SINGAPORE: Patients from two healthcare institutions across Singapore will be able to carry out physiotherapy exercises in the comfort of their own homes, after a national tele-rehabilitation pilot was launched on Friday (May 5) by Integrated Health Information Systems (IHiS).
IHiS, Singapore’s healthcare technology agency, developed the system together with T-Rehab, a start-up founded by researchers from the National University of Singapore (NUS).
To use the service, patients open an app on an iPad - called Smart Health TeleRehab - and put on neck and limb sensors, depending on which part of the body they are exercising. The instructions are available in five languages: English, Mandarin, Bahasa Melayu, Tamil and Tagalog.
Video demonstrations of the exercises prescribed by the therapists will then be played via the app. The therapist is able to customise the level of difficulty of each exercise, from the number of repetitions to the angle of each limb movement.
The patient’s movements are also recorded for the therapist to review, and to motivate the patient to complete his or her exercises, the system designed to have gaming elements. For instance, there are coloured bars to indicate if the patient has achieved the desired exercise angle, and a counter for the number of repetitions completed.
After the patient completes the exercises, a record of the patient’s performance is sent to the therapist.
The service is available to those deemed suitable to perform physiotherapy exercises without the physical supervision of a physiotherapist. This includes those recovering from strokes, lower limb joint replacements and amputations, falls and fractures.
It is currently offered by NTUC Health and TOUCH Home Care. Twelve other institutions including Ang Mo Kio-Thye Hua Kwan Hospital, Khoo Teck Puat Hospital, and the National University Hospital will provide the service by end-2017.
There are 200 sets of tele-rehabilitation equipment available, which is rented out to the healthcare institutions for a fee. IHiS hopes to get 1,000 patients on the programme by the end of the two-year pilot and currently has around 11 patients on the service since February this year, said Mr Chua Chee Yong, director of IHiS' planning group.
OVERCOMING INCONVENIENCE, HIGH COSTS
This service comes two-and-a-half years after clinical trials were conducted by the researchers from T-Rehab.
A total of 100 stroke patients were recruited from Ang Mo Kio-Thye Hua Kwan Hospital and the Singapore General Hospital since January 2014, said Dr Gerald Koh, an associate professor and the director of medical undergraduate education at Saw Swee Hock School of Public Health at NUS. He is one of the founders of T-Rehab.
They chose to develop a tele-rehab system after an earlier study he conducted found that only two out of five patients wanted to continue with rehabilitation after discharge, he said. This is despite close to four out of five of them stating that rehabilitation was useful.
According to Dr Koh, many of them cited inconvenience, high costs and difficulty getting to the rehab centre without a caregiver as the main reasons why they stopped going for rehabilitation.
“The very reason why I need rehabilitation is the very reason why I can’t get to the day rehab centre three times a week,” Dr Koh said of the issue of immobility faced by patients.
His study found that those who got therapy through tele-rehabilitation recovered as well as those who did their exercises with a therapist present.
This new service, Dr Koh added, will help to boost rehabilitation participation rate and remove the barriers to carrying out physiotherapy and this will prevent their conditions from deteriorating further.
One of the early adopters of the system, TOUCH Home Care, found that the service benefits both patients and its healthcare workers since it implemented the system in March 2017.
For TOUCH Home Care, the price per session is still the same as a home visit at S$18. However, as the patient is able to carry out the exercises more frequently and at their own time, the hope is that he or she will recover faster and overall, fewer therapy sessions are required, said a physiotherapist at TOUCH Home Care Vivian Lim.
The operator's therapists have also been more productive.
So far, they spend about 50 minutes on each tele-rehabilitation session, which include prescribing the exercise via the system, reviewing the elderly client’s exercise records and conducting video consultations or calling the patients to provide feedback. A home visit will typically take about 100 minutes, including time to travel from one home to another.
The sessions are not meant to substitute home visits entirely, said Ms Lim, but can replace some of the weekly sessions.
However, not all clients are able to benefit from the new service, as those with conditions such as chronic giddiness and seizures will not be able to perform their exercises without direct supervision, said Ms Rachel Lim, a senior occupational therapist from TOUCH Home Care.
Some of the seniors also “lack confidence” in using technology, while others may not have the right caregivers at home. "There are some caregivers are also elderly who are frail (themselves), with sensory deficits…they can’t help put on the sensors,” said the occupational therapist.
TOUCH Home Care hopes to get 90 of its 300 clients using the remote rehabilitation tool by the end of this year. It now has seven on board.
MEETING SINGAPORE’S HEALTHCARE NEEDS
The tele-rehabilitation service was developed in light of Singapore’s healthcare landscape, said IHiS' Mr Chua.
“Our growing ageing population (means) we have more aged elderly in the community… more healthcare workers, including our therapists, are also getting older,” he said. This means that there will be greater demand for rehabilitation services, while there will be a growing need to “stretch our manpower resources”.
The service is one of three telemedicine initiatives that will begin this year. A remote vital signs monitoring system will launch later this year, while a national videoconferencing platform for healthcare services was launched in April.