OBJECTIVE

To investigate factors influencing adherence of caregivers to prescribed out-patient management of children with cerebral palsy (CP).

METHODOLOGY

This prospective cohort study enrolled 106 children with CP and their caregivers seen at the Philippine General Hospital (PGH) from July 1, 2018 to April 30, 2019 to investigate the association of patient profile, caregiver profile, accessibility of treatment center, and type of therapy, to adherence to out-patient management.

RESULTS

Atotal of 106 pediatric patients with CPand their caregivers participated in the study with no dropouts observed. Adherence to therapy was defined as completion of patient of at least 50% of the prescribed therapy sessions or completion of at least one set of therapy. Adherence was significantly increased when patients were referred to: (1) physical therapy (OR=34.5, CI 7.21 to 167, pCONCLUSION

Caregiver's adherence to out-patient rehabilitation program was seen to be significantly influenced by the type of therapy the patient with CPwas referred to undergo (i.e., PT, OT, SLT).

Human ; Cerebral Palsy ; Caregivers

BACKGROUND

During the COVID-19 pandemic, social isolation and quarantine measures set to control the spread of the infection paved for the increased utilization of virtual methods of consultation and follow-up. Telerehabilitation allows access to rehabilitation services despite distance and makes possible the continuation of rehabilitation services despite the lack of face-to-face interaction. This is difficult for pediatric patients who are dependent on their caregivers for understanding and making decisions regarding their health. Loss of continuity of rehabilitation services led to poorer outcomes in children with disabilities. Although advantageous for them, pediatric patients may not benefit from telerehabilitation if caregivers have negative perceptions of the process and are unwilling to utilize the service.

OBJECTIVES

This study determined caregivers’ perceptions and willingness to participate in telerehabilitation as a method of outpatient follow-up for pediatric patients admitted to a COVID-referral center in a developing country.

METHODS

The study utilized a descriptive cross-sectional design. Respondents were adults (≥19 years old) caring for pediatric patients admitted at non-COVID wards of the Philippine General Hospital and who were referred for rehabilitation services. A survey tool adapted from a previous study on willingness to utilize telemedicine among caregivers of pediatric patients was translated into the Filipino language and used in the study. A dataset from Excel was imported in STATA 16 (StataCorp, Texas, USA) and was exhaustively checked for completeness, accuracy, and consistency before analysis. The association between patient characteristics and willingness to utilize telerehabilitation for any app was determined using Pearson’s chi-squared test or Fisher’s exact test, as appropriate. The latter was used when more than 20% of the cells had an expected value of less than or equal to five. A P value of less than 0.05 was considered significant for all tests.

RESULTS

Of 123 respondents, 92 (75%) reported willingness to utilize telerehabilitation for outpatient consultation and therapy using video calls or a customized telerehabilitation app when available. Among 31 (25%) respondents who were not willing or unsure of participation, the main reasons identified were preference for face-to-face, lack of financial resources/load, poor connectivity, and doubt about the effectiveness of telerehabilitation.Patients with younger age (Fisher’s exact test, P=0.023), low usage of video call service (Fisher’s exact test, P=0.020), and lack of available devices (Fisher’s exact test, P=0.015) significantly reduced willingness to utilize telerehabilitation. Caregiver age, sex, educational attainment, estimated monthly income, number of devices used, speed of internet connectivity, and technological behaviors did not show statistical significance in association with willingness to participate in telerehabilitation.Most caregivers recognized the usefulness of a service allowing transmission of health data to and from the hospital, consultation with a doctor in case of an emergency, sending of reminders for medical visits and therapy, and provision of a list of home exercises and nutritional recommendations. Telerehabilitation was perceived advantageous, but concerns regarding privacy, trust, lack of human contact, and technological difficulty were also present.

CONCLUSION

With high levels of willingness among caregivers, telerehabilitation is a viable method of providing rehabilitation services for the continuation of management after inpatient admission among pediatric patients. Limitations in its utilization include technological issues including the lack of devices, low level of service use, and slow internet connectivity. Although well perceived as advantageous, there are concerns regarding loss of human contact, difficulty in using technological devices, and trust and privacy issues that may affect utilization.

Human ; Telerehabilitation ; Caregivers ; Pediatrics ; Children With Disability ; Disabled Children ; Covid-19 ; Developing Countries

Objective: As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos. Methods: Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila. Results: The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation. Conclusion A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.
Rehabilitation ; Rehabilitation of Speech and Language Disorders ; Neurobehavioral Manifestations ; Cognitive Behavioral Therapy ; Behavioral Symptoms ; Communication Disorders ; Insurance, Major Medical

Introduction: The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective: This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods: The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results: The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Health Services Administration ; Telemedicine ; Telecommunications ; Remote Consultation ; COVID-19

Introduction: In compliance with the COVID-19 infection control guidelines outlined by the Center for Disease Control and the World Health Organization, non-urgent and non-essential services have been postponed in most healthcare institutions in the Philippines, including medical training institutions wherein responses and strategies for the residency program vary. These changes may impact the trainees’ knowledge, skills, and attitudes on their training. Specifically, most services were halted indefinitely in Physical Medicine and Rehabilitation (PM&R). Some resident trainees were deployed to treat COVID-19 patients not as PM&R residents but as generalists to augment the number of medical front-liners. Objective: To determine the PM&R residents’ COVID-19 risk preparedness in terms of relevant knowledge, attitudes, practice, and perceived barriers, and to describe the impact of COVID-19 on residency training. Methods: In this descriptive cross-sectional survey, the population consisted of a sample of PM&R residents from the six training institutions in the Philippines. A 15-20-minute web-based assessment tool was used to gather the following: participant characteristics; level of awareness and knowledge of residents towards COVID-19; risk preparedness through risk perception, knowledge, and attitudes regarding COVID-19; and impact of COVID-19 on residency training. Results: A total of 62 PM&R residents participated in the study. The majority were female and aged at least 30 years. The respondents had the following mean scores: 12.84 out of 14 for knowledge (interpreted as good), 9.16 out of 35 for attitude (interpreted as positive), and 5.65 out of 6 for practiced adherence to COVID-19 and infection control measures in their respective institutions (interpreted as good). The most commonly cited barriers to COVID-19 infection control included overcrowding in the emergency room (95%), lack of knowledge about the mode of transmission of the disease (92%), and limitation of infection control resources (92%). The majority reported that the main impact of the pandemic on PM&R residency training included the lack of clinical exposure to cases and procedures. Conclusion The study provided local baseline data on the PM&R residents’ level of COVID-19 risk preparedness and the perceived impact of the pandemic on their training. The study results may help the faculty plan for program improvement measures amid the changing COVID-19 landscape.
COVID-19 ; Physical and Rehabilitation Medicine ; Internship and Residency

Objective: This study described levels of fear, anxiety, depression, and contributing factors among health providers and administrative staff of the Department of Rehabilitation Medicine, Philippine General Hospital (PGH-DRM) during the COVID-19 pandemic. Methods: The cross-sectional study was conducted from August to November 2020. We recruited 71 participants who were working in the premises of the hospital and those who were working from home by purposive sampling. The fear numerical rating scale and Hospital Anxiety and Depression Scale were used to determine the presence of fear, anxiety, and depression. The 36-Item Short Form Survey (SF-36) was used to determine the baseline level of physical and mental wellness among participants. Results: Seventy-three percent of the full-time, permanent employees of the PGH-DRM unit joined the study. Majority of the respondents were health providers (86%) but only one hospital staff had high-risk contact with patients with COVID-19. Most participants (63%) did a combination of on-site work and home-based work and three (4%) worked entirely from home. Moderate to severe levels of fear was reported by 54% of the participants. Fear levels were highest among those who worked on-site. Anxiety was borderline in 32%, and abnormal in 30%, while depression was borderline in 21%, and abnormally high in 34% of the participating employees. Feelings of anxiety were higher among those who worked on-site and who worked both on-site and from home, while depression was highest among those who worked from home. The SF-36 Physical Health Summary score (x̄ = 72.49) was higher than the Mental Health Summary score (x̄ = 55.45). Employees who worked from home had the highest SF-36 summary scores for both mental and physical health. Conclusion The employees of the DRM had low-risk contact work assignments when the PGH transitioned to a tertiary level COVID-19 referral hospital. Half of the employees experienced fear, anxiety, and depression and had low SF-36 summary scores in mental health. Further studies are needed to determine the key factors that affect their mental health and well-being during the pandemic. A relevant mental health and wellness program is strongly recommended.
Depression ; Anxiety ; Fear ; COVID-19 ; Mental Health

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Telerehabilitation ; COVID-19 ; Continuity of Patient Care

OBJECTIVES: Data is necessary for a hospital-wide cerebral palsy (CP) profile, this being the leading pediatric diagnosis at the PGH Rehabilitation Medicine Out Patient clinic. This study aims to identify clinical features, severity of disability and common interventions in pediatric CP patients.

METHODS: CP profile data collection forms were accomplished from September 2014 to December 2015.

PRIMARY RESULTS: Among 125 participants: 55% were < 5 years old, 47% were delivered vaginally, 42% had perinatal onset of condition, 34% had normal birth weight and 23% were moderately preterm. Most were quadriplegic (36%) and spastic (50%). Primary caregivers were mostly mothers (45%) and

CONCLUSION: A hospital-wide cerebral palsy profile should be established to monitor CP, given its multifactorial cause and complex functional impact. Trends should be correlated with maternal and patient factors, healthcare provision and socioeconomics

Human ; Male ; Female ; Cerebral Palsy ; Motor Skills ; Patient-generated Health Data