sign130

of improvement. There were no significant improvements in socialising, predictive employment or anxiety
and depression. 173
In one small retrospective cohort study (n=55) which used the European Brain Injury questionnaire, patients
with a traumatic brain injury who received post acute community based rehabilitation subjectively reported
improved psychosocial outcomes. The effect was demonstrated even for a subgroup (n=26) beyond two
years post injury. Carers in this subgroup did not report the same improvements as patients. 172
The British Society of Rehabilitation Medicine and Royal College of Physicians, commenting on rehabilitation
in the community, recommend that it “should move progressively from formal therapy to a guided and
supported resumption of chosen activities over months or years.” 175
10.3 TElEMEDICINE
Scotland is a demographically varied nation with areas of high density urbanisation as well as many large
areas which are remote and rural. Telerehabilitation (TRH) is a potentially useful delivery method for outreach
rehabilitation.
10.3.1 DEFINITIONS
Telehealth is the provision of health care to patients at a distance using a range of technologies, such as (but
not limited to) mobile phones, internet services, digital televisions, video-conferencing and self monitoring
equipment.
Telecare is the use of technology (for example, falls monitors, motion sensors, alarms) to support individuals
with a range of health and/or social care needs to live more independently and remain at home safely. These
services are mainly provided by local authorities.
Telerehabilitation is the provision of rehabilitation services at a distance using telecommunications technology
as the delivery medium. 176
10.3.2 LIMITATIONS IN THE EVIDENCE BASE
Many patients with a brain injury have particular difficulties with new learning and concentration. It may
be unsafe to assume that telerehabilitation strategies shown to be effective in other conditions could
be extrapolated to be effective in patients with a brain injury. One crossover study found that younger
participants with TBI did less well than older participants following stroke at learning to use a telemedicine
intervention despite having a presumed generational advantage of being more familiar with digital
technologies. 177 For this section of the guideline, evidence from studies where the majority of the population
did not have TBI was excluded.
There are also concerns about the generalisability of some studies which originate from healthcare systems
which are significantly different from NHSScotland. 178
10.3.3 INTERVENTIONS USING TELEREHABILITATION
10 • Service delivery
One high quality systematic review considered TRH for different medical conditions. 179 RCTs involving patients
with TBI showed TRH to be effective in reducing depressive symptoms, improving behavioural outcomes
and increasing the probability of returning to employment. Non-randomised studies cited in this review
suggested that TRH was as effective as standard methods. One quasi-experimental study showed that
telephone groups were as effective as FTF groups in providing support and education with rural caregivers
of people with brain injury. An observational study found that there was no difference in performance to
retell stories between participants in the TRH or FTF groups.
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