Physical Telerehabilitation in Multiple Sclerosis: A Qualitative Inquiry

Thursday, May 29, 2014
Trinity Exhibit Hall
McKenzie E Bedra, MPH , Johns Hopkins University, Baltimore, MD
Susan Conroy, PT, DSc. PT , VA Maryland Health Care System, Baltimore, MD
Patricia McCarthy, OT , VA Maryland Health Care System, Baltimore, MD
Mitchell T Wallin, MD, MPH , Washington, DC VAMC, MS Center of Excellence, Washington, DC
Christopher T Bever Jr., M.D., M.B.A. , Neurology, University of Maryland School of Medicine, Baltimore, MD
Walter Royal, MD , Neurology, University of Maryland School of Medicine, Baltimore, MD
Joseph Finkelstein, MD, PhD , Johns Hopkins University, Baltimore, MD


Physical telerehabilitation can potentially facilitate home-based exercise and patient self-care. However, successful implementation of such systems is predicated by integrating patient needs, values and preferences in the system design.


The goal of this study was to identify telerehabilitation acceptance, attitudes, and preferences in patients with multiple sclerosis (MS) who used a physical telerehabilitation system for 6 weeks.


At the baseline visit information was collected which included socio-demographics, disease history, psychological and behavioral profiles. A Home Automated Telerehabilitation (HAT) system was used by patients at home for 6 weeks. HAT included pre-exercise symptom diary, individualized tailored exercise plan prescribed by a licensed physical therapist after a full clinical evaluation, daily exercise progress log, exercise videos with instructions on how to properly perform each exercise, structured education, and 2-way communication with study team. At the 6-week follow-up, patients completed an attitudinal survey measuring their attitudes and acceptance of the telerehabilitation system which was followed by a semi-structured qualitative interview aimed at identifying patient values, needs, and preferences.


Despite varying levels of previous exercise and computer experience, nearly all participants expressed high interest and dedication to continued use of the program. Patients felt safer knowing they were monitored by the system at home: “the major benefit of using this system is that it monitors me and my symptoms daily.” Patients also reported that using the system has helped with remembering to exercise correctly and on time: “the system also helps with my memory because you have to remember to log in and do the exercises because you are being held accountable, it becomes part of your routine.” Major additions to the system requested by the patients included adding voiceover to the pre-exercise diary questions, addition of a question about level of motivation to exercise daily, and making program more challenging.


All patients were comfortable with the intensity and frequency of exercises prescribed as well as using a computer at home to exercise at their own pace throughout the day. Addressing needs, values and preferences of MS patients can facilitate their use and further acceptance of physical telerehabilitation systems for exercise and self-care.