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Remote hand rehabilitation

Sweden Distance treatment
Patients in need of rehabilitation after injuries or surgical procedures in the hand or arm are offered treatment via video in their home or at the nearest healthcare center. The rehabilitation consists of investigation, intervention and evaluation. Patients in need of assistance, or those lacking access to required technology, participate using the videoconferencing system at the nearest primary healthcare facility. The procedure is routine since 2009 and about 10 percent of the patients who are rehabilitated at the clinic receive at least parts of their rehabilitation remotely via video. The rehabilitation team also monitors initiated treatments and provides consultancy support to colleagues at healthcare centers and hospitals.
Some of the highlighted benefits are that an equal rehabilitation can be offered to the county's and the region's patients regardless of their place of residence, and that the patients are given greater opportunity to fit rehabilitation into their everyday life. Environmental benefits and reduction in costs for travel and overnight stays are other important outcomes of this work model.
Patients in need of rehabilitation after injuries or surgical procedures in the hand or arm, Occupational therapists, physiotherapists and doctors at the Hand and plastic surgery clinic at the Univesity Hospital of Umeå as well as Occupational therapists and physiotherapists at healthcare centers.
Vård på distans-2.jpg
With remote hand rehabilitation via video, the patient can get his or her rehabilitation at home or close to home

Quotes/testimonials

"The working method is a complement to traditional rehabilitation in order to increase the quality and make the efforts more patient-centered."

- Agneta Carlsson, Occupational therapist at University Hospital of Umeå, Region Västerbotten

Elaboration

Needs and challenges

The hand rehabilitation team at the Hand and plastic surgery clinic at the University Hospital of Umeå is responsible for the rehabilitation of patients with injuries in the hand and forearm throughout the northern healthcare region, ie the four northernmost counties in Sweden.

With traditional working methods, a rehabilitation session can lead to travel for patients in Västerbotten up to 500 km one way and up to 700 km one way for regional patients. Since the patient often needs rehabilitation for a long period, it have a big impact on the patients everyday life. 

Solution and function

The offer of rehabilitation via video is given to selected patient groups and patients with long-term rehabilitation needs both in Västerbotten, Norrbotten, Västernorrland and Jämtland. With remote rehabilitation via video, the patient can get his or her rehabilitation at home or close to home. The rehabilitation consists of investigation, intervention and evaluation. The most common issues are amputations of the hand and fingers, arthrosis of the thumbs and flexor tendon injuries in the fingers.

Occupational therapist and physiotherapist in Umeå connect to the patient via video conferencing system or computer. The patients who have access to technical equipment as a computer, tablet or smart phone can get rehabilitation in their home. In this way, the staff also can see how the patient works in their home environment. For patients who do not have access to technology or need support in other ways, video rehabilitation can be offered at the nearest healthcare center. Because the patients do not have to travel long distances, shorter follow-ups can be planned. 

The rehabilitation team at the hospital also provides support to its colleagues in primary care, as well as in handing over when primary care takes over the rehabilitation responsibility for the patient from the hospital clinic. 

The Hand and plastic surgery clinic in Umeå has since 2016 also been commissioned within national highly specialized care for obstetric plexus bradichalis injuries and traumatic plexus brachialis injuries for adults. A plexus brachial injury is an injury on the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. Within the assignment, which includes patients from large parts of Sweden, a significant part of the care and rehabiliton takes place remotely via video. 

Economy

During 2018, 408 rehabilitation sessions were carried out remotely, of which 297 replaced a trip, corresponding to 98 620 kilometers. An increase in the number of sessions by 47% compared to 2017.

Other economic benefits:

  • Saving in time and cost for assistants who had to accompany patients during physical visits 
  • Reduced need for sick leave and leave of absence in connection with rehabilitation 
  • Parents do not need to take leave to accompany their children for physical visits 

Process

Region Västerbotten started the first telemedicine projects already in 1995. Ten years later, the speech therapy department was the first to rehabilitate patients via video directly in their homes.

Large parts of the working methods that were designed in the field of speech therapy could also be used in hand rehabilitation, which meant that implementation could take place relatively quickly. The work method has since been further developed by a small number of enthusiasts and has been broadened to several groups of staffs. At first, it was optional for patients to choose whether they wanted rehabilitation remotely or not, today it is included in regular care programs for certain patient groups. 

Organisation and politics

Support from politics and management over the years has created good conditions for the development of new working methods based on telemedicine and remote care in Region Västerbotten.

Among other things, there has been a development grant that has enabled support to activities that want to test and evaluate new working methods. 

Follow-up/monitoring

The number of remote rehabilitation sessions has been followed since the work method was established in 2009 as well as the number of miles saved for patients.

The working method has been fully implemented in regular care processes since 2011. 

Communication

Patients in need of rehabilitation are informed about the possibility of distance rehabilitation in connection with visits to the hospital clinic.

Procedures are established for education and information for existing staff and new employees. 

More about effects

There are many positive effects from this solution. Press "show" to learn about the benefits this solution can provide for residents/patients and the healthcare.

Benefits for resident/patient 

  • Patients will have access to equivalent highly specialized rehabilitation regardless of place of residence 
  • The patient is given greater opportunity to control his or her own time and can better fit in the rehabilitation to everyday life 
  • Patients avoid tiring trips, which is especially important for elderly and weak patients 
  • Creates better conditions for parents of children with rahabilitation needs 
  • The patients experiences an increased safety and quality with video instead of telephone 
  • Client centered rehabilitation 

Benefits for the healthcare 

  • Reduced costs for patient travel and overnight stays at patient hotel 
  • Knowledge transfer to colleagues during visits and consultation  

Other benefits 

  • Reduced travel leads to positive environmental effects 
  • Sick leave may decrease and return to work can be done faster 

Learnings

When the working method was established, it was mainly occupational therapists and physiotherapists who were involved. As distance rehabilitation developed and volumes increased, staff from several professions were interested, including doctors. The lesson is that it is often successful to establish new working methods among the staff who see the opportunities and where the driving forces exists. It is then easier to extend the working methods to several professions. 

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Remote rehabilitation is an example of how highly specialized care can come closer to the patient. The work method is expected to be spread to many more patient groups and healthcare activities. Highly specialized care does not consist of physical buildings but of competence and smart working methods. 

Since video technology is well established within healthcare throughout the Nordic countries, the threshold for implementing this type of work method is considered to be relatively low. 

Agneta Carlsson, Occupational therapist at University Hospital of Umeå, Region Västerbotten agneta.carlsson@regionvasterbotten.se 

+46 90 7851492 

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