Telerehabilitering : sjukgymnastik på distans

Sammanfattning: The overall aim of this thesis was to study physiotherapy at a distance in the home after surgery on the shoulder joint as well as conditions for (physical examination) palpation at a distance. Technical developments have contributed to shorter hospital stays and more care and rehabilitation outside the hospital and in the patient’s home. Distance-spanning technology can be a tool to this development to take place while providing the same or better quality. Study I was a controlled quantitative study. A series of 25 patients underwent shoulder joint replacement and initial physiotherapy at the hospital. After discharge, 12 patients were referred to conventional out-patient physiotherapy (control), while 10 patients participated in a telerehabilitationintervention of interactive video-based physiotherapy at home with the physiotherapist situated at the hospital. Shoulder function, activity limitations and health-related quality of life were assessed before surgery and two months after surgery. The telerehabilitation intervention group was also interviewed twomonths after the surgery and physiotherapy at distance at home.Study I showed that the telerehabilitation group members had participated in more physiotherapy sessions and showed significantly better recovery regarding shoulder pain, shoulder joint external rotation, shoulder function and activity limitations in two dimensions of health-related quality of life, compared to the control group.In study II the content analysis of interviews with the telerehabilitation group members showed that all participants expressed that they were satisfied with the rehabilitation and that they had experienced the videocommunication technique and the exercise as safe. The analysis of the interviews showed that participants experienced accessibility to specific frequent physiotherapy at a distance at home as a prerequisites for recovery competence. Participantsexperienced closeness to the physiotherapist at distant. The analysis revealed a process from dependent patients to strengthened responsible persons.In study III and IV seven experienced physiotherapists and one technical engineer with experience of video communication technique participated in qualitative focus group interviews. The aim was to describe the concept palpation (study III) and to describe conception of palpation at a distance (study IV). Qualitative content analysis showed that palpation was an important part of the physiotherapy assessment and examination. The study points to an intrinsic relationship between “manual and technical skills”, and “the relationship between the physiotherapist and the patient”. The analysis of the focus group interviews showed an important aspect of palpation where the physiotherapist and the patient communicate and interact with each other. In the focus group interviews, participants view on robotic palpation was developed, revealing a change from doubts and skepticism to interest and fascination. The physiotherapists saw a potential for palpation at a distance to meet their needs and their conceptions of their patients’ needs. The interviews revealed thoughts of technical demands on design of the robot. A future with robotic palpation as the “physiotherapists extended arm” should change the physiotherapists’ professional role.Furthermore, in study IV, these descriptions of palpation and conceptions of robotic palpation were used when developing a prototype for robotic palpation, which, in turn, was the subject of a field trial among four participants of the focus groups. A prototype master-slave system was built using budget haptic robots. It included a palpation force measurement system and a force/position controller using open-source software. The field trial of the prototype developed revealed accordance in the palpation force used between manual and robotic palpation. Despite the technical shortcomings and lack of sensory feedback appeared a feeling similar to manual palpation of and to during the test. In conclusion, a novel working prototype for robotic palpation was produced, and focus group interviews as well as field trial experiences resulted in a description of the potential of distance palpation and needs for further development.In summary, this thesis shows that physical therapy at a distance after surgery with shoulder prosthesis is feasible and may have particular advantages. The explanation for this may be several: more physiotherapy sessions, access to physiotherapist with specialized skills and an involved patient. Palpation at a distance is a challenging development, which can stimulate and enhance distance-spanning technologies in physiotherapy and provide an additional complement in contact with the patient. The technology needs to be further developed adjusted to patient´s and physiotherapist´s needs and benefits. Furthermore ethical and safety issues need to be addressed in more recent studies.