We attended a variety of virtual sessions over four days of ACRM 2020, including seminars, panel debates and product exhibitions from a diverse range of institutions, clinicians and entrepreneurs.
Coronavirus was obviously a pervasive theme. Clinicians and rehabilitation providers have been forced to innovate in challenging circumstances, which has generated a large body of new studies and research. Technological solutions predominated, with many speakers sharing and comparing their experiences of business continuity and reinvention during the pandemic.
The conference provided insights regarding rehabilitation developments for all types of life-changing injuries. Looking across the event as a whole, some of the main issues and trends were as follows:
- There is significant investment in harnessing data science to predict longer-term outcomes following catastrophic injuries, whether by analysing data samples of similar patients, or by comparing therapy performance.
- Data science is also being used to design better targeted therapy or ‘precision rehabilitation’. Sensors can now easily be located in clothes, shoes, watches or even jewellery. In one case study, movement data from wearable technology was being used to help prescribe the optimum intensity, duration and frequency of physical therapy sessions.
- There were new market initiatives for peer collaboration and crowdsourcing of data. The National Limb Loss and Preservation Registry (NLLPR) is one such project funded by the US National Institute of Health and the US Department of Defence. It aims to develop a database of information and resources to facilitate improvements in amputee rehabilitation and prosthetic design.
- There has been a predictable increase in adoption of telehealth rehabilitation models for both physical and talking therapies. One study of remote cognitive behavioural therapy found a comparable working relationship to face-to-face sessions and high levels of patient satisfaction.
- A growth area in rehabtech is ‘gamification’ where exercise is performed in a game mode or virtual reality environment to motivate the user.
- One study found that remote therapy compliance can naturally decline over time but that, once logged into a session, users work as hard as before. In response, software developers are analysing usage statistics for behavioural profiling in order to continuously redesign and improve their platforms to incentivise initiation and sustain engagement.
- Some of the previous generation of breakthrough technologies have not achieved the transformational changes in quality of life that perhaps some expected; for example exoskeletons for spinal injury patients are still not sufficiently functionally practical in daily life and their primary application appears to be as a therapy aid in clinics.
- Innovation is not limited to technology. There have been surgical breakthroughs, notably the Agonist-Antagonist Myoneural Interface (AMI) technique during surgical amputation, for better muscle control of a prosthetic device.
- The pandemic has necessitated a shift towards family-centred care in the community for some patients, due to care supply chain disruption or infection control. This can even extend to nursing tasks such as ventilation, tube feeding, continence management, or positioning and turning. Some hospitals have responded by offering family training and education prior to discharge, including simulated transitional living facilities where family carers can practice under clinical supervision.
This year’s conference was particularly interesting because of its mid-pandemic timing. The speed and scale of coronavirus-related innovation is particularly impressive. Many providers are running to catch up or to keep up.
In the hospital setting, organisational changes have been made to support clinicians with rehabtech integration, including in relation to procurement, staff training and awareness, product champions, after-sales support, ongoing competency checks, and user group meetings.
In the community setting, therapists have had to quickly develop new protocols for the telehealth revolution, such as issuing guidance to patients regarding the initial logon, trouble-shooting any connection issues, and creating a suitable home environment for effective treatment.
The rehabilitation trend from inpatient to outpatient delivery seems likely to perpetuate beyond the pandemic, because it offers wider possibilities beyond infection control. Such opportunities include: reaching geographical areas with inadequate local health infrastructure; serving patients who might struggle to attend clinic-based appointments due to transport issues; or meeting the expectations of an increasingly technology-literate population.
The pandemic has understandably fast-forwarded the progress of rehabilitation research and development. One speaker perceptively labelled it the ‘Fourth Industrial Revolution’ for rehabilitation. The evidence base from the multitude of current trials will ensure that rapid innovation continues for the foreseeable future. The challenge for compensators and claims professionals will be to keep abreast of changes in order to maximise patient choice and rehabilitation outcomes.