COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home-Lessons Learned From a Pilot Case Study.
Addie Middleton, Kit N Simpson, Janet Prvu Bettger and 1 others
PMID 32372072WHAT IT FOUND
A single stroke survivor completed a 36-session telehealth strength and balance program.
He improved in sit-to-stand speed and perceived recovery, but walking speed and daily step count barely changed. The program cost about $158 per session, far exceeding standard Medicare reimbursement rates.
Key findings
01The participant completed all 36 sessions and maintained target exertion levels for 35 of them.
02Functional measures showed improvement in sit-to-stand performance and balance confidence, but little change in walking speed or daily steps.
03The estimated cost per session was $158, which is significantly higher than the average Medicare allowable charge for similar in-person services.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study involved only one participant, so the results cannot be generalized to other patients. There was no control group, so it is impossible to know if the improvements were due to the telehealth program, natural recovery, or other factors. The cost analysis assumes a specific staffing model (physical therapist and assistant) that may not reflect typical clinical practice. The participant had already been discharged from physical therapy, which may limit the applicability to patients currently in active care. Remote delivery inherently limits the provider's ability to physically guard the patient, increasing fall risk.
Declared interests
The study was funded by the National Center for Advancing Translational Sciences and the National Institutes of Health. The funders played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not assume this program is cost-effective or clinically proven for a broader population. The financial analysis is based on a single case with a high-cost staffing model, and the functional improvements, while notable, occurred without a control group to rule out spontaneous recovery.