There's no time limit on you today, maybe half an hour or so. Perfect. 10 minutes on each slide, right? Yeah. Including the title. All right. Hey, everyone. My name is Martin Barilak. It's good to see some familiar faces in the crowd. I'm a fourth year medical student at Virginia Tech Carilion School of Medicine, and along with one of my mentors, Dr. Jane, we're looking at the relationship of COVID-19 and critical illness myopathy and critical illness polyneuropathy. We first did this through a literature review, and then after doing the literature review, we wanted to look at it at our own institution, and so we just about a week ago got some raw data from our retrospective single-center study. That data is still a little bit raw, so take it with a grain of salt, but I thought I'd share a little bit of the results from the literature review and our single-center study with you all. Just to kind of set the scene here, as we know, COVID, all the research over the last few years about COVID has shown that COVID has had pretty broad-spanning complications among almost every single organ system, and more and more research has been emerging on the relationship of COVID-19 and different neuromuscular disorders and different neuromuscular disease processes. So we know that during the height of COVID, there were so many patients in the ICU because of COVID, and we know that critical illness myopathy and polyneuropathy are correlated with the ICU, so we were kind of looking at why or if COVID is related to, then, critical illness myopathy and polyneuropathy. CIM and CIP, I'll refer to them as CIM and CIP moving forward, they're debilitating neuromuscular disorders. They commonly, again, affect individuals in the ICU or in pretty severe illness states. The Venn diagram, I guess, of CIM and CIP is probably like 90 percent overlap. They're pretty similar disease processes in terms of their symptom profile and how they present, but generally, CIM will impact the muscles a little bit more. Those symptoms that we look for in CIM are profound weakness usually starts out more distal and affects proximal muscles as well. You often have flaccid tone and a difficulty weaning off ventilation, so prolonged mechanical ventilation. Critical illness polyneuropathy, on the other hand, is hitting the neurons a little bit harder, or the nerves a little bit harder, so it's going to attack our peripheral nerves. Again, we'll get that symmetric weakness, a lot of that flaccid tone, but more sensory deficits are present with CIP and decreased reflexes as well. The pathophys of both of these is pretty complex. There's a lot of different kind of theories and hypotheses as to how these different disease processes cause CIM and CIP, but it seems to be a combination of inflammatory responses, vascular changes, ischemia, metabolic derangements, electric alterations, and all these kind of come together to cause that muscle and that nerve damage. Analysis is usually done with a pretty comprehensive clinical evaluation. Often EMGs or nerve conduction studies are done as well. Sometimes muscle biopsies are necessary, and then excluding other potential causes. Management will include basically treating the underlying cause of what has the patient in the ICU, and then from that point on, working on strengthening and rehabilitating moving forward. But again, we're not really sure on what that relationship looks like with COVID-19, and so there's been more and more work in this topic. Even since writing this literature review, there's been a handful of more articles published, so we're excited to see this kind of body of work keep growing, but from when we did the literature review, we looked on PubMed and kind of scrubbed through PubMed for CIM and CIP and COVID-19. We originally had 55 articles that came up, and after looking through them a little closer, the ones that really were highlighting CIM and CIP and COVID as kind of the main players of the article and rather not just mentioning them in the article, we ended up with 20 articles in total. Most of these were case reports, so we had eight case reports, four prospective studies, four retrospective studies, three miniature literature reviews, and one case series. We had some key takeaways from our literature review. The most common takeaway, the most common conclusion was that COVID-19 is correlated with neuromuscular involvement. This was kind of intuitive. We could probably guess that COVID-19 is correlated with neuromuscular involvement based on other papers that were published, other research in the field, but this was kind of the main conclusion that we were seeing, which wasn't super satisfying. There were some that gave us a little more details on how this might play out. A few studies looked at COVID-19, patients with CIM and CIP that had COVID-19 compared to patients that had CIM and CIP that didn't have COVID-19, and the COVID-19 patients seemed to show greater signs of muscle membrane depolarization, increased distal compound muscle action potentials, and more absent F waves. Some studies looked at different cytokines and chemokines to suggest kind of how this is happening, what are the disease processes that are causing this, and so they looked a little more into the different, again, cytokines and chemokines for this. And then a handful of studies looked at comorbidities, so it seemed like, you know, obesity, previous respiratory diseases, diabetes are more closely correlated with COVID-related CIM and CIP, and then treatment options. One study looked at IVIG as a potential treatment option for COVID-related CIM and CIP and suggested looking into this a little bit more as well. And then just looking at raw incidents with COVID and CIM and CIP, some studies said that COVID increases incidents and then other studies said that COVID-19 does not increase incidents, so kind of all over the board in terms of that relationship. The only common theme among all 20 of these studies is that more research is needed, which is kind of the catch-all for all these studies, and so we wanted to do just that and see what we found in our hospital here in Roanoke, Virginia. So we put together an IRB-approved retrospective study looking at our overall hospital and then our IPR unit as well. We have a level one trauma center that services a pretty wide area down in southwest Virginia. And so our retrospective study was divided into two cohorts. We had one cohort that looked for the diagnosis of CIP and CIM before the pandemic, pre-pandemic time, so this was basically all of 2018 and 2019. And then we had another cohort for, I guess, like post-pandemic or during pandemic times from June to June of 2020 to 2022, and we wanted to see what we'd find in terms of maybe COVID potentially impacting our CIP and CIM rates. Again, I will say we got this data output pretty recently, and so we haven't really scrubbed through it all for confounders, for covariates, and so this is pretty—take these results with a little bit of a grain of salt because I don't want to be misleading and sending out information that's not right, but because we got this data, I was excited to at least share what we found so far. So we had 128 patients with the diagnosis of CIP and CIM in the pre-COVID cohort. Of those 128 patients, 26 of them were admitted to our inpatient rehab unit. That was roughly 20% of those patients. And so those 26 patients that had CIM and CIP in our rehab unit was 3.8% of our IPR admissions. We looked at the two years during the pandemic, and we had 81 patients with the diagnosis of CIP and CIM, and of those 81 patients, 29 of them were admitted into our inpatient rehab unit, and those 29 patients made up 3.5%, so very similar to the total number of patients in our rehab unit. So again, it's hard to say, and we're going to have to look through the data a little bit more to make sure these numbers are accurate in what they tell us, but it looks like there isn't a significant increase in incidence of CIM and CIP. Just looking at the pre-COVID cohort and post-COVID cohort, we were thinking that maybe these numbers would like double or triple or quadruple, but it looks like it's relatively stable. But again, take these results with a little bit of a grain of salt. That's all I have for you. That's about my 10-minute mark here. Happy to field any questions. I'll do my best to answer them. I'm by no means an expert in this topic, but these are also emails if you want to send over any questions. Nice job, Martin. Anybody have any questions? Because I have some questions. So your overall hypothesis to start was that there would probably be more CIP or CIM? Yeah, we were thinking that there would be more just based on we've seen COVID impact a lot of or have an impact on a lot of different neuromuscular disorders and some literature suggesting that it increases the incidence of CIM and CIP, but then again, our results kind of showed that there wasn't that profound. Kind of disprove your hypothesis. Yeah, please. Yeah. Did you find any commonalities or anything that actually increased why people would have CIP or CIM? What were your leading causes that weren't necessarily COVID-related, but why they still got this? Could you repeat that? It's a confusing question. Yeah. So you got your numbers. Did you find any commonalities? Did you look at other things or just pure COVID? We will look at other commonalities in the future. For now, we just looked at COVID. So there was nothing else that you were coming down looking at parameters, you're just looking at the one COVID thing in each thing, because it's retrospective, so you're doing chart review. Yeah. And you're just looking at one thing at it, and that's just the one thing you're looking at. You don't happen to eyeball something else and nobody who's reviewing it says, oh, look, there's that thing. Maybe I should go back and look. Sure. And that little thing flares on others. Well, I guess there are other things that we looked at in this data pool, like vitamin D levels, like how long they were on the vent. That's what I'm getting to. So length of time in the ICU, how long they've been on the vent, what oxygen percent they need on the vent, what other comorbidities they may or may not have, smokers, nonsmokers, diabetics, non-diabetics, right? That was a whole thing of COVID, right? Diabetics are worse, people with COPD worse, people who are overweight worse, people over 60 worse, right? So you don't know if they combed all that. We do have the data, but I haven't looked through it yet to be able to say what the data shows. Yeah, I think we for most of these patients, I think the diagnosis was made just on a clinical picture without nerve conduction studies or EMGs being done. And so that's how we kind of included both of these in the study, because I think sometimes a patient might be diagnosed with CIM or CIP or both and not necessarily be correctly diagnosed into one of these buckets. And so some of these patients have a proper diagnosis with a nerve conduction study. Some of them are just based on a clinical picture. And so it's hard to kind of say which diagnosis they hold completely accurately. Any other questions? Fourth year medical student. Good job. Thank you. Okay, next we have Manas Chimblunker, who's gonna talk about neuropathic pain and associated, sorry, is associated with cognitive dysfunction and reduced quality of life in long COVID. All right, well, thank you everyone for being here. Martin, great presentation there. It's gonna be hard to follow that one up, but my name is Manas. I'm a fourth year medical student at Rowan School of Osteopathic Medicine. I did a project at Mount Sinai under the guidance of Dr. Tabachoff and Dr. Petrino. It's titled, Neuropathic Pain is Associated with Cognitive Dysfunction and Reduced Quality of Life in Long COVID. So let's get started. So first, some background. Long COVID is defined as experiencing new, returning or ongoing health problems four or more weeks following the initial COVID-19 infection in the absence of any specific organ damage. So most recent estimates right now have about 65 million people dealing with post-COVID symptoms and over 200 different types of symptoms. This can range from anything with GI systems, cardiopulmonary symptoms, but also pain symptoms. The most common are post-exertional malaise, fatigue, cognitive dysfunction. And the most common peripheral nerve symptoms can be loss of olfactory and gustatory senses, visual damage, and then neuropathic pain. So I'm gonna be focusing on neuropathic pain today. There's been an increase in neuropathic pain in Long COVID and this is presenting as a public health burden. So it's an important subject to talk about. One of the objectives was to identify common symptoms in Long COVID patients. Another objective was to distinguish patients with neuropathic pain from the overall population. And then most importantly, we wanted to determine associations between neuropathic pain and other symptoms in Long COVID to see if there's any relationship. So the methods here, this is a cross-sectional observational study of patients attending the Mount Sinai post-acute COVID clinic. The inclusion criteria was any 18 year olds and older, they had to be diagnosed with Long COVID. There was no exclusion criteria. The patients were surveyed with questions pertaining to their demographics, their clinical characteristics. There was a symptoms checklist as well that went through all their symptoms that they might be going through. And there was also a lot of functional and pain scales. So you might be familiar with some of these, the SLANS scale, which looks at neuropathic pain, the EQVAS, which is looking at generalized health, and then NeuroQOL, which is looking at quality of life. So the SLANS also with the full name is Self-Administered Leads Assessment of Neuropathic Symptoms and Signs. So this is used to identify predominantly if the pain is neuropathic in origin or nociceptive in origin. And the score cutoff that was used was 12. So if it was greater than 12, they're neuropathic, and if it was less than 12, they'd be non-neuropathic. So those are the two groups I was using. The questionnaire asked questions like, do you have pins and needles? Do you have a change in color in the painful area? Do you have, how does the pain come on? Is it intermittent or is it like a sudden burst or is it constant? So things like that to kind of characterize what kind of pain they're dealing with. The EQVAS score is basically zero being the worst health possible, 100 being the best imaginal health, so they would just rate it. And then NeuroQOL was basically looking at different factors. So it was a way to monitor their physical, mental, and social effects in neurological conditions. So looking at the quality of life, basically, in neurological disorders. And then statistical analysis I did was some chi-squares and independent t-tests to see if there was any association between some symptoms. So let's get into the results. First, with demographics, this is just the breakdown. We found that there was 31 people who were dealing with neuropathic pain and 122 in the non-neuropathic pain group, so 153 participants in total. As you can see here in the neuropathic pain group, there's about 26 females and only five males, so that's something to consider. Some of the most common symptoms we have are fatigue, difficulty of concentration, reading, and brain fog, and then headache. So this is based on that symptoms checklist I talked about earlier. So I broke it up based on neuropathic pain and non-neuropathic pain, and they're actually the same exact, most common for both groups here, so no difference. But there was a difference with the neuropathic pain group and cognitive dysfunction as a symptom. So as you can see here, this chi-square shows a p-value of .028, which is less than .05, making this statistically significant, and shows that there is a significant association between neuropathic pain and that brain fog and cognitive dysfunction. There was also a significant association between neuropathic pain and the neural qual, so there was a significant decrease in the neural qual score here, showing that there is a decrease in their quality of life. As you can see, the p-value here was .011 in this t-test. And lastly, in the EQVAS scale, there was also a significant decrease in the overall score here, being .045. So this was just their generalized health, again, zero being the worst, 100 being the best health. So you can see the means here was 59.82 in the non-neuropathic and then went down, and 51.61 in the neuropathic pain. So, looking at all the data, so in my population, there was only about 20% of the participants dealt with neuropathic pain, but there is other studies showing about 34% of patients in the whole general population deal with neuropathic pain, so my study showed a little bit less of prevalence, but that is noteworthy still, because I still had found some significant associations with cognitive dysfunction and the other scales I mentioned before. So, the three most common symptoms in non-neuropathic pain and the neuropathic pain group was fatigue, difficulty with concentration, and headache. So there might be a possible pathophysiology link between these two, and that's something to consider in the future. So the independent t-test showed a significant association between the neuropathic pain group and the other scales, the EQVAS and the NeuroQOL. So this really points to show how neuropathic pain can be really distressing in long COVID individuals. It can affect their activities of daily living, so this needs to be studied further, and I think the pathophysiology behind why long COVID is happening is really unknown right now, for the most part, and that needs to be looked into further, but this is a good way to characterize the disease and this is a good place to start. So, as mentioned before, the chi-scares were also significant for cognitive dysfunction, so is neuropathic pain somehow linked on a molecular basis to cognitive dysfunction? That's something to link into. And in the future, I think there needs to be more studies that I can also do with demographics. So I mentioned before, there are a lot more females in the neuropathic pain group. You know, are females more likely to get neuropathic pain in long COVID? That's something to consider. Maybe is their age have a factor in this? So that's all things we could do in the future. And yeah, so at the end of the day, neuropathic pain group was associated with an increased cognitive dysfunction and reduced quality of life compared to the non-neuropathic pain group. Neuropathic pain and cognitive dysfunction secondary to long COVID may have a similar pathophysiology, and that's something that needs to be looked into further. And the presence of neuropathic pain may negatively impact cognition and quality of life in individuals with long COVID. And yeah, that's all I have for you guys today. Thank you for listening. Thank you, Manis. All right, any questions for young Manis? Yes, ma'am. You get the mic. Are there any... Thank you also for this great presentation. So I know that you said that the pathophysiology is kind of unknown. Are there any like general thoughts or I guess, like, sorry, I can't think of the word. Are there like any possibilities that people are studying for long COVID and pathophysiology? Yeah, I think the preliminary data is, I think it has to do with, from what I've looked at so far, has to do like viral persistence and autoimmunity, I think triggers it as well. So there's also a theory of reactivation of like a latent virus. So all of these things can lead to the auto reactivity of T cells to affect the whole system. Now, when it comes to neuropathic pain specifically, I think I read one study where there was, in mice, they've done a study where they saw basically seven months after the mouse was infected with COVID, they saw like a legal dendrocyte loss and demyelination. So that's something that could be contributing to these symptoms in humans. So yeah, but that's something that needs to be really studied further and to help mitigate the disease and possibly treat in the future, so yeah. So if nobody else has questions, I have questions. You know, I wasn't gonna let you off this easy, right? So total N of affected people, 31. 26 female, five male. Yeah. Age variance. So here are the little things, right? Because you're doing clinical work. This is retrospective looking at it. We're prospectively questionnaire how many months after illness? It was retrospectively, yeah. So this was from chart review? No, sorry, sorry, prospective, yeah. So you prospectively sent out things, questionnaires, the amount of questionnaires you got back was how many percent of what you sent, do you know? I do not recall, yeah. Okay, so you know, these are all things, we don't expect you to know everything as a fourth year, right? We're just picking on you because I can. Okay? We want you to come back and present every year now for the next 50 years though, right? That's what we're trying to get you to do. So if I start picking on you too much, just go like that and I'll stop, okay? I can handle it, I can handle it. Yeah, I won't stop. So I think what we wanna know is, you know, it's a pretty, you know, in the big picture, it's a pretty low end, it's a nice pilot study, it's purely clinical, it's got nothing to do with pathophysiology because you haven't asked any of those questions and you're trying to sit there and go, well, maybe it's because of this, that, and the other thing. And the actuality is you really don't know, right? You know what you sampled from sending out questionnaires to patients and the patients answering. And then you just cobbling that together and you did a really nice job with the stats and stuff. But if you look at the people who have headaches and then persistent problems or neuropathic pain, I'm sorry, neuropathic pain, persistent problems, how much of this is medication induced? Did you look at the differences in medication? Did you look and see who's a smoker, who's diabetic, who's obese, who's older, who's younger? And now you have a very small amount, you have 31 people, right? Right. Those are the things I would wanna know. So it's a good place to start. Right. You can't make anything about bench science on this. You can't say anything. Right. Because you don't know. This is just a purely clinical thing of people's complaints, for lack of a better word, symptoms. Because patients don't complain they have symptoms, right? So I think these are things to think about. As a fourth year, you're kind of thrust into things and you're learning. And it's good, it's a good place to start. And it's something to think about in the future when you do further work, whether it's on this or something else. These are all the little confounders you have to start looking at. Because nothing's pure. And especially if you go into PM&R, everybody we see has multiple problems. I mean, maybe the sports guys, we're a little lucky, we get to see one problem at a time. Any other questions, comments, thoughts? Really good job. Thank you for coming. We appreciate you as a fourth year coming here. Thank you. Thank you for having me. Yes, sir. So Eleanor's going to talk about long COVID and negative impact on self-image and relationship a qualitative study of was that live experiences lived experiences Hi everybody, I'm very orange because originally my poster was orange and I was very excited about that, but now it's green so it's less matching, but nice to meet you all. going. And then it's also with Dr. Roth and Dr. Cherney at Shirley Ryan. So to begin, we've all learned a little bit about long COVID recently, but as of October 2023, 5.3% of people in the U.S., according to the CDC, were experiencing long COVID. Much remains unknown about the complex physical, psychological, and cognitive symptoms of the And our objective was to use a qualitative study to characterize the psychosocial impact that long COVID has on self-image and relationships. This study has several limitations. As you'll see, it's a very small study with selective bias. But what we did was use semi-structured interviews adapted from the McGill illness narratives interview and work rehabilitation questionnaire. Interviews were all conducted, recorded, and then transcribed and iteratively coded and analyzed until theme saturation using In Vivo software by two coders. I was one of them. Lily Lair, who's the resident, was the other coder. And all participants were recruited from a general rehab clinic and by word of mouth in Chicago, Illinois, from November 2021 to March 2022. All participants met WHO criteria for the definition of long COVID and currently or previously engaged in full-time work and employment. Lily's entire study was looking at employment impacts. So all of eight people who were interviewed for long hour and a half sessions were either previously or currently employed because we were also looking at the impact on their work environment. I won't go into the WHO definition of long COVID because we just saw two other presentations on it, too. But all eight participants met the criteria. We had six females and two males, but we abstained from collecting other demographic information, which, again, is a limitation to this project specifically. But we coded and analyzed for many themes, including physical and cognitive symptoms that patients experienced. But for this presentation, I'm focusing on the psychosocial impact of the condition on self-image and relationships as patients reported in their interviews. We found both by the numbers and by themes, three prominent themes, negative psychosocial impacts of long COVID. And so I'll read those out. The first one was shame and embarrassment about long COVID-related mental slowness or delayed recovery time. The second was avoidance of social situations because of difficulty with conversation due to word-finding trouble, memory loss, or brain fog. And the third was fear of not being believed by others regarding symptoms. This is just a quick graphic I had up that would originally have been on my poster that I thought was nice to simplify it. Of the eight people extensively interviewed, in their interviews, five specifically reported negative impacts on self-image. Two did not reference it all during their roughly hour-to-hour-and-a-half-long interviews. And an eighth person actually reported positive impacts on his self-image and relationships in his interview. I'll keep them up there just because I think with the quality of the project like this, it's really helpful to actually see the words. And I'll read a few of them out. Each of these quotes under each of the major themes is from a separate individual. So the first one, shame and embarrassment about long COVID related mental slowness or delayed recovery time. I'll go through a few of the quotes, but everyone wants you to, excuse me, everyone wants you to just get better. Like, why are you not better? Why are you not better? I just felt slow and I felt dumb. I was like, that's pretty much, I felt really slow and dumb. And then, so all this stuff is lost. There is that sort of a persistent doubt feeling. Social situations can be harder or more difficult. I cannot articulate and I start fumbling and I sound kind of for lack of I don't reach out, I, you know, I don't reach out because I sometimes forget what I'm talking about. And then the last one, fear of not being believed by others regarding symptoms. I think this one is very important to talk about, and obviously we're all here to learn more about this condition, but these two quotes, or you feel like you're not being believed, or you feel like you have to, like you're making excuses, and that part is overwhelming. Like even, like with the stuff with work and the short-term disability, I'm just ready to like give up on all of it. It's disingenuous and embarrassing to tell a 50, I don't know how old I am, whose father was 107 years old to say that it's just old age. There's no dimension in my family, and believe the patients when they're telling you that I am not, there's no way I'm back at 100% capacity before COVID. So to summarize, that was just a sample of some of the quotes and longer interviews that we conducted. But our results showed that long COVID can have a burdensome and isolating impact, and that everyone's psychosocial experiences are diverse and unique, and that a multidisciplinary and individualized approach to care is most valuable, most valuable, excuse me, but more than anything, I think I, as a learner, I'm learning more about qualitative research, but I think. Nice job. Nice job. Fourth-year student, right? Third-year student. Wow. Any questions? Oh, good. I don't have to be the mean one. Oh, excellent presentation. Thank you so much. You kind of alluded a little bit to it. With the eight people you had, positive, neutral, and negative, what was the gender split between your participants? Like, it sounded like the one positive was a male versus. It was a male versus a female. And I forgot. So the quotes that were shown were interesting, well done. Were they from the initial visit, the quotes? And how many visits per do we know? Yeah. So they were all, each of the quotes were from the, there was only one long interview. So it was just one hour and a half long interview, no follow up, no therapy in between that we know. No. We didn't look at, some of the patients were having recurring sessions at Charlie Ryan, but some of the patients actually did not need a procedure then. So these patients were inpatients at Northwestern, presumably, or someplace? Some of them were. Some of them either were considering therapy and then didn't do it. Were they hospitalized for the acute COVID? Again, some of them were. But not all of them? Yeah. So, it's well done, you know, 30 years ago you'd come to this meeting and more things were qualitative than quantitative and we used to be a much softer, friendlier society. And now everything's a lot more digitized and we are much more Mark. So Mark Louis Hippolito-Lapuz, going to be wrong on that, evaluation of user experience and acceptability of healthcare workers towards the use of tele-rehabilitation in a tertiary government hospital, a single center cross-sectional study. Thank you very much. So, magandang hapon, or good afternoon in English. Again, I am Dr. Mark H. Lapus, currently a third-year resident from the Philippines, and in behalf of my colleagues, I'll be presenting our research entitled Evaluation of User Experience and Acceptability of Healthcare Workers Towards the Use of Tele-rehabilitation in a Tertiary Government Hospital, a Single-Center Cross-Sectional Study. We all know that COVID-19 is an infectious disease that leads into a pandemic a few years ago. And during this pandemic, face-to-face rehabilitation was limited, especially in our country, the Philippines. This leads to the utilization of tele-rehabilitation to provide care for patients with rehabilitation needs. However, despite of its benefits, there are still barriers to its adoption and utilization. And based on our literature review, user acceptance by the healthcare worker is one of the identified factors as a possible barrier to its implementation. To date, especially in my country, there is still a positive research regarding COVID-19, especially tele-rehab. So this is the, so this is the, what do you call this? This is the, sorry, this is the inspiration in our study. So the study aimed to assess the user experience of tele-rehabilitation using the system usability skill questionnaire and to evaluate the factors influencing the acceptability using the theory of acceptance model. So it is a single-center cross-sectional study done at the Rehabilitation Department of the Veterans Memorial Medical Center from February to March 2022. So all the rehabilitation medicine healthcare workers, including the MDs, the PT, the OT, and the speech therapists were included in this study using the convenience sampling. So questionnaire was given to the participants that includes the patient's demographics, the SUS questionnaire, as well as the TAM questionnaire, and the mean, median, frequency, as well as the percentage were used to present the Likert I-scale items. So as you can see on the graph on your right, a total of 33 participants completed the questionnaire, mostly comprised of the PTs and MDs. So the next table showed the theory of acceptance model questionnaire result, which was used to evaluate the factors influencing the acceptability of tele-rehab. So it is a five-point Likert scale developed by Fred Davis in 1980, and it is comprised of five constructs highlighted on yellow. So the interpretation of the mean of the Likert scale was used to interpret the result. So the responses based on the TAM reflects how the user come to accept and use technology based on their perception of its usefulness and ease of use. So as you can see on the first construct, which is the perceived usefulness, so it is defined as the degree to which a person believes that a particular system enhances its productivity, and the study had a neutral result, and this can be due to the lack of awareness regarding the role and benefits of tele-rehab. And based on several studies, this can be addressed by providing seminars, training, as well as symposia, as suggested by the study of CELERS, that education regarding the purpose as well as the benefit of tele-rehab is one of the possible solution to prepare the healthcare workers for new technology. Also, increasing the knowledge and the perception of the healthcare workers will lead to an increase in tension and actual use of the tele-rehab that will eventually lead to a higher satisfaction of the healthcare workers in using telemedicine. On the second construct, which is the perceived ease of use, the overall mean is also at a neutral level, and as you can see on the individual item, the item that tells that telemedicine helped to get current diagnosis and treatment plans for the patient showed a positive result, while the item that the telemedicine is rigid and not flexible got the lowest mean. This is because most of the rehabilitation healthcare workers are computer literate, and with the growing use of the social media platforms and comfort in using computers and mobile phones, the healthcare workers learn how to operate and conduct telemedicine with ease. So regarding the remaining construct, which is the behavioral intention and the actual use of the tele-rehab, the first two construct, which is the perceived usefulness and the perceived ease of use, had a direct impact on these two construct. The behavioral intention depicts as the intention to either accept or reject a program, and in this study, the respondent has a positive response, which implies that they have a positive attitude to adapt and utilize tele-rehabilitation in their practice. This study also showed that healthcare workers found tele-rehab beneficial in their practice because it enables them to provide care and to be in contact with their patients who seldom come to the hospital, which is beneficial, especially during this time of the pandemic. And for the last construct on this table, which is the provider satisfaction, this determines the user level of satisfaction, and the study showed a positive level of satisfaction regarding telemedicine. So the next two table represents the SUS questionnaire, and the last table is regarding the comparison of the participants' demographics. So in the SUS questionnaire, it is used to assess the user experience in tele-rehab, and it's a 10-item questionnaire with a five-point Likert scale developed by Jay Brook in 1986, and the benchmark for the interpretation was based on the study of Bangor et al. So the results showed that the perceived usability is an acceptable level with a mean SUS score of 59.3. So this implies that tele-rehab in our country is acceptable based on the health worker's perspective. However, there is still some usability problem that needs to be scrutinized and improved. So the item three on this table, which states that the system is easy to use and learn, yielded the highest mean score, while the item 10, which states that a lot of things is needed to be learned, yielded the lowest mean, which demonstrate that the positive perception in the use of tele-rehab. So a positive perception may also reflect the readiness of the healthcare workers to adopt telemedicine in our healthcare system. Lastly, in terms of the demographics, which is the last table on the right, there's no significance difference noted in terms of the participants' characteristics associated with the user experience and acceptability. So in conclusion, the experience and attitude of healthcare workers were positive towards tele-rehabilitation. However, there are still some issues that should be addressed. One is that we should focus including further education and training to increase the perception of the healthcare workers regarding the usefulness of tele-rehab, and to address this problem, and addressing this problem will eventually increase the intention, as well as the actual use of the program that will lead to a higher user satisfaction. Again, this is Dr. Mark Lui-Lapos from the Philippines. Maraming salamat po. Thank you. Nice job, Mark. Thank you for coming all the way from the Philippines. Yeah. We appreciate it. Any questions? I have to start again? Man, you guys are tough. So it looks like a pretty comprehensive study to use the PACS. So you use the PACS system, right? P-A-C-S system? Yes. So in the Philippines, are you guys over the hump like we think we're over the hump with COVID? Sorry? Is COVID like a done thing? Is it finished, completed? Yeah. In the Philippines? We already lifted the restrictions. Okay. So like us, so we think we're done with it. Okay. So you take this information, everybody's pretty happy using the telehealth system. Are you continuing to use it now because of the numbers you generated here? Actually, one of the limitation of this study is the participants. Wherein, initially during the time when I made this study, it is the peak of the pandemic, wherein I only concentrated with the healthcare workers in our institution. So one of the limitation of this study is the small sample size. And one of the recommendations we made in this study is to conduct the research together with the other institution, as well as to further induct the research with the patients. Well, have you guys gone back to your pre-pandemic way of seeing patients or are you staying with the telehealth at this time? Actually, one good thing after the pandemic is we had both. So right now we can do face-to-face rehab. And for the patient who are far and they opted to do tele-rehab, we can also provide tele-rehab for the patient. So is it patient choice or is it physician or therapy choice? It's more on a patient's choice since a majority of our patients are veterans and some of them doesn't have the means to go to the hospital. And it looked like in the pie chart that there was a large percentage doing therapy, which you would think versus the physicians because we don't see the patients nearly as often. Do you think if you looked at the ailment or problem that the patient had and going through therapy at home on telehealth versus coming in and working out in a therapy gym, did you get a sense of any group doing better or worse from telehealth versus coming in in person? Right now we don't have a study yet for that, but based on our experience, I think they still benefit even with the tele-rehab. I'm good at asking the questions nobody else thinks about. So it's, you know, so it's, yeah, because you get involved in the research and you look at the one thing, but there are all these other parameters. And it's great that everybody found this easy to use and was friendly and stuff, but are your outcomes the same? And if you're not getting the appropriate outcomes, it's like a nice telephone call, you know? So the question is how clinically useful is it really? And depending on how the patient does, right? It's all about patient outcome. That's why we have jobs. So, but interesting. Dr. G. In our institution, we made a protocol wherein initially the patient can be evaluated through tele-rehab and eventually after a few PT sessions, we ask the patient to come in our institution even for one session so that we can re-evaluate them if they have an improvement or not. In physical examination and physical rehab. Any other questions for Mark? Thank you so much for coming all this way from the Philippines. Thank you, sir. I appreciate it. I hope you have a good time in New Orleans. Yeah. I look forward to your next presentation. Thank you very much. So we had a fifth speaker and I don't know if the persons here didn't see that they lined anything up. Azadeh? No? Thank you all for coming to today's best of the best of, I guess, the COVID pandemic. This will be the last time that we separate out COVID as a separate thing. It's going to go back into general rehab starting next year. But you all did a really nice job. I'm appreciative of all the medical students and residents presenting. We as an academy really appreciate that because we're retiring basically and we need fresh blood to continue this. We can't keep doing the same thing. So you all have to take over at this point. But thank you so much for doing that and good luck on your boards. You'll do okay. Just keep your head down. And I think after this, I think we're doing PEDS in the next year. Just do that, am I in this? Should I go here? He was sleeping, he was sleeping, he wasn't paying attention.

long COVID

patient care

COVID-19

critical illness myopathy

critical illness polyneuropathy

cognitive dysfunction

quality of life

tele-rehabilitation

healthcare workers