatment sessions* (€) 25.5 (1.8-191.8) 97.7 (2.6-299.2) Median travel distance and cost per patient (n=165) *0,20€/km
  17. 17. Clinical results Time investment Usual Care  During CLEAR  Project Optimization  after CLEAR  Project Physical Therapist time/patient  (hour) time/patient  (hour) time/patient  (hour) patient's assessment at baseline 1 1,42 1 patient's training to the use of Habilis platform 0 2 2 first week of treatment 0 1,75 1 successive 11 weeks of treatment 22 16,5 11 patient's final assessment 1 1 1 Total for Physiotherapist 24.0 22,67 16.0 Physiotherapist time investment for usual care, CLEAR project, and optimization of treatment protocol
  18. 18. Future work Limits Possible Corrective actions •Problems of transportation and social support to attend kiosks •Increase geographical distribution of kiosks •Assisted transportation •Home tele-rehabilitation (using equipment already available at home?) •Very difficult to find space from no profit organizations •Economic support by Regional Health Authority •Participation to costs by participants •Limited number of patients •Extend the program to other conditions •Integration with conventional treatment programs •Poor connectivity in rural areas •Wide band •Patients ICT interactions •Paedagocic incentive •Exercise program very similar to that performed at home •Instrument the Habilis platform •Serious games •Limited computer skill of participants •More friendly interface About kiosk experience
  19. 19. Main critical issues: 1. Acceptance; 2. Policy; 3. Infrastructures (broadband and places); 4. Organizational problems; 5. Lack of a contextual framework allowing continuity of care. Fracture and main intervention area: management from hospital to territory
  20. 20. Telerehab service future scenarios Health House District • Information on continuity of care • Empowerment • Rehabilitation treatment (Kiosk like) • Tele consultation/ videoconference Home • Rehabilitation treatment: o stroke (bag+ Habilis) o frailty (Otago libraries + Habilis) o orthopaedics (libraries + Habilis) o BPCO (libraries BPCO + Habilis) o cognitive (libraries + Habilis) •Teleconsultation / videoconference •Telemonitoring HOSPITAL • Information on continuity of care • Empowerment • Initial treatment (sub acute phase) • Tele consultation/ videoconference GP/ACCESS POINTS • Information on continuity of care • Patient management Habilis Habilis HABILIS Service Centre •Treatment management Service acces points Treatment provision Patient routing
  21. 21. Horizon 2020 3. Advancing active and healthy ageing – 3b Service and social robotics in support of active and independent living 4. Integrated, sustainable, citizen-centred care – 4d Advanced ICT systems and services for Integrated Care – 4f Citizen engagement in health, wellbeing and prevention of diseases – 4g mHealth for disease management – 4h Patient empowerment
  22. 22. Thank You! Francesco Benvenuti Dipartimento Territorio-Fragilità UOC Cura e Riabilitazione delle Fragilità Azienda Unità Sanitaria Locale 11 di Empoli f.benvenuti@usl11.toscana.it www.usl11.toscana.it www.habiliseurope.eu Contacts

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