Stellenbosch University’s FMHS launches telerehabilitation teaching
Telehealth has come a long way since the days of landline and two-way radio chats between health practitioners who found themselves in different locations.
These days patients and caregivers can access advice, consultations, training and even group sessions in real time or at leisure via Zoom, WhatsApp, voice recordings, photographs, emails and the like.
Three years ago, it was still illegal for South African occupational therapists, physiotherapists, speech therapists and others offering rehabilitation services to provide virtual home visits, remote consultations, group and individual therapy or do augmented supervision. Only doctors could legally consult via technological means – and only if another health professional was in the same room as the patient.
It meant that South Africans living in remote areas or others struggling to access health professionals were cut off from rehabilitation specialists – unlike people living in the Australian outback or Canada’s snowfields who have easy access to telerehabilitation services.
However, by April 2020, the Health Professions Council of South Africa fast-tracked legislation in response to Covid-19 lockdown measures, enabling rehabilitation professionals to treat current and new patients virtually or remotely.
By May 2020 the Occupational Therapy Association of South Africa and related professional bodies started publishing their own guidelines on how to deliver telerehabilitation services, how to bill for sessions, and how to record these for quality control.
Fantastic potential, many advantages
“Telerehabilitation has fantastic potential as long as ethical issues, such as confidentiality and privacy, are taken care of,” says Prof Nicola Plastow, Head of the Division of Occupational Therapy in the Faculty of Medicine and Health Sciences (FMHS).
“It can be as effective as face-to-face sessions. Communication is improved, more regular contact is possible, and patients can be sent more information to work through in a home programme.”
The new regulations benefit practitioners as well as patients.
“It opens up new employment prospects. Rehabilitation specialists living in remote areas can now run online practices if they have sufficient connectivity. Healthcare professionals are no longer limited to providing services in their own province,” Plastow adds.
Pioneers in telerehabilitation training
In response to these changes, the heads of the Divisions of Occupational Therapy, Physiotherapy and Speech-Language and Hearing Therapy in the FMHS Department of Health and Rehabilitation Sciences, along with distinguished professor in innovative rehabilitation and departmental head, Prof Quinette Louw, realised that students needed focused, quality training.
The Stellenbosch University Telerehabilitation Initiative was launched in October 2020, through generous support by the FMHS. Among others, advice was sought from two Australian universities with years of experience in running telerehabilitation clinics.
Plastow has since late 2021 chaired the Department’s Telerehabilitation Steering Committee consisting of Prof Marianne Unger (physiotherapy), Dr Gouwa Dawood (speech-language and hearing therapy) and Monique de Wit (initiative coordinator).
At a time when lecturers and students worldwide were adjusting to online classes, the steering committee started developing course material for an online interprofessional undergraduate module – the first training on how to deliver telerehabilitation services in South Africa.
It was tested in 2021, and by March 2022, 235 undergraduate students had already received theoretical and practical training. Nine postgraduate students completed the short course for clinical professionals (see additional information below).
A Telerehabilitation Hub was furnished with dedicated hardware, software, and supervision personnel. It has since served as a space for both training and patient consultation.
It allowed a six-week empowerment group session for patients normally attending the Tygerberg Hospital Pain Clinic to continue when lockdown measures limited face-to-face meetings. Furthermore, home-based caregivers at the Bishop Lavis Rehabilitation Centre and the Andrew Murray Children’s Home in Wellington could still receive online training. Clinical sites in other provinces, such as Upington in the Northern Cape, now receive support and capacity training.
Complements and strengthens usual care
However, telerehabilitation services cannot replace all in person sessions. Connectivity and data issues can be frustrating.
In a guest editorial in the South African Journal of Occupational Therapy, De Witt and her colleagues emphasised that “telerehabilitation is an adjunct service to complement and strengthen usual care, and not a replacement thereof”.
“For instance, it’s not practical, safe or possible to do all physiotherapy sessions without someone at hand,” Plastow explained.
However, telerehabilitation has real value, added Louw: “Rehabilitation as a health strategy aims to improve people’s functioning ability, but is often not recognised or prioritised. Innovation plays a key role in strengthening rehabilitation in low- and middle-income countries like South Africa where health systems are constrained by fiscal and other factors.
“Strengthening rehabilitation within the health system should involve innovative service delivery modalities to promote access and equity.”