Disruption of the Complex Rehabilitation Technology (CRT) service and delivery model as the result of the COVID19 pandemic has led many clinicians and providers to explore telerehabilitation as a potential alternative to clinic based face-to-face evaluations.

The prospect of engaging in the CRT evaluation remotely is novel for many clinicians and Rehabilitation Technology Professionals, and understandably, elicits many questions in terms of logistics and efficacy.
 
One of the most frequently asked questions surrounds the capture and documentation of objective measures as they relate to the need for seating and mobility.
 
Over the last several years the standard for clinical documentation has evolved to include an algorithmic approach ruling out least costly
alternatives, in conjunction with specific objective measures that support a subjective narrative of client need.
 
How can this standard be met without the clinician being in the room to administer physical tests
and measures?
 
Discussions with document and funding professionals and clinicians, experienced in telerehabilitation, reveal some common threads.

 In a scenario where the clinician is remote, greater emphasis must be placed on functional testing via observation of task performance vs. traditional tests and measures that require a hands-on approach by the clinician.
 
“Measuring” of movement or strength may be completed and documented effectively from a reviewer’s perspective, when described in relation to completion of a functional task in the home environment. Examples of this may be a client having insufficient strength to lift a 12 oz. bottle of water from the table or insufficient ROM to remove a shirt from the closet. Measuring “functionally” may also prove to have some inherent advantages in presenting a more understandable picture of the clients need, to a prospective claims reviewer.
 
While clinical tests and measures are undeniably valuable in documenting progression of treatment or condition, the clinical review process for CRT goes beyond hard numbers. Those charged with reviewing claims for CRT are looking for a more broadly painted picture of the individual; including current level of function, how the recommended equipment will enable the client to interact with their environment and why a less costly piece of equipment would not work. This can be illustrated adequately and objectively through the observation and documentation of functional performance.
 
Clinical Reviewers may also consider relevant tests and measures that may have been documented within a reasonable timeframe prior to the telerehabilitation visit (within 3-4 months).

Inclusion of relevant historical documentation helps to establish a baseline from which the clinician can document any progression or change of condition utilizing functional tests and measures.

Testing Through Observation of

Standardize Test/ Measure Range of Motion	Example Functional Task
Range of Motion	Actual or simulated wheel stroke Reach for an object below/at or above shoulder level Kicking a ball
Strength/Muscle Testing	Chair push up Picking up a quart of milk Opening a door
Neuromuscular Status (spasticity/tone/adnormal reflex, etc.)	Picking keys, and letting them go Passing a tennis ball from one hand to another across midline
Balance/Gait/Transfers	Time walk with caregiver (TUG)

 
While conducting an evaluation remotely is likely unfamiliar to most CRT teams, telerehabilitation has been qualitatively proven, to be a useful tool in the context of seating and wheeled mobility.
 
“Treating the evaluation like any other” would appear to be good advice for CRT professionals considering engaging in a remote process. The clinician guides the process, gathers and documents information relevant to the clients mobility needs, painting a picture of necessity for the reviewer.
 
The method by which critical information is captured and reviewed may be different but the outcome should be the same.

Click to watch a wheelchair evaluation, home assessment and wheelchair delivery & final fitting in action. 
 
If you have any questions about remote documenting contact eric.grieb@numotion.com or andria.pritchett@numotion.com.