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Innovations Using Technology to Closing the Gap between Clinic and Workplace Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Karen Jacobs, EdD,

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Promoting Activity and Participation Among Persons with Arthritis

Innovations Using Technology to Closing the Gap between Clinic and Workplace

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Promoting Activity and Participation Among Persons with Arthritis

Karen Jacobs, EdD, OTR/L, CPE, FAOTA Boston University, Boston, MA Nancy A. Baker, ScD, MPh, OTR/L University of Pittsburg, Pittsburgh, PA

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Imagine the following scenario…

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Arthritis State of the Science Meeting

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Learning Objectives

  • Define telehealth
  • Discuss models of care in telehealth
  • Describe a pilot study in tele-ergonomics

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Pentagon City, Virginia | April 7, 2014 5

Ergonomics

“the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design in order to optimize human well-being and overall system performance”

(www.iea.cc/01_what/What%20is%20Ergonomics.html)

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Pentagon City, Virginia | April 7, 2014 6

Telehealth

“…the application of evaluative, consultative, preventative, and therapeutic services delivered through telecommunication and information technologies”

(Cason, et al., 2013)

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Telehealth Benefits

  • Reduce inequities in access to health resources by

experts remotely to underserved areas

  • Improve efficiency in delivery of services by

eliminating travel time, providing instantaneous access, and improving the coordination of care

  • Reduce the costs of assessments, interventions, and

education

  • Promote client-centered care, since health

professionals can observe clients in their own environments

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Methods

  • Information gathering
  • POTS
  • Electronic forms
  • Webcams/video conferencing
  • Sensors
  • Immediate vs stored
  • “Direct” or through and intermediary
  • Considerations
  • Capacity of technology
  • Access to technology
  • Skill of client/therapist

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Pani et al., 2014

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Models of Care in Telehealth

Evaluation Consultation Intervention Monitoring Supervision

(Richmond, 2013)

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-evaluation

  • Diagnosis or identification of problem areas using

telecommunication technologies

  • Considerations
  • Type of evaluation (self-report/observational)
  • Validity of evaluation methods

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Evidence: Tele-evaluation

Evaluation areas

  • Wheelchair prescription
  • Barlow, Liu, & Sekulic (2009)
  • Schein et al., 2008
  • Schein, et al., 2010;
  • Schein, et al, 2011
  • Neurological assessment
  • Savard et al., 2003
  • Adaptive equipment prescription and

home modification

  • Sanford et al., 2007
  • Ergonomic assessment
  • Baker & Jacobs, 2013

.

Evaluation Tools

  • Functional Reach Test and European

Stroke Scale

  • Palsbo et al., 2007
  • Kohlman Evaluation of Living Skills and

the Canadian Occupational Performance Measure

  • Dreyer et al., 2001
  • Functional Independence Measure,

Jamar Dynamometer, Preston Pinch Gauge, Nine Hole Peg Test, and Unified Parkinson’s Disease Rating Scale

  • Hoffman et al., 2008

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Example of Tele-evaluation

Videoconferencing technology between provider and client Assessed Activities of Daily Living (ADL) Occurred in client’s natural environment

(Richmond, 2013)

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Teleconsultation

  • Virtual consultation for the

purpose of obtaining and sharing medical information or advice between:

  • Expert provider and client; or
  • Expert provider and local

provider with the client present; or

  • Expert provider and local

provider without client present

  • Play performance in

children with special needs

  • Wakeford et al., 2002
  • Veterans with traumatic

brain injury

  • Girard, 2007
  • Wheelchair seating

consultations between distant and local providers

  • Schein, et.al, 2008

Teleconsultation defined Key Support Studies

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Example of Teleconsultation

Consultation between expert provider and local provider with client present

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-intervention

  • Interventions using telecommunication technologies
  • Clinic/Home
  • Methods to provide guidance
  • Person (visual/auditory)
  • Built in reminders
  • Sensor
  • Analytics

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Evidence: Teleintervention

Evidence supports the use of telehealth to deliver interventions in the areas of:

  • Children and Youth
  • Productive Aging
  • Mental Health
  • Rehabilitation and

Participation

  • Health and Wellness
  • Work and Industry
  • Early intervention services
  • Cason, 2009, 2011; Heimerl & Rasch, 2009
  • Kelso et al., 2009
  • Older adults
  • Bendixen et al., 2007; Harada et al., 2010
  • Hori et al., 2009
  • Stroke
  • Chumbler et al., 2010a; 2010b; Hermann et al.,

2010

  • Work space modifications
  • Bruce & Sanford, 2006
  • Chronic Diseases
  • Darkins et al., 2008; Steel, Cox & Garry, 2011

Interventions Key Support Studies

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Evidence: Telemonitoring

Use of telecommunication technology to:

  • Monitor a client’s adherence to an

intervention program

  • Monitor and facilitate progressive

therapy program

  • Monitor and support client in

natural environments (i.e. home, work, community)

  • ADLs (Smartphones)
  • Tang & Venables, 2000
  • Home exercise programs
  • Popescu et al., 2000
  • Chronic disease management
  • Darkins et al., 2008

(Cason, et al., 2013)

Telemonitoring defined Key Support Studies

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Example of Telemonitoring

Monitoring or tracking a client’s therapeutic progress remotely through telecommunication technology

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Evidence: Tele-supervision

  • Tele-supervision requires

consideration of:

  • State licensure laws
  • Institution specific guidelines
  • Professional Societies’

Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Treatment

  • Professional Societies Code of

Ethics and Ethics Standards

  • Telehealth technologies

can be used to support students and practitioners working in isolated or rural areas, and nontraditional fieldwork placements that cannot offer on-site supervision

  • Miller et al., 2003
  • Hubbard, 2000

Supervision Key Support Studies

(AOTA, 2009; AOTA 2010; Cason, et al., 2013)

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Example of Tele-supervision

Tele-Supervision of student or practitioner

Image from http://www.infanthearing.org/telehealth/index.html

Slide Source: Cason, J., Richmond, T., Jacobs, K., Slater, D. (2013) Providing OT Services via Telehealth: Ethical, Legal and Regulatory Considerations and Resources. AOTA conference.

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Exemplar: Tele-ergonomics

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-ergonomics – Pilot Studies

  • Purpose
  • Establish proof-of-concept for the feasibility of delivering

ergonomics assessments & interventions for computer users via web-based Tele-CES

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-ergonomics – Pilot Studies

  • Validity of remote

assessment of workstations

  • Design – Single group

pre/post test

  • Participants - 30
  • Remote assessment

compared to live assessment (gold standard)

  • Validity of remote delivery
  • f ergonomic intervention
  • Design: Single-subject AB

design

  • Participants: 10
  • Implementation of

recommendations made through remote ergonomic intervention assessed

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Jacobs, Blanchard, & Baker, 2012; Baker & Jacobs, 2013

Study 1 – Baker et al., 2013 Study 2 – Jacobs et al., 2012

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-ergonomics

  • Telerehabilitation Computer Ergonomics System (Tele-CES)
  • Using existing previously validated ergonomic instruments
  • Input from healthcare professionals and consumers
  • Conducted by ergonomically trained health professionals
  • Remotely assess the computer workstation
  • Generate explicit participant-specific workstation modification

recommendations

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-CES Assessments: Worker Characteristics

  • Demographic

information

  • Demographic survey
  • Computer Workstation

Checklist

  • Self-report assessing

computer use

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(Baker, Livengood, & Jacobs, 2013)

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*+),,),--

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-CES Assessments: Worker Characteristics

  • Pain
  • Joint Pain Homunculus

(JPH)/Pain Visual Analog Scale (P-VAS)

  • Comfort
  • Comfort Visual Analogue

Scale (C-VAS)

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-CES Assessments: Workstation Use

  • Computer Use
  • The Computer Problem

Survey (ComPS)

  • Computer Usage
  • RSIGuard Software

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-CES Assessments : Workstation Use

  • Multiple photographs of

worker in workstation

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Validity of Tele-CES Assessment

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  • (Baker et al., 2013)
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Pentagon City, Virginia | April 7, 2014

Recommendations implemented by participant

  • 30

(Jacobs et al., 2012)

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Pentagon City, Virginia | April 7, 2014

Recommendations implemented by category

  • 31

(Jacobs et al., 2012)

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Arthritis State of the Science Meeting

Pentagon City, Virginia | April 7, 2014

Tele-CES Assessments: Workstation/Worker

Blackboard Learn™ Photographs and video recordings

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Pentagon City, Virginia | April 7, 2014

Tele-CES Assessments: Workstation/Worker

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Pentagon City, Virginia | April 7, 2014 34

Thank you!

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References

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http://dx.doi.org/10.5014/ajot.63.6.797

  • American Occupational Therapy Association. (2010). Telerehabilitation. American Journal of Occupational Therapy, 64(Suppl.),

S92–S102. http://dx.doi.org/10.5014/ajot.2010.64S92Baker, N. & Jacobs, K. (2013). The feasibility and accuracy of using a remote method to assess computer workstations. Human Factors.

  • Baker, N., Livengood, H., Jacobs, K. (2013). Reliability and Concurrent Validity of the Computer Workstation Checklist. WORK,

213–221.

  • Barlow, I. G., Liu, L., & Sekulic, A. (2009). Wheelchair seating assessment and intervention: A comparison between

telerehabilitation and face-to-face service. International Journal of Telerehabilitation, 1, 17–28. http://dx.doi.org/10.5195/ijt.2009.868

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Association: Bethesda, MD.

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References

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Telerehabilitation, 3, 19–28. http://dx.doi.org/10.5195/ijt.2011.6071

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Occupational Therapy, 66, 131-136.

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telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14, 1118–1126 http://dx.doi.org/10.1089/tmj.2008.0021

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Developmental Disabilities Special Interest Section Quarterly, 32, 1–4.

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