Attitude Toward Telerehabilitation Among Physical and Occupational Therapists in Korea: A Brief Descriptive Report

Telerehabilitation (TR), defined as the delivery of rehabilitation services at a distance using electronic information and communication technologies [1], has been temporarily allowed by the government after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic. The change in the socio-legal environment regarding TR has led to vigorous attempts to adopt TR in clinical situations, as well as increased interest among therapists in Korea [2]. The attitude toward TR of service providers (i.e., therapists) is an important factor in the successful adaptation of TR to real-world clinics; nonetheless, an investigation into the perception of TR by therapists has not yet been implemented in Korea. In this brief report, the authors present therapists’ attitudes toward TR with demographic data.

A nationwide survey of therapists (both physical therapists [PTs] and occupational therapists [OTs]) was performed using an internet-based survey tool. The survey consisted of 15 structured questionnaires on TR in 8 domains: awareness (AW), attitude (AT), perceived usefulness (PU), perceived behavioral control (PBC), self-efficacy (SE), facilitating conditions (FC), barriers (B), and behavioral intention (BI), which were adopted from a virtual reality (VR)-related attitude survey [3].

The AT, SE, and BI areas had one questionnaire item corresponding to each area, and the remaining areas were composed of several questionnaire items. The questionnaire item in the AT area was ‘I think it’s good to use remote rehabilitation for treatment.’ The questionnaire item in the SE area was ‘I am generally confident about implementing remote rehabilitation.’ Moreover, the questionnaire item in the BI area was ‘I have a plan to use remote rehabilitation in the future.’ Examples of questionnaire items in the remaining areas included ‘I have heard of remote rehabilitation’ in the AW area, ‘Remote rehabilitation will improve the quality of patient care’ in the PU area, and ‘I have the knowledge necessary to perform remote rehabilitation’ in the PBC area. There were items such as ‘I have enough space to perform remote rehabilitation’ in the FC area and ‘It is difficult for me to receive technical support when performing remote rehabilitation’ in the B area.

The survey used a 5-point Likert scale, with 1 meaning that the respondent totally disagrees and 5 meaning that the respondent totally agrees with the given question. Demographic information, including age, sex, working area, number of years of service, and type of affiliation, was acquired with experience in TR. We hypothesized that therapists with experience in TR would have a more favorable attitude toward TR than therapists without experience in TR. The results of the survey were analyzed using SciPy library version 1.5.2 (Enthought, Austin, TX, USA) in Python version 3.6 (PSF, Wilmington, DE, USA). The study was approved by the Institutional Review Board (IRB) of Seoul National University Bundang Hospital (IRB No. B-2210-785-303).

A total of 350 therapists responded to the survey, of whom 191 were PTs, and 159 were OTs. Among the participants, 40 (15 PTs and 25 OTs) had experience with TR, whereas 310 (176 PTs and 134 OTs) did not have experience with TR. The proportion of therapists who had experience with TR was significantly higher in the OT group (p = 0.03). Otherwise, there were no significant demographic characteristics that differed between respondents with and without TR experience (Table 1).

Table 1
Demographic characteristics of the respondents (n = 350)

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Among the 8 domains of attitude toward TR, all domains, except B domain, were significantly higher (p < 0.05) in therapists with TR experience (Fig. 1). The difference in all domains (except B) according to experience with TR remained significant (p < 0.05) when the analysis was performed in the PT and OT subgroups.

Fig. 1
Comparison of the domains according to TR experience.
AW, awareness; AT, attitude; PU, perceived usefulness; PBC, perceived behavioral control; SE, self-efficacy; FC, facilitating conditions; B, barriers; BI, behavioral intention; TR, telerehabilitation.

^*p < 0.05.

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In the B domain, there were 3 questions regarding barriers: insufficient insurance fees, privacy security, and a lack of technical support. Interestingly, therapists with TR experience had higher scores (meaning more concerned with the issue) in the lack of technical support, although this was not statistically significant (TR experience vs. no TR experience was 3.6 vs. 3.68, p = 0.27).

Physical and occupational therapy has traditionally been recognized as therapeutic acts performed face-to-face by therapists. Owing to the COVID-19 pandemic, non-face-to-face medical provision is being attempted in various medical fields, including rehabilitation medicine [4]. Moreover, recent accelerated Internet communication technology has become the driving force behind the adaptation of TR in the clinical field [5]. In this transitional period, therapists’ attitudes provide valuable insight into the future direction for the successful adoption of TR.

In this study, a multi-domain survey was conducted on the attitudes toward TR regarding both PTs and OTs and revealed that participants in the TR experience group had more favorable attitudes toward TR in most of the domains. In particular, there was a significant difference between the 2 groups in BI, which asks for future intentions to adopt TR in practice. This implied that experience in TR has a significant impact on the willingness to use remote rehabilitation in the future. These results align with surveys on attitudes toward TR in other countries [6], as well as surveys on the adaption of new technologies in rehabilitation, such as VR therapy [3].

Regarding the barriers to TR, both the therapists in the TR experience group and the no TR experience group answered that the lack of sufficient insurance fees for TR was the largest barrier to adopting TR, suggesting that an adequate insurance fee would facilitate the usage of TR. In addition, concern regarding technological support was higher among therapists in the TR experience group, implying that the respondents may have experienced technological problems in practicing TR. Moreover, since patients undergoing TR are mostly old, technological support would be an important issue in facilitating TR from the patients’ viewpoint [7].

The percentage of respondents in the TR experience group was 11.4% (40/350), which was higher than expected since TR practice in Korea was mostly conducted for research purposes. The distribution of affiliations was not significantly different between the groups; however, the percentage of respondents working in the academic institute might be higher than the real population since the respondents were gathered via text messaging by the therapist society. In addition, OTs had a significantly higher rate of TR than PTs, which may be attributed to the easier applicability of occupational therapy to TR compared to physical therapy.

For the limitations of this study, the survey did not question the type of TR the therapists have experienced or the quantity of the experience, hindering us from an in-depth analysis.

To our knowledge, this is the first study to examine therapists’ attitudes toward TR using structured questionnaires in Korea. Considering that therapists’ attitudes, perceptions, and willingness to TR can be very important factors for the establishment and actual implementation of TR, the results of this study will provide grounds for future rehabilitation medical policies regarding TR.