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Efficiency of Patient Throughput During Pre-Surgery Telerehabilitation

The efficiency of Patient Throughput during Pre-Surgery Telerehabilitation

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EFFICIENCY OF PATIENT THROUGHPUT DURING PRE-SURGERY TELEREHABILITATION Keywords: pre-surgery Length of Stay, MSF reconstructive surgical hospital, MSF telerehabilitation, pre-surgery telerehabilitation. Introduction The length of stay (LOS) pre-surgery is affected by medical insurance, hospital charges, and injury severity. Using telerehabilitation is a proposed approach to reducing the LOS presurgery. A proposal has been drawn from the ankle tendon transfer at the MSF reconstructive surgical hospital in Jordan Amman. Ankle tendon transfer surgery is of primary interest to the research owing to the prevalence of the procedure. According to Nori and Stetarnski (2020), the incidences of fibular neuropathy are variable. In the study, the prevalence of foot drop was 19 per 100000 people. Tendon transfer generalizes the procedure undertaken when a tendon is removed from its specific anatomic location and transferred to the ankle to restore normal movement. The research further shed light on the MSF reconstructive surgical hospital in Jordan Amman due to its concerted effort put into helping victims and patients in Iraq and other war-torn countries. The research highlights some of the indirect and direct effects of telerehabilitation on individuals under the reconstructive surgery program in Amman. This content addresses how the efficiency of throughput of pre-surgery telerehabilitation relates to the length of stay. MSF Reconstructive Surgical hospital in Jordan Amman has been used as the pilot study to determine the outcomes of telerehabilitation on LOS. The pre-surgery length of stay in this context has been taken as the date between the admission and the ankle tendon transfer surgery day. The literature review analyzes the existing research and the progress made in the field. Other complementary topics

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have been used as a comparative tool to determine the effects of pre-surgery telerehabilitation on LOS. Literature Review The RSP (Reconstructive Surgery Programme) was launched in 2006 at Jordan Amman and purposed to treat individuals injured in war-torn areas. However, the high-tech expertise in surgical procedure, comprehensive medical facilities and a holistic approach for providing healthcare services make this program more efficient and thus unique. These aspects offer hope for the victims of war to access treatment from MSF hospital. (Balouziyeh, J., 2016). MSF offers services that are otherwise inaccessible in the native countries of the patients. It was established to treat patients with complex injuries. Most facilities in Palestine, Yemen, Syria, and Iraq since the countries do not have the capacity to serve a significant number of patients, especially during wars. Fundamentally, the reason for bringing victims of war to MSF is that their countries are unable to access essential healthcare facilities and amenities due to the disorganization during the war (MSF, S.F., 2015, pp671). The physiotherapy procedure at the MSF Hospital in Amman is that they conduct a follow-up for their patients prior to arriving at the hospital for surgical treatment(s) and a supplementary follow up once they are cleared after treatment (Homan E. A. et al., 2021, p19). Additionally, telerehabilitation, the utilization of advances in data and information systems innovation to offer excellent rehabilitative assistance that surpasses the traditional healthcare services, has proven to be a cost-effective treatment system. The Impact of Telerehabilitation to LOS pre-surgery Over the last few years, the improvement in information system and technology has brought about the rapid development and adaptation to telerehabilitation services (Rosen, M.J.,

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1999. pp.11-26.) The benefits of telerehabilitation include distance barriers, flexibility in the treatment plan, and improved quality of life (Carignan, C.R. and Krebs, H.I., 2006, p.695). Nonetheless, one aspect of telerehabilitation highly welcomed among practitioners and patients is the effects telerehabilitation has on LOS. Using the ankle tendon transfer surgery as a point of reference at the Jordan Amman. Reduction in the preoperative delays Preoperative delay is one of the major problems faced by practitioners (Mayo N. E. et al., 2011, p514). The preoperative procedure comprises of travel barriers and cost of operation brought about by the subsequent consultation. Telerehabilitation in MSF in Jordan Amman, with the help of physiotherapists, help in reducing the overall cost of pre-surgery care (Frederix, I. et al., 2017. pp. 1717). Physiotherapists help in preventing a reduction in physiological capacity before the surgery and after the surgery. The same can be mirrored during the ankle tendon transfer surgery. Maintenance of physical activity is an intervention recommended by physiotherapists and affects the overall effectiveness of the surgery (Hoogeboom. J., 2014, p161). According to Hoogeboom, there is ample evidence that indicates the effectiveness of exercise before the surgery. While Hoogeboom highlights cardiovascular surgery, he further notes that the effectiveness of exercises is seen in thoracic, abdominal and joint replacement surgery. The correlation between the reduction of preoperative delays and telerehabilitation is thus drawn. The correlation is drawn in the sense that exercising is part of the throughput of presurgery. Improved Quality of Life Stemming from decreased LOS Telerehabilitation of the patients in exercises and motor training skills help the eventual outcome even as the patient undertakes the postoperative regimen. Therefore, the pre-surgery

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LOS for the ankle tendon transfer in MSF reconstructive surgical hospital is reduced by offering therapy and motor skills training via telerehabilitation. Telerehabilitation has had tremendous success in the past, with its acceptability peaking by the day (Rogante M. et al., 2010, pp304). Patients coming into the MSF reconstructive surgical hospital in Amman include Palestine, Yemen, Syria, and Iraq. The distance barrier can be overcome using telerehabilitation. Patients can have intensive healthcare services in the pre and post-surgery phases of ankle tendon transfer surgery (Moseir-LaClair, S. et al., 2001, pp291.). While the comparison between the conventional approach in surgical care and telerehabilitation as a tool for pre-surgery care are still inconclusive, the throughput of pre-surgery, which includes accommodating the patient in the facility, settling the patient in, and allocating resources to the pre-surgery care are eliminated thus cutting down on the pre-surgery LOS and improving the quality of life (Senchak J. J. et al., 2019, pp11). The Length of Stay as a Quality Measurement Tool Questions encompassing the legitimacy and quality of results acquired when conducting telerehabilitation persist. Cabana et al. (2010) depicted that medical factors regularly estimated in up close and personal assessments can be estimated effectively listed in telerehabilitation conditions with reasonable dependability. They evaluated patients once they are discharged from an intensive care unit for joint surgical procedures. Telerehabilitation assessments were performed with a zoom meeting interface in the presence of either the member's household or a medical practitioner. A physiotherapist was at a distant medical Centre, and the parties were connected using a private DSL connection of 512-kilo bytes. As indicated by Wu and Keyes (2006), the locally established telemedicine-based exercise should concentrate on clinical muscular recovery, and the results criterion include client fulfilment, clinical adequacy, and

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economy of planned techniques. Initiating a telerehabilitation home program provided organized, intuitive, and managed practice through a video conferencing system. In one instance, the instructor provided balance instruction which helped older folks' adjust and reduce the risk of falling. According to Kilgour et al. (2008) study, older subjects can participate in the zoom meetings conducted over the internet in their households, allowing uninterrupted correspondence with the activity tutor. Works of literature have exhibited that telerehabilitation during surgery as a means to reducing the LOS pre-surgery is adequate and welcomed by elderly folks for different clinical issues (Bendixen, R.M. et al., 2007, pp51), (Cheville, A.L. et al., 2019 pp 652), (Zanaboni, P. et al., 2013, pp429.). The consistency was recorded in around 98 percent of the elderly folks under the telerehabilitation program. Oneself directed, locally situated exercise telerehabilitation program was a compelling method to help women following a medical procedure for an altered extremist mastectomy and axillary hub analysis during the two-week recuperation period following a medical procedure to use the LOS as one of its quality indicators. The telerehabilitation exercise followed up on the LOS following the telerehabilitation program. Collins et al. (2009) discovered that patients with acute blood vessel sickness could benefit by utilizing an instructive video to reduce the LOS. The same could be locally practised at MSF. The telerehabilitation program is suitable for the elderly with trouble travelling from their homes to the clinic or hospital. The aftermath is a significant cut back in the length of stay for the elderly before the surgery. Vestergaard et al.'s (2008) study directed at determining the impacts of locally practised zoom sessions yielded the conclusion that physical execution, practicability, quality of life, personal satisfaction stemmed from telerehabilitation. Member's

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adherence to the planned session was at 89.2 percent. The viability of telerehabilitation to reduce the length of stay has been openly adopted across the board. The study concluded that home organized preparations for the surgery were linked with improved quality of life and personal satisfaction. The Humanitarian Context of Telerehabilitation in relation to LOS It can be argued that hospital can sometimes be depressive, and health care practitioners are dedicated to reducing the LOS (Corsonello, A., 2019, pp74.). According to Moneeza Walji (2015), telerehabilitation can be brought to a humanitarian context. Walji provides a classic example of a young man injured during conflict in the Middle East. The young man suffers a gunshot wound on his leg, and after his blood is restored and a venous graft carried out, he is given some medication for the pain. However, the question remains as to how he will manage the wound post-operation. In the article, Walji suggests using a rapid trend across countries such as Canada, Germany, and the United States, telerehabilitation. The low resource requirement involved in making telerehabilitation can help reduce the length of stay for the young man injured during the war (Calvaresi, D. et al., 2019, pp 231) (Krpic, A., Savanovic, A. and Cikajlo, I., 2013, pp171.). The Medicines Sans Frontieres has provided a humanitarian aspect to telerehabilitation. It can therefore be argued that reduction of the LOS is one of the goals of undertaking telerehabilitation. The humanitarian aspect of telerehabilitation can also be drawn from the fact that it helps the elderly attain the pre and postsurgery requirements. Hospital stays run up the cost, and consequently, shortening the LOS presurgery can be considered a humanitarian act by the MSF Reconstructive Surgical Program (Magone, C. et al., 2012). The Relevance of the Research

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This research shows the additional advantage of undertaking telerehabilitation and prehabilitation before ankle tendon transfer surgery; in any case, different examinations neglected to exhibit a reasonable advantage of the innovation with respect to LOS between the admission date and date of surgery. The usage of telerehabilitation in the presented research has emphasized the decreased LOS and willingness of patients to the telerehabilitation approach (Remy, C. et al., 2020, pp411). This is backed by the faster hospital discharges contrasted with the standard preoperative and postoperative procedures. Amid the discussion encompassing telerehabilitation and prehabilitation, the present investigation gives early proof to help support the advantages and unignorably evident benefits of telerehabilitation in the pre-surgery phase. Fundamentally, since the LOS is reduced, it implies that more patients will be discharged within a short period. Research Question • To what extent pre-surgery Telerehabilitation and the use of pre-surgery telerehabilitation affect the patient length of stay LOS in MSF reconstructive surgical Hospital in Amman before ankle tendon transfer surgery? • What are the main contributing factors that could affect patients LOS before tendon transfer? • What are the underlying and sub-contexts of telerehabilitation initiative by MSF, and how LOS applies in a humanitarian setting? Aim: • To analyze the effect and utilization of pre-medical procedure telerehabilitation applications on the LOS of the clinic before lower leg ligament moves a medical procedure at MSF Reconstructive Surgical clinic in Jordan.

Efficiency of Patient Throughput During Pre-Surgery Telerehabilitation 10 • Explore the possible indirect and direct impacts that telerehabilitation may have on the pre-surgery LOS at MSF Reconstructive Surgical. Objectives: • To evaluate the adequacy of a T.R. package utilized before ankle tendon transfer, including its effect on momentary results. • To conjecture that telerehabilitation utilizing a telehealth stage would diminish LOS and certainly influence the disposition of discharging following ankle tendon transfer. • To analyze whether patients are partaking in a telerehabilitation program affected LOS and the disposition of their discharge. Epistemological Approach: This study is quantitative, employing a pilot study to determine the effects of telerehabilitation on patients at MSF Reconstructive Surgical hospital. The study uses data collected from two groups of patients. This approach has been used as it offers a control group. The control group comprises individual who did not undergo pre-surgery telerehabilitation. Later, I compare the LOS of the two groups and draw conclusions based on the number of days spent between the date of admission and the date of surgery. Using statistical calculations, I determined the standard deviation and mean. A comparison of the standard deviation and the mean is held up against the two groups. The approach was particularly interesting as it offered a broader study, and thus, the yielded results are more generalized. By selecting fewer variables, it was easier to come up with close-ended conclusions. Moreover, it was faster and easier to compute the data as it was done automatically. Methods Study Design

Efficiency of Patient Throughput During Pre-Surgery Telerehabilitation 11 The proposal's viability is mainly hinged on the success of the pilot study presented as the method used to investigate the potentiality of pre-surgery LOS and how it is affected by telerehabilitation. The pilot study has been presented using secondary data as a smaller-scale version of the full-swing implementation of the proposal. A section has been featured to showcase some improvements that could be made to the pilot study to make the pre-surgery LOS feasible using telerehabilitation. Moreover, the pilot study has presented a chance to review the misconceptions and the ethical aspect of the proposal. Setting MSF has been practising telerehabilitation since 2010 and has expanded its operation across the world. MSF was inspired by Dr Laurent Bonnardot, from France, who at some point took his team to the field. Walji (2015) noted that the setting is of particular interest since it has recorded 1301 incidents stemming from 243 referral sites globally. With operations in Malawi, Central African Republic, and South Sudan, it has had an evaluation from 300 field users and in 2014 was established to be 91% helpful (Walji, M., 2015). The patients coming to the MSF Reconstructive Surgical hospital are ankle tendon transfer patients. The study is based on the MSF Reconstructive Surgical emergency hospital in Jordan Amman, which provides care to the Jordan population and other countries such as Syria (Ansbro, E. et al., 2021, p19.). I picked it since it treats patients injured in wars and backhanded survivors of brutality from nations like Iraq, Syria, Yemen and Palestine, which are affected by wars. Sampling Approach The first approach to selecting the 42 patients is that they had to be undergoing ankle tendon transfer surgery in the next 120 days. The ankle tendon was selected since its the least

Efficiency of Patient Throughput During Pre-Surgery Telerehabilitation 12 complicated surgery that requires pre-surgery care. Moreover, the recovery period included timed physiotherapy sessions. Thus, the pilot study was bifurcated.

Sample Inclusion and Exclusion Criteria Patients from different countries are incorporated into the pilot testing. The patient had to be above 20 years and below 50 years. The age range was selected to allow some benefit of the doubt on the use of digital devices such as laptops or tablets. Children and elderly folks were excluded from collecting secondary data used in the pilot study due to the increased risk of miscommunication (Vartanian, T.P., 2010). Recruitment Any patients who had previously undergone joint surgery that required physiotherapy or were currently undergoing post-surgery physiotherapy were excluded from the study. The sexes were distributed with men comprising 51 percent while women consisted of 49 percent of the patients involved in the pilot testing. Patients with a background in the use of digital services were prioritized. Data collection method Secondary data was used in the LOS period taken as the day of the admission and surgery date. The secondary data was collected in two phases. The first phase addressed the patient cohort that required ankle transfer surgery but did not undergo pre-surgery telerehabilitation sessions. In contrast, the second phase is a group of patients expected to undergo the ankle tendon transfer surgery and undertook pre-surgery telerehabilitation sessions. I further used the secondary input to come up with the mean and the standard deviation. The validation for using the secondary data was that it provides consistent results instead of, say, open questions where

Efficiency of Patient Throughput During Pre-Surgery Telerehabilitation 13 the answers might differ and was thus suitable to compare effects of telerehabilitation to presurgery LOS at MSF Jordan Amman. Collection of secondary data is preferred since it addresses a specific group, helps understand the problem from a numerical perspective, can be mapped to predict future trends, and makes it easier to draw comparisons. Instruments Secondary data was used as the main instrument to draw a comparison between the two groups. The availability of the data makes the research more feasible. Moreover, the relevance of the data, which is constituent of the LOS provided in days and further computed to derive the mean and the standard deviation, is mor...