Can eHealth Technology Enhance the Patient-Provider Relationship in Rehabilitation?

Sophia Wang; Dan Blazer; Helen Hoenig

doi:10.1016/j.apmr.2016.04.002

From the editors' desk| Volume 97, ISSUE 9, P1403-1406, September 01, 2016

Can eHealth Technology Enhance the Patient-Provider Relationship in Rehabilitation?

Sophia Wang, MD
Sophia Wang
Affiliations
Department of Psychiatry, Indiana University, Indianapolis, IN
Center for Health Innovation and Implementation Science, Indianapolis, IN
Mental Health Service Line, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN
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Dan Blazer, MD, PhD
Dan Blazer
Affiliations
Department of Psychiatry and Behavior Sciences, Durham Veterans Administration Medical Center, Durham, NC
Center for the Study of Aging, Durham Veterans Administration Medical Center, Durham, NC
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Helen Hoenig, MD, MPH
Helen Hoenig
Correspondence
Corresponding author Helen Hoenig, MD, MPH, Physical Medicine and Rehabilitation, Durham Veterans Administration Medical Center, 508 Fulton St, Durham, NC 27705.
Contact
Affiliations
Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC
Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
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Published:April 21, 2016DOI:https://doi.org/10.1016/j.apmr.2016.04.002

Keywords

List of abbreviations:

CPT (Common Procedural Terminology)

Technology has a long history of use in rehabilitation, both for therapeutic interventions (eg, to provide various kinds of exercise or modalities such as ultrasound) and for remediating disability (eg, assistive technology and prosthetic limbs). However, the use of electronic technology is increasingly pervasive in the delivery of health care, including rehabilitation. The term eHealth refers to use of electronic technologies in health care, many of which fall under the broad category of Telehealth. The use of the term eHealth is rapidly evolving, but some eHealth technologies with potential relevance to rehabilitation include videoconferencing, store-and-forward imaging, mobile apps, sensor-based and Internet-based systems for data collection/communication, and algorithmic software to help interpret electronic data (eg, data in the electronic health record and sensor-based data).

¹

Health Resources and Service Administration. Telehealth. Available at: http://www.hrsa.gov/healthit/telehealth/. Accessed December 12, 2015.

Google Scholar

^,

²

Dicianno B.E.
Parmanto B.
Fairman A.D.
et al.

Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation.

Although eHealth offers many benefits, the effects on the patient-provider relationship have been problematic. The constant presence of such technology can consume health care providers, sometimes requiring that they spend more time with electronic health records and software to support medical decision making than seeing patients face to face,

³

Verghese A.

Culture shock—patient as icon, icon as patient.

which, in turn, is perceived by patients as less effective.

⁴

Street R.L.
Liu L.
Farber N.J.
et al.

Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.

Increasingly, patients themselves are turning to the Internet to find information on their disorders and using algorithmic searches to “e-diagnose” themselves.

⁴

Street R.L.
Liu L.
Farber N.J.
et al.

Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.

^,

⁵

Fox S, Duggan M. Health online 2013. Available at: http://www.pewInternet.org/∼/media/Files/Reports/PIP_HealthOnline.pdf. Accessed May 1, 2015.

Google Scholar

Like other health care providers, rehabilitation providers face the technologically driven loss of human interaction with their patients.

⁶

Lee A.C.
Harada N.

Telehealth as a means of health care delivery for physical therapist practice.

Models for rehabilitation patient-provider communication emphasize the importance of therapeutic connection, and studies

⁷

Lequerica A.H.
Kortte K.

Therapeutic engagement: a proposed model of engagement in medical rehabilitation.

^,

⁸

Jesus T.S.
Silva I.L.

Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes.

^,

⁹

Hall A.M.
Ferreira P.H.
Maher C.G.
Latimer J.
Ferreira M.L.

The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review.

show that the therapeutic relationship can affect rehabilitation outcomes. It is critical that as a field we are aware of new and developing eHealth technologies that might help to foster patient-provider connection and patient-centered health care in the context of rehabilitation.

The goal of this Editorial is to raise awareness among rehabilitation providers about a growing body of technology, its diversity, and its potential applications to support and enhance the critical patient-provider relationship in rehabilitation. To critically examine the potential ways eHealth technologies might be used to enhance the rehabilitation patient-provider relationship, we focus on 3 aspects of a model proposed by Jesus and Silva

⁸

Jesus T.S.
Silva I.L.

Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes.

for patient-provider communication in rehabilitation: (1) knowing the person and contextual factors; (2) effective information exchange and education; and (3) shared goal setting and action planning.

Knowing the person and contextual factors

Given the importance of contextual factors in disability outcomes,

¹⁰

World Health Organization. International classification of functioning, disability, and health. Available at: http://www3.who.int/icf/icftemplate.cfm. Accessed December 15, 2015.

Google Scholar

it is critical for rehabilitation providers to understand the patient's contextual factors. Lack of information on contextual factors may render useless otherwise effective interventions, particularly those whose effectiveness depends on environmental context and contextually relevant training (eg, assistive technology). Home visits are a helpful solution

¹¹

Clemson L.
Mackenzie L.
Ballinger C.
Close J.C.
Cumming R.G.

Environmental interventions to prevent falls in community-dwelling older people a meta-analysis of randomized trials.

^,

¹²

Mann W.C.
Ottenbacher K.J.
Fraas L.
Tomita M.
Granger C.V.

Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: a randomized controlled trial.

^,

¹³

Gitlin L.N.
Winter L.
Dennis M.P.
Corcoran M.
Schinfeld S.
Hauck W.W.

A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults.

^,

¹⁴

Gitlin L.N.
Levine R.
Geiger C.

Adaptive device use by older adults with mixed disabilities.

; however, home visits are expensive and inefficient and challenging to coordinate, and health providers with the relevant expertise may not be available.

¹⁵

Fairchild D.G.
Hogan J.
Smith R.
Portnow M.
Bates D.W.

Survey of primary care physicians and home care clinicians.

^,

¹⁶

Parker E.
Zimmerman S.
Rodriguez S.
Lee T.

Exploring best practices in home health care: a review of available evidence on select innovations.

^,

¹⁷

Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC. Health professions per 10,000 population: maps. Available at: http://www.shepscenter.unc.edu/workforce_product/2012-health-professionals-per-10000-population-maps/. Accessed July 1, 2016.

Google Scholar

In fact, most rehabilitation providers see their patients out of context in the hospital or a clinic, with its inherent limitations. Providers compensate through intensive discharge planning; nonetheless, that disconnect can affect the patient-provider relationship either during treatment, when the patient does not feel fully understood, or on return home, when disparities between the hospital-/clinic-based therapeutic plans and reality become apparent. Teletechnology offers a potential solution.

Photos and videos can enable patients to provide real-time information on their particular challenges, enabling “ecological momentary assessment.”

²

Dicianno B.E.
Parmanto B.
Fairman A.D.
et al.

Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation.

Real-time televideo has been used to remotely deliver in-home therapy services with improved outcomes over usual care.

¹⁸

Sanford J.A.
Griffiths P.C.
Richardson P.
Hargraves K.
Butterfield T.
Hoenig H.

The effects of in-home rehabilitation on task self-efficacy in mobility impaired older adults: a randomized clinical trial.

^,

¹⁹

Jackson J.
Ely E.W.
Morey M.C.
et al.

Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation.

^,

²⁰

Chumbler N.R.
Quigley P.
Li X.
et al.

The effects of tele-rehabilitation on physical function and disability for stroke patients: a randomized, controlled trial.

It also has been used to support in-home rehabilitation of severely impaired veterans

²¹

Bendixen R.M.
Levy C.E.
Olive E.S.
Kobb R.F.
Mann W.C.

Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes.

and for rehabilitation after orthopedic surgery.

²²

Moffet H.
Tousignant M.
Nadeau S.
et al.

In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty.

^,

²³

Tousignant M.
Giguère A.M.
Morin M.
Pelletier J.
Sheehy A.
Cabana F.

In-home telerehabilitation for proximal humerus fractures: a pilot study.

Photovoice is a technique wherein photo/video images are used to depict one's life and share it with others—the richer subjective fostering improved understanding.

²⁴

Baker T.A.
Wang C.C.

Photovoice: use of a participatory action research method to explore the chronic pain experience in older adults.

To provide a concrete example: in commenting about a photovoice documentary of daily experiences of 3 patients who lived in wheelchairs, a physician wrote, “None of which [the patient's fears] were apparent during the conversation with his doctor.”

²⁵

Berland G.

The view from the other side—patients, doctors, and the power of a camera.

The efficacy of photo/video images across these diverse populations and modes of use is striking, lending truth to the aphorism a picture speaks a thousand words.

Effective information exchange and education

In-person health care delivery is constrained by time. Electronic technology has the potential to increase opportunities for communication and education, with technology ranging from simple home messaging devices that query patients periodically (eg, about particular problems

²⁶

Galea M.
Tumminia J.
Garback L.M.

Telerehabilitation in spinal cord injury persons: a novel approach.

or therapeutic goals

²⁷

Harada N.D.
Dhanani S.
Elrod M.
Hahn T.
Kleinman L.
Fang M.

Feasibility study of home telerehabilitation for physically inactive veterans.

) to sensor-based systems to sophisticated interactive systems. Data on the direct effects of sensor-based technologies on patient-provider communication are limited, but there are some studies showing beneficial effects on rehabilitation outcomes. For example, a number of studies have examined use of accelerometers to guide treatment, with several studies showing improvements in physical activity and gait, albeit with limited long-range health outcomes.

²⁸

Geirish J.M.
Goode A.P.
Batch B.C.
et al.

The impact of wearable motion sensing technologies on physical activity: a systematic review.

Google Scholar

Interactive patient educational systems are another example, having been shown to improve outcomes for diverse medical populations,

²⁹

Kao D.P.
Lindenfeld J.
Macaulay D.
et al.

Impact of a Telehealth and care management program on all-cause mortality and healthcare utilization in patients with heart failure.

^,

³⁰

Salonen A.
Ryhänen A.M.
Leino-Kilpi H.

Educational benefits of Internet and computer-based programmes for prostate cancer patients: a systematic review.

and they seem promising for use in rehabilitation, given the central role of patient education in many rehabilitation interventions.

Electronic technologies for patient education also include mobile apps, a rapidly growing type of health care technology.

¹⁵

Fairchild D.G.
Hogan J.
Smith R.
Portnow M.
Bates D.W.

Survey of primary care physicians and home care clinicians.

Commonly referred to as mHealth, in 2013 there were more than 17,000 health-related mobile apps targeting consumers/patients.

³¹

Aitken M, Gauntlett C. Patient apps for improved healthcare: from novelty to mainstream. Available at: http://www.imshealth.com/en/thought-leadership/ims-institute/reports/patient-apps-for-improved-healthcare. Accessed December 11, 2015.

Google Scholar

More than 60% of mHealth apps have informational and/or educational components.

³⁰

Salonen A.
Ryhänen A.M.
Leino-Kilpi H.

Educational benefits of Internet and computer-based programmes for prostate cancer patients: a systematic review.

A number of mobile apps have been developed for physical rehabilitation, for example, to support exercise training

³²

Ahmed O.H.

The smartphone app ‘Rotator Cuff Injury/Strain’ by Medical iRehab.

Google Scholar

and measurement (eg, gait, balance, and range of motion).

³³

How T.V.
Chee J.
Wan E.
Mihailidis A.

Mywalk: a mobile app for gait asymmetry rehabilitation in the community.

^,

³⁴

Wai AA, Duc PD, Syin C, Haihong Z. iBEST: intelligent balance assessment and stability training system using smartphone. In: 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC’14); 2014 Aug 26–30; Chicago (IL). p 3683-6.

Google Scholar

^,

³⁵

Milani P.
Coccetta C.A.
Rabini A.
Sciarra T.
Massazza G.
Ferriero G.

Mobile smartphone applications for body position measurement in rehabilitation: a review of goniometric tools.

In addition, in their effort to better meet the health and behavioral needs of veterans, the Department of Veterans Affairs and the Department of Defense are in process of developing a wide array of mobile apps, including some that enable ecologically embedded assessment of self-care and behavioral function.

³⁶

Weingardt K.R.
Greene C.J.

New electronic tools for veterans.

Although mobile app development has far outpaced its evidentiary support,

³⁷

Kuehn B.M.

Is there an app to solve app overload?.

^,

³⁸

van Mechelen D.M.
Van Mechelen W.
Verhagen E.A.

Sports injury prevention in your pocket?! Prevention apps assessed against the available scientific evidence: a review.

mHealth has great potential application in rehabilitation for 2 reasons: (1) enabling practice outside the clinical setting could facilitate motor learning believed to underpin outcomes for many conditions treated by rehabilitation

³⁹

Hollands K.L.
Pelton T.A.
Tyson S.F.
Hollands M.A.
van Vliet P.M.

Interventions for coordination of walking following stroke: systematic review.

^,

⁴⁰

Sawers A.
Hahn M.E.
Kelly V.E.
Czerniecki J.M.
Kartin D.

Beyond componentry: how principles of motor learning can enhance locomotor rehabilitation of individuals with lower limb loss—a review.

and (2) the broad availability and portability of mobile phones could enable provision of real-time, ecologically embedded information (ie, ecological momentary assessment).

Shared goal setting and action planning

One common problem with patient care is adherence—the best laid plans come to naught without adherence. Adherence and outcomes in rehabilitation can be improved by shared goal setting and action planning, personally tailored educational interventions, and feedback to patients' about their performance.

⁴¹

Keating A.
Lee A.
Holland A.E.

What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review.

^,

⁴²

Davies P.
Taylor F.
Beswick A.
et al.

Promoting patient uptake and adherence in cardiac rehabilitation.

Electronic technologies, sometimes referred to as persuasive technologies, are available to help with all these.

⁴³

Kelders S.M.
Kok R.N.
Ossebaard H.C.
Van Gemert-Pijnen J.E.

Persuasive system design does matter: a systematic review of adherence to web-based interventions.

For example, technologies to enhance physical activity may attempt to motivate patients by personalized goal setting, providing various rewards and reminders, journaling by the patient, and linking with the patient's social network.

⁴⁴

Munson SA, Consolvo S. Exploring goal-setting, rewards, self-monitoring, and sharing to motivate physical activity. In: 6th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth 2012); 2012 May 21–24; San Diego (CA). p 25-32.

Google Scholar

Indeed, focus groups and user feedback indicate that shared goal setting and tailored feedback in particular may better enable the patient to effect change.

⁴⁵

Klasnja P, Consolvo S, McDonald DW, Landay JA, Pratt W. Using mobile & personal sensing technologies to support health behavior change in everyday life: lessons learned. In: AMIA Annual Symposium Proceedings; 2009. p 338-42.

Google Scholar

A major advantage of the increasing wealth of electronic technology is that it supports multimodal ways to reach out to the patient. For instance, a successful cardiac rehabilitation intervention

⁴⁶

Antypas K.
Wangberg S.C.

E-Rehabilitation—an Internet and mobile phone based tailored intervention to enhance self-management of cardiovascular disease: study protocol for a randomized controlled trial.

provided standardized education about cardiovascular disease through the Internet, provided access to Internet-based discussion forums, and sent the patients tailored content via the website along with mobile text messages, with resultant higher levels of physical activity as shown in a small randomized trial.

⁴⁷

Antypas K.
Wangberg S.C.

An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial.

Mobile apps have particularly broad potential applicability for both goal setting and action planning, with the Veterans Affairs taking a lead in developing tools to foster veterans' engagement in their own health care.

³⁵

Milani P.
Coccetta C.A.
Rabini A.
Sciarra T.
Massazza G.
Ferriero G.

Mobile smartphone applications for body position measurement in rehabilitation: a review of goniometric tools.

The added information on goals and personal action plans enabled by such technologies may not only foster enhanced understanding of the patient's perspective but also stimulate discussion, which, in turn, reinforces the patient-provider relationship.

Limitations and next steps

These new technologies may confer novel benefits, but they also confer some novel challenges, limitations, and required next steps.

Challenges and limitations

Any sort of health information brings with it 3 interrelated concerns—privacy, confidentiality, and security—each of which may be uniquely affected by the type of technology, the information the technology enables, and who interfaces with the technology. The eHealth and related mHealth fields are rapidly evolving, both from a technological perspective and from a legal perspective. Clinicians who may wish to use novel eHealth technology and have questions about information security, privacy, or confidentiality should consult their local “privacy officer,” office of information technology, and/or the manufacturer or vendor of the technology; technology should be avoided if information is lacking about the risks and protection of the patient's data. The interested reader is referred to reviews by Martínez-Pérez et al

⁴⁸

Martínez-Pérez B.
De La Torre-Díez I.
López-Coronado M.

Privacy and security in mobile health apps: a review and recommendations.

and Lumpkin.

⁴⁹

Lumpkin J.R.

e-Health, HIPAA, and beyond.

Clinicians may worry “who has the time to watch these things or tell the patient what to film?” Increasingly, third-party payment is available to compensate clinicians for time spent using eHealth technologies, but compensation can vary according to the type of technology, the types of clinicians using the technology (eg, physician vs allied health provider), the location of services (eg, rural vs urban and clinic vs home), the condition being treated, and with the third-party payer.

⁵⁰

Health Resources and Services Administration. What are the reimbursement issues for Telehealth? Available at: http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/whatarethereimbursement.html. Accessed August 4, 2016.

Google Scholar

The Centers for Medicare and Medicaid Services provide compensation for “telehealth” at the same rate as other face-to-face care, but only if that care is provided using real-time televideo and it further limits payment for some services to one of several rural health demonstration projects.

⁵¹

Centers for Medicare and Medicaid Services. Telehealth. Available at: https://www.cms.gov/Medicare/Medicare-General-information/telehealth/. Accessed August 4, 2016.

Google Scholar

The Centers for Medicare and Medicaid Services has 2 Common Procedural Terminology (CPT) codes broadly relevant to the use of eHealth technologies: The CPT codes 99090 may be used for the “analysis of clinical data stored in computers (eg, electrocardiograms, blood pressures, hematologic data)” and 99091 for “the collection and interpretation of physiologic data (eg, electrocardiogram, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional.”

⁵²

American Telemedicine Association. Update on CMS payment decision—two steps forward, one back. Available at: http://www.americantelemed.org/news-landing/2014/11/07/update-on-cms-payment-decisions–-two-steps-forward-one-back#.VwPYWDZf2Uk. Accessed August 4, 2016.

Google Scholar

Both CPT codes 99090 and 99091 may be used in any location.

Next steps

Electronic technology has great potential to enhance the rehabilitation patient-provider relationship. However, meeting that potential will require dedicated attention to 3 critical areas: (1) policy, regulations, and payment; (2) research and evidentiary support; (3) clinician and patient training. In general, policy, payment, and regulations pertaining to Telehealth, eHealth, and mHealth are rapidly evolving and can vary considerably by payment source, by state, and within particular health care organizations. The Veterans Health Administration has developed detailed policy, regulations, and training for Telehealth,

⁵³

U.S. Department of Veterans Affairs. VA Telehealth services. Available at: http://www.telehealth.va.gov/. Accessed December 28, 2015.

Google Scholar

and more recently mHealth.

⁵⁴

U.S. Department of Veterans Affairs. VA mobile health. Available at: https://mobile.va.gov/. Accessed December 28, 2015.

Google Scholar

The American Telemedicine Association

⁵⁵

American Telemedicine Association. ATA State Telemedicine Toolkit: improving access to covered services for telemedicine. Available at: http://www.americantelemed.org/docs/default-source/policy/ata-state-telemedicine-toolkit–-coverage-and-reimbursement.pdf?sfvrsn=4. Accessed August 4, 2016.

Google Scholar

and the Center for Connected Health Policy

⁵⁶

Center for Connected Health Policy. Telehealth Medicaid & state policy. Available at: http://cchpca.org/telehealth-medicaid-state-policy. Accessed August 4, 2016.

Google Scholar

are good sources of information on current reimbursement and regulations.

Research and implementation studies are needed within and across conditions to inform clinicians and policymakers about when, where, and what types of eHealth to support. For example, most eHealth technology has targeted toward less disabled populations, so concerns may be raised about its use with persons who have more severe impairments. Pilot studies supports potential applicability of eHealth technologies to persons with more severe impairments,

⁵⁷

Forducey P.G.
Glueckauf R.L.
Bergquist T.F.
Maheu M.M.
Yutsis M.

Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting.

but further research is needed to show efficacy, to adapt the technology for use by special populations, and to develop appropriate training both for patients and for providers. Training requirements for patients and providers are complex; however, lessons learned from implementation science might be fruitfully applied to help with “technophobia” and skill acquisition.

⁵⁸

Kilbourne A.M.
Neumann M.S.
Pincus H.A.
Bauer M.S.
Stall R.

Implementing evidence-based interventions in health care: application of the replicating effective programs framework.

^,

⁵⁹

Grol R.
Grimshaw J.

From best evidence to best practice: effective implementation of change in patients’ care.

We believe that eHealth technology has broad potential applicability in rehabilitation and that it is particularly germane to the patient-provider interface so critical to successful rehabilitation. Although more work still is needed (eg, to provide evidentiary support and policy/regulatory development), the technological building blocks already are there. Rehabilitation providers have significant expertise and comfort with technology and they have broad expertise in effective patient-provider communication, which means the field is well-placed to take a leader role in use of eHealth technologies to enrich the patient-provider relationship.

References

Health Resources and Service Administration. Telehealth. Available at: http://www.hrsa.gov/healthit/telehealth/. Accessed December 12, 2015.
View in Article
- Google Scholar
- Dicianno B.E.
- Parmanto B.
- Fairman A.D.
- et al.
Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation.
Phys Ther. 2015; 95: 397-405
View in Article
- Verghese A.
Culture shock—patient as icon, icon as patient.
N Engl J Med. 2008; 359: 2748-2751
View in Article
- Street R.L.
- Liu L.
- Farber N.J.
- et al.
Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.
Patient Educ Counsel. 2014; 96: 315-319
View in Article
Fox S, Duggan M. Health online 2013. Available at: http://www.pewInternet.org/∼/media/Files/Reports/PIP_HealthOnline.pdf. Accessed May 1, 2015.
View in Article
- Google Scholar
- Lee A.C.
- Harada N.
Telehealth as a means of health care delivery for physical therapist practice.
Phys Ther. 2012; 92: 463-468
View in Article
- Lequerica A.H.
- Kortte K.
Therapeutic engagement: a proposed model of engagement in medical rehabilitation.
Am J Phys Med Rehabil. 2010; 89: 415-422
View in Article
- Jesus T.S.
- Silva I.L.
Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes.
Clin Rehabil. 2016; 30: 315-328
View in Article
- Hall A.M.
- Ferreira P.H.
- Maher C.G.
- Latimer J.
- Ferreira M.L.
The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review.
Phys Ther. 2010; 90: 1099-1100
View in Article
World Health Organization. International classification of functioning, disability, and health. Available at: http://www3.who.int/icf/icftemplate.cfm. Accessed December 15, 2015.
View in Article
- Google Scholar
- Clemson L.
- Mackenzie L.
- Ballinger C.
- Close J.C.
- Cumming R.G.
Environmental interventions to prevent falls in community-dwelling older people a meta-analysis of randomized trials.
J Aging Health. 2008; 20: 954-971
View in Article
- Mann W.C.
- Ottenbacher K.J.
- Fraas L.
- Tomita M.
- Granger C.V.
Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: a randomized controlled trial.
Arch Fam Med. 1999; 8: 210-217
View in Article
- Gitlin L.N.
- Winter L.
- Dennis M.P.
- Corcoran M.
- Schinfeld S.
- Hauck W.W.
A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults.
J Am Geriatr Soc. 2006; 54: 809-816
View in Article
- Gitlin L.N.
- Levine R.
- Geiger C.
Adaptive device use by older adults with mixed disabilities.
Arch Phys Med Rehabil. 1993; 74: 149-152
View in Article
- Fairchild D.G.
- Hogan J.
- Smith R.
- Portnow M.
- Bates D.W.
Survey of primary care physicians and home care clinicians.
J Gen Intern Med. 2002; 17: 253-261
View in Article
- Parker E.
- Zimmerman S.
- Rodriguez S.
- Lee T.
Exploring best practices in home health care: a review of available evidence on select innovations.
Home Health Care Manage Pract. 2014; 26: 17-33
View in Article
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC. Health professions per 10,000 population: maps. Available at: http://www.shepscenter.unc.edu/workforce_product/2012-health-professionals-per-10000-population-maps/. Accessed July 1, 2016.
View in Article
- Google Scholar
- Sanford J.A.
- Griffiths P.C.
- Richardson P.
- Hargraves K.
- Butterfield T.
- Hoenig H.
The effects of in-home rehabilitation on task self-efficacy in mobility impaired older adults: a randomized clinical trial.
J Am Geriatr Soc. 2006; 54: 1641-1648
View in Article
- Jackson J.
- Ely E.W.
- Morey M.C.
- et al.
Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation.
Crit Care Med. 2012; 40: 1088-1097
View in Article
- Chumbler N.R.
- Quigley P.
- Li X.
- et al.
The effects of tele-rehabilitation on physical function and disability for stroke patients: a randomized, controlled trial.
Stroke. 2012; 43: 2168-2174
View in Article
- Bendixen R.M.
- Levy C.E.
- Olive E.S.
- Kobb R.F.
- Mann W.C.
Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes.
Telemed J E Health. 2009; 15: 31-38
View in Article
- Moffet H.
- Tousignant M.
- Nadeau S.
- et al.
In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty.
J Bone Joint Surg Am. 2015; 97: 1129-1141
View in Article
- Tousignant M.
- Giguère A.M.
- Morin M.
- Pelletier J.
- Sheehy A.
- Cabana F.
In-home telerehabilitation for proximal humerus fractures: a pilot study.
Int J Telerehabil. 2014; 6: 31-37
View in Article
- Baker T.A.
- Wang C.C.
Photovoice: use of a participatory action research method to explore the chronic pain experience in older adults.
Qual Health Res. 2006; 16: 1405-1413
View in Article
- Berland G.
The view from the other side—patients, doctors, and the power of a camera.
N Engl J Med. 2007; 357: 2533-2536
View in Article
- Galea M.
- Tumminia J.
- Garback L.M.
Telerehabilitation in spinal cord injury persons: a novel approach.
Telemed J E Health. 2006; 12: 160-162
View in Article
- Harada N.D.
- Dhanani S.
- Elrod M.
- Hahn T.
- Kleinman L.
- Fang M.
Feasibility study of home telerehabilitation for physically inactive veterans.
J Rehabil Res Dev. 2010; 47: 465-475
View in Article
- Geirish J.M.
- Goode A.P.
- Batch B.C.
- et al.
The impact of wearable motion sensing technologies on physical activity: a systematic review.
U.S. Dept of Veterans Affairs, Health Services Research & Development Service, Washington (DC)2015 (VA ESP Project #09-009)
View in Article
- Google Scholar
- Kao D.P.
- Lindenfeld J.
- Macaulay D.
- et al.
Impact of a Telehealth and care management program on all-cause mortality and healthcare utilization in patients with heart failure.
Telemed J E Health. 2016; 22: 2-11
View in Article
- Salonen A.
- Ryhänen A.M.
- Leino-Kilpi H.
Educational benefits of Internet and computer-based programmes for prostate cancer patients: a systematic review.
Patient Educ Counsel. 2014; 94: 10-19
View in Article
Aitken M, Gauntlett C. Patient apps for improved healthcare: from novelty to mainstream. Available at: http://www.imshealth.com/en/thought-leadership/ims-institute/reports/patient-apps-for-improved-healthcare. Accessed December 11, 2015.
View in Article
- Google Scholar
- Ahmed O.H.
The smartphone app ‘Rotator Cuff Injury/Strain’ by Medical iRehab.
Br J Sports Med. 2015 Oct 16; ([Epub ahead of print])
View in Article
- Google Scholar
- How T.V.
- Chee J.
- Wan E.
- Mihailidis A.
Mywalk: a mobile app for gait asymmetry rehabilitation in the community.
in: Proceedings of the 7th International Conference on Pervasive Computing Technologies for Healthcare. 2013: 73-76
View in Article
Wai AA, Duc PD, Syin C, Haihong Z. iBEST: intelligent balance assessment and stability training system using smartphone. In: 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC’14); 2014 Aug 26–30; Chicago (IL). p 3683-6.
View in Article
- Google Scholar
- Milani P.
- Coccetta C.A.
- Rabini A.
- Sciarra T.
- Massazza G.
- Ferriero G.
Mobile smartphone applications for body position measurement in rehabilitation: a review of goniometric tools.
PMR. 2014; 6: 1038-1043
View in Article
- Weingardt K.R.
- Greene C.J.
New electronic tools for veterans.
N C Med J. 2015; 76: 332-334
View in Article
- PubMed
- Google Scholar
- Kuehn B.M.
Is there an app to solve app overload?.
JAMA. 2013; 313: 1405-1407
View in Article
- van Mechelen D.M.
- Van Mechelen W.
- Verhagen E.A.
Sports injury prevention in your pocket?! Prevention apps assessed against the available scientific evidence: a review.
Br J Sports Med. 2014; 48: 878-882
View in Article
- Hollands K.L.
- Pelton T.A.
- Tyson S.F.
- Hollands M.A.
- van Vliet P.M.
Interventions for coordination of walking following stroke: systematic review.
Gait Posture. 2012; 35: 349-359
View in Article
- Sawers A.
- Hahn M.E.
- Kelly V.E.
- Czerniecki J.M.
- Kartin D.
Beyond componentry: how principles of motor learning can enhance locomotor rehabilitation of individuals with lower limb loss—a review.
J Rehabil Res Dev. 2012; 49: 1431-1442
View in Article
- Keating A.
- Lee A.
- Holland A.E.
What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review.
Chronic Respir Dis. 2011; 8: 89-99
View in Article
- Davies P.
- Taylor F.
- Beswick A.
- et al.
Promoting patient uptake and adherence in cardiac rehabilitation.
Cochrane Database Syst Rev. 2010; : CD007131
View in Article
- PubMed
- Google Scholar
- Kelders S.M.
- Kok R.N.
- Ossebaard H.C.
- Van Gemert-Pijnen J.E.
Persuasive system design does matter: a systematic review of adherence to web-based interventions.
J Med Internet Res. 2012; 14: e152
View in Article
Munson SA, Consolvo S. Exploring goal-setting, rewards, self-monitoring, and sharing to motivate physical activity. In: 6th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth 2012); 2012 May 21–24; San Diego (CA). p 25-32.
View in Article
- Google Scholar
Klasnja P, Consolvo S, McDonald DW, Landay JA, Pratt W. Using mobile & personal sensing technologies to support health behavior change in everyday life: lessons learned. In: AMIA Annual Symposium Proceedings; 2009. p 338-42.
View in Article
- Google Scholar
- Antypas K.
- Wangberg S.C.
E-Rehabilitation—an Internet and mobile phone based tailored intervention to enhance self-management of cardiovascular disease: study protocol for a randomized controlled trial.
BMC Cardiovasc Disord. 2012; 12: 50
View in Article
- Antypas K.
- Wangberg S.C.
An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial.
J Med Internet Res. 2014; 16: e77
View in Article
- Martínez-Pérez B.
- De La Torre-Díez I.
- López-Coronado M.
Privacy and security in mobile health apps: a review and recommendations.
J Med Syst. 2015; 39: 1-8
View in Article
- Lumpkin J.R.
e-Health, HIPAA, and beyond.
Health Aff (Millwood). 2000; 19: 149
View in Article
Health Resources and Services Administration. What are the reimbursement issues for Telehealth? Available at: http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/whatarethereimbursement.html. Accessed August 4, 2016.
View in Article
- Google Scholar
Centers for Medicare and Medicaid Services. Telehealth. Available at: https://www.cms.gov/Medicare/Medicare-General-information/telehealth/. Accessed August 4, 2016.
View in Article
- Google Scholar
American Telemedicine Association. Update on CMS payment decision—two steps forward, one back. Available at: http://www.americantelemed.org/news-landing/2014/11/07/update-on-cms-payment-decisions–-two-steps-forward-one-back#.VwPYWDZf2Uk. Accessed August 4, 2016.
View in Article
- Google Scholar
U.S. Department of Veterans Affairs. VA Telehealth services. Available at: http://www.telehealth.va.gov/. Accessed December 28, 2015.
View in Article
- Google Scholar
U.S. Department of Veterans Affairs. VA mobile health. Available at: https://mobile.va.gov/. Accessed December 28, 2015.
View in Article
- Google Scholar
American Telemedicine Association. ATA State Telemedicine Toolkit: improving access to covered services for telemedicine. Available at: http://www.americantelemed.org/docs/default-source/policy/ata-state-telemedicine-toolkit–-coverage-and-reimbursement.pdf?sfvrsn=4. Accessed August 4, 2016.
View in Article
- Google Scholar
Center for Connected Health Policy. Telehealth Medicaid & state policy. Available at: http://cchpca.org/telehealth-medicaid-state-policy. Accessed August 4, 2016.
View in Article
- Google Scholar
- Forducey P.G.
- Glueckauf R.L.
- Bergquist T.F.
- Maheu M.M.
- Yutsis M.
Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting.
Psychol Serv. 2012; 9: 144-162
View in Article
- Kilbourne A.M.
- Neumann M.S.
- Pincus H.A.
- Bauer M.S.
- Stall R.
Implementing evidence-based interventions in health care: application of the replicating effective programs framework.
Implement Sci. 2007; 2: 1-10
View in Article
- Grol R.
- Grimshaw J.
From best evidence to best practice: effective implementation of change in patients’ care.
Lancet. 2003; 362: 1225-1230
View in Article

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Published online: April 21, 2016

Footnotes

Supported by the Veterans Health Administration Office of Rehabilitation Research and Development (grant no. F0900-R).

Disclosures: none.

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DOI: https://doi.org/10.1016/j.apmr.2016.04.002

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Can eHealth Technology Enhance the Patient-Provider Relationship in Rehabilitation?

Keywords

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Knowing the person and contextual factors

Effective information exchange and education

Shared goal setting and action planning

Limitations and next steps

Challenges and limitations

Next steps

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