Patients undergoing physiotherapy can soon opt to carry out their rehabilitation activities at home, using wearable sensors to monitor if they are doing it correctly while being filmed on a tablet for a therapist to review the session remotely, under a nationwide pilot of tele-rehabilitation involving 14 institutions.
This option will be rolled out by the Integrated Health Information Systems (IHiS), the IT arm of the Ministry of Health. NTUC Health and TOUCH Home Care have already implemented such sessions while various hospitals as well as SPD, an organization that helps those with physical disabilities, will do so by the end of the year.
Speaking at a media briefing for the Smart Health TeleRehab pilot, National University of Singapore (NUS) Associate Professor Gerald Koh noted that while the most rehab patients acknowledged that inpatient rehabilitation was beneficial, only four in 10 wanted to continue with rehabilitation after they were discharged.
The main obstacle was the functional barrier they faced ambulating from home to the rehabilitation centre, said Assoc Prof Koh. “The very reason why (they) needed rehabilitation is the very reason why (they) can’t get to the day rehab centre three times a week,” he added.
Other issues included inconvenience in travelling to the centre, having no caregiver to accompany them as well as the high-costs involved, such as when hiring private transport.
The NUS Department of Electrical and Computer Engineering and the Saw Swee Hock School of Public Health jointly developed the monitoring system — believed to be the first of its kind — which includes a set-up comprising of a tablet, a neck and limb motion sensor, depending on which part of the body the patient would be exercising with, and a tablet stand.
A patient app accompanying the service is also available in five languages.
To start the tele-rehab session, the sensors are first strapped onto the patient. After launching the app, the patient can start performing the exercises — as prescribed by their therapists through the app — which will be recorded via the tablet. Each set of exercise comes with video demonstrations, a counter to keep track of the number of repetitions completed, audio clips of words of encouragement to keep the patient going, among other things.
On the therapists’ end, they will receive exercise charts on how their patient performed during the tele-rehab sessions. They are also able to adjust the difficulty levels, repetition, among other things for the patient via the app.
A video conference can be arranged between the patients and their therapists for further assessment.
Suitable patients for tele-rehab include those who suffered from stroke, fractures, lower limb joint replacement or amputations, falls, musculoskeletal conditions among others.
In an ongoing trial started in 2014, Assoc Prof Koh found that the physical recovery with tele-rehab is as good as the usual rehabilitation process, which involves only face-to-face sessions with the therapists.
Another study by IHiS and NUS in 2015 also found that institutions are 30 per cent more productive when they adopt tele-rehab systems. For example, a therapist can see 9 patients a week, up from 6, by working remotely.
Due to the small sample size of the trial, the upcoming pilot will be used to gather more data on how effective the system is, patient receptiveness, productivity gains and its cost efficiency.
The participating institutions would determine the cost of the system. At TOUCH Home Care, each client would pay S$18 for a session that involves a therapist’s assessment while at Ang Mo Kio-Thye Hua Kwan Hospital, the cost will range from S$3 to S$50, depending on the amount of subsidies each patient receives. This pilot comes as a national platform for telemedicine was launched last month to have hospitals and other healthcare institutions offer consultations remotely.
Senior Minister of State for Health Chee Hong Tat said the new system could transform how therapy services are delivered in Singapore. “Patients will benefit from greater convenience, cost savings and better outcomes. Therapists and therapy service providers will also benefit from the productivity improvements,” he added.