Teletherapy

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The meaning of the term teletherapy (from tele "fern") has changed over time. Under teletherapy refers to a a form of radiotherapy (German: radiotherapy ) with photons , electrons , carbon ions or protons , in which in contrast to the brachytherapy acts radiation from a certain distance ( "remotely") on the patient and the thus is irradiated from the outside. Various techniques are available for this purpose (using a linear accelerator or cyberknife or a cyclotron or synchrotron ): intensity-modulated radiotherapy (IMRT), volumetrically modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT), PBT ( proton beam therapy ) and IMPT ( intensity modulated proton therapy ) as well as two-dimensional radiotherapy (2D-RT).

On the other hand, since around the year 2000, teletherapy has also been used to describe the therapeutic sub-area in health care that enables therapy under supervision using modern media. The term supervised teletherapy is understood as a combination of face-to-face sessions with a large number of supervised therapy units on a computer networked via remote data transmission. This term is made up of the words telematics and therapy .

General

Teletherapy is an application area of telemedicine . Teletherapy is understood to be the provision of therapy services with the support of modern technology without losing control by the therapy specialist.

Teletherapy is available in the form of asynchronous and synchronous (e.g. video treatment) provision of services. Due to the outbreak of SARS-CoV-2 (Corona), recommendations for the therapeutic products sector were issued in March 2020. Accordingly, video treatments are basically possible in the following areas: voice, speech and language therapy, swallowing therapy (only for disorders of the oral act of swallowing), occupational therapy, physiotherapy (in three specified position numbers) and nutritional therapy. This procedural regulation initially applies to all treatments carried out up to and including June 30, 2020; it does not constitute a prejudice for the time thereafter. Psychotherapeutic video sessions and telephone consultation hours were regulated separately.

The core element of teletherapy is professional and personal advice. As the central contact person, the therapist controls the course of the treatment and prescribes the therapy exercises for the patient in the care process. Treatment by means of teletherapy is not software for self-therapy by the patient himself, the patient can only train within the framework specified by the therapist, whereby the software can be used for communication and support, for example with a connection via the Internet .

The services should be able to be provided on various end devices, but the requirements for accessibility should always be met (e.g. accessible design of buttons, buttons and menus, navigation, audio, multimedia and video files as well as functions, font and language) .

Teletherapy takes place exclusively according to the specifications of an approved service provider from the health professions. The exercise is not tied to a specific location. The exercise program and the results are transmitted via telematics. Teletherapy does not necessarily mean a spatial separation of therapist and patient. It is mainly used to intensify an existing therapy or to supplement “face-to-face” treatments.

Teletherapy is a telemedical solution in the areas of neurology, orthopedics and cardiology that enables patients to get fit again more quickly. The aim of the care is to enable the patient to reintegrate more quickly into professional and private life.

With asynchronous teletherapy, from an economic point of view, the first thing to emphasize is the time it saves for the therapist. He can prescribe widely accepted, established and effective rehabilitation measures for the patient without having to be present himself. In this way, he can look after several patients at the same time or devote himself to problem patients more intensively than before.

The need for integrated care has been the subject of a controversial debate in which the influence of the legislature as well as the effects on the medical device industry were discussed. The German healthcare system has indeed suffered from a number of problems such as rising costs, but progress can only bring solutions, not just discussions. Teletherapy could provide a solution for this.

Treatment areas

Requirements for teletherapy

  • Teletherapy must not be a software solution that leaves the patient to himself
  • Teletherapy services may only be carried out according to the specifications of an approved service provider from the medical professions
  • The therapist must remain in control of the therapy so that he can turn the "right wheels" at all times during therapy
  • Teletherapy must allow individual therapy for each individual patient
  • The execution of the exercise by the patient must not be tied to a specific location or time
  • Performing the exercises on a modern medium must be easy and understandable for patients
  • The media used should not require any special knowledge of the application

Benefits of teletherapy

  • Brings therapy into the patient's personal environment
  • Increase in training frequency
  • Time independence of the training phases from the therapist's schedule, thanks to asynchronous supervision
  • Securing of rehab successes
  • Possibility of integrating home exercises into everyday life
  • Accompaniment by the trusted therapist as you re-enter everyday reality
  • Inexpensive outsourcing of routine parts of therapy
  • Support in the event of a shortage of skilled workers
  • Possibilities for further monitoring in high-risk patients
  • Case management options also beyond cost unit responsibilities
  • "Rehabilitation of the person"

Standard supply

The first approved treatment method in standard care has been EvoCare teletherapy since July 8, 2013 . This was by Achim Hein signed in 2002 for a patent, he is considered the inventor of teletherapy, a therapy system and method of therapy. The approved supply procedure is currently used in the aftercare of the Deutsche Rentenversicherung Bayern Süd . This approval was issued after the publication of the DRV's own study to investigate the effectiveness. The cost unit of the Deutsche Rentenversicherung Rheinland has taken over this form of teletherapy for your insured persons in the Aggertalklinik. The profitability was evaluated in a feasibility study by the Aggertalklinik, rehabilitation clinic for orthopedic diseases of the DRV Rhineland. With regard to profitability, the study comes to the following conclusion: "Costs and revenues were transferred to a contribution margin calculation. [...] Both show a positive overall result for the clinic." In 2017, the EvoCare treatment procedure with a teletherapeutic application as tele-aftercare after a full-day rehabilitation measure became possible nationwide for insured persons of the German pension insurance as a unimodal treatment offer in the orthopedic indication. The new digital therapy offer gives insured persons with findings on the posture and musculoskeletal system the opportunity to continue gymnastic exercises (for muscle building, endurance, strength, flexibility and coordination) with individual care from a rehab clinic at home. For multimodal tele-care (based on IRENA) or in other indications, EvoCare can be used as a model in rehabilitation facilities approved by the German Pension Insurance, these are diseases of the cardiovascular system, neurological diseases, metabolic diseases as well as mental and psychosomatic ones Disruptions.

Legal framework

There are approved accounting structures for teletherapy, which have been successfully checked by data protection officers from various institutions.

See also

literature

  • Eckart Rupp, Simone Sünderhauf, Jürgen Tesak: Teletherapy in the treatment of aphasia. Aphasia and related areas 2/2008.
  • Uwe Eisermann, Ingo Haase, Bernd Kladny: Computer-Aided Multimedia Training in Orthopedic Rehabilitation . In: American Journal of Physical Medicine & Rehabilitation . tape 83 , no. 9 , September 2004, ISSN  0894-9115 , p. 670-680 , doi : 10.1097 / 01.PHM.0000137307.44173.5D ( lww.com ).
  • D. Kraft: Telematics in Healthcare. DuD specialist articles. German university publisher. 2003, ISBN 3-8244-2166-6 .
  • M. Schellenberger, M. Dittrich, G. Eichner, B. Kleist, W. Schupp, WF Beyer: Investigation of the effectiveness of the aftercare concepts IRENA and EvoCare teletherapy in patients with diseases of the musculoskeletal system in relation to physical parameters . In: DRV writings . tape 103 , 2014, p. 268–271 ( deutsche-rentenversicherung.de [PDF]).

Web links

Individual evidence

  1. ^ Federal Office for Radiation Protection: Teletherapy . June 25, 2019, accessed April 13, 2020.
  2. ↑ Arne Grün, Thomas Kuhnt et al.: Re-irradiation for locally recurrent head and neck tumors and for prostate cancer. In: Deutsches Ärzteblatt. Volume 117, Issue 10, March 6, 2020, pp. 167–174, here: p. 169.
  3. ↑ Teletherapy in the treatment of aphasia
  4. ↑ Berliner Schlaganfall Allianz, glossary, accessed on the Internet on October 28, 2015 Evocare teletherapy
  5. ↑ Conference "Quality management and teletherapy", 19 February 2002 Bernd Kladny , Head of Orthopedics, m & i specialist clinic computer based multimedia training in orthopedic rehabilitation
  6. ↑ M. Johanni, D. Tietze, R. Setz, A. Hein: EvoCare: a new standard in tele-therapy. In: Studies in health technology and informatics. Volume 108, 2004, pp. 228-234, PMID 15718651 .
  7. ↑ a b R. Kohnen, M. Schellenberger: Teletherapy - Future-oriented therapy on the advance. (PDF)
  8. ↑ Possibilities and limits of telemedical treatment offers for cognitive and communicative disorders ( [1] ). Retrieved May 20, 2019.
  9. ↑ First approval for TeleTherapy from the German Pension Insurance - initially limited to Bavaria South, July 8, 2013, Internet access: October 31, 2019 ( [2] ) /
  10. ↑ Patients benefit from tele-rehab. In: Deutsches Ärzteblatt . Issue 1/2014.
  11. ↑ German Patent and Trademark Office, accessed on the Internet November 22, 2015 Patent, file number 102 47 440.0, designation "Therapy system and therapy method"
  12. ↑ Investigation of the effectiveness of the aftercare concepts IRENA and EvoCare teletherapy in patients with diseases of the musculoskeletal system in relation to physical parameters. In: DRV writings. Volume 103, 2014, pp. 268-271. ( online )
  13. ↑ EvoCare telemedicine as teletherapeutic aftercare at the Aggertalklinik, Engelskirchen, August 19, 2014, Internet access: May 20, 2019 ( [3] ) /
  14. ↑ Tele-treatment: economic efficiency proven and published, 23 November 2016, E-HEALTH-COM, Internet access: 28 June 2018 ( [4] ) /
  15. ↑ Excerpt from the feasibility study for EvoCare® teletherapy as an aftercare offer of the Aggertalklinik, rehabilitation clinic of the DRV Rheinland In: STUDIES AND PUBLICATIONS EvoCare® treatment . ( [5] ), accessed October 31, 2019
  16. ↑ German Federal Pension Insurance, nationwide recognition, remuneration rates for EvoCare, October 11, 2017 ( [6] ) /
  17. ↑ New therapy offer for patients after rehabilitation !, October 26, 2017, E-HEALTH-COM, Internet access: June 28, 2018 ( [7] ) /
  18. ^ Wilfried Berg: Telemedicine and data protection. In: Medical Law. Springer, issue 8/2004.