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Health care has progressed heavily and in the past year and a half, telehealth has been a very prominent form of health care because of COVID-19. Telehealth has been beneficial in a way where it truly reduces contact between individuals. This in turn  has helped us get through this pandemic. It has made it convenient for individuals to get treated in the comfort of their own home. While working in a pediatric clinic during the midst of the pandemic, telehealth was the main source of our visits with the kids. This was probably consistent with many practices around the world. As stated before, it has its positives but it also has its negatives. Are we able to give the same quality treatment in person then you would through telehealth?

How reliant can we be on the client to be as compliant as possible? The article states, “the current model implemented as part of the emergency response relies on a patient's ability to discuss their wound and symptoms with the clinician remotely without the use of a clinical liaison, to decrease close contact and movement outside the home.” It's clear to see that things can go south in this situation. There are many aspects into analyzing wounds that can really only be done right with a health care provider such as depth, length, width and measurement of the wound. How confident can patients be to clearly communicate their wound to their healthcare provider? This lack of communication is probably faced by many healthcare providers across the world. At the moment in time, telehealth is  a great supplement to health care but isn’t advanced enough to be a primary source of treating patients.

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Healthcare has come a long way in the past few years with regard to Telehealth. With the advancements in technology, patient to practitioner communication has never been easier. Access to this technology has also become more widely available, making telehealth a viable option for many patients. With the pandemic in 2020, healthcare has had to make a more drastic switch to telehealth than ever before. This comes with its own challenges. As mentioned in the article, when telehealth was tested for efficacy in diabetic foot care, photos and static images had low diagnostic value in both diagnosis and treatment decisions. Due to this, it is thought that such tools should not be used as a stand-alone assessment tool.

So with that said, what do we do regarding patients with chronic wounds who were affected by the stay at home orders put in place due to Covid. According to the article, a guideline

was developed to support clinicians who had to decide where telehealth can be an appropriate substitute for a face-to-face review. But the authors still feel that evaluation of patient outcomes, experience, and staff feedback are required to assess the tool's reliability in determining patient suitability for telehealth. The determination from this article wasn’t to say that telehealth has no place in chronic wound care. With the current development of telehealth and guidelines, we can provide a baseline for ongoing expansion within telehealth and it can prove to be an important tool for wound management in the future.

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Imih Celainne Go

There is no doubt that during these times telehealth has become a significant form of health care delivery. As DPT students, we have heard of medical appointments and physical therapy through telehealth, however one does not hear about wound care through telehealth that often. Healthcare is very hands-on, so the adaptation of healthcare's many fields of study has definitely proven beneficial for many patients who otherwise would not have been prioritized during the pandemic. It also presented a way for the continuum of care can well...continue. Although telehealth sounds amazing and full of benefits, it does have its disadvantage.

The article states that "the current model implemented as part of the emergency response relies on a patient's ability to discuss their wound and symptoms with the clinician remotely without the use of a clinical liaison, to decrease close contact and movement outside the home." In healthcare, communication is essential for proper patient-centered care. In telehealth, patients may feel less comfortable talking through a screen and be less inclined to give information. Also, not only that, non-verbal communication may be harder to read. It is hard to ensure that the patient will be honest and will be able to properly and effectively communicate their concern. This is a unique challenge to telehealth when examining the wound's characteristics, but taking a patient history and noting their experience may be easier to receive given the proper questions.

In the Touro College Integumentary course, one can see that wounds can affect a patient's body, life, and functional abilities, so it is imperative that they be taken care of. Wound care and the necessary examinations are very important and extensive. Measurements of the wound, drainage (or lack thereof), and even odors can tell a DPT the needed information to determine what kind of wound it is and what steps need to be taken. In the article, photographs and videos were said to be insufficient to "provide accurate evaluation, and requires confidence in a patient's ability to articulate their symptoms." With the differing specs for technology and different levels of access to technology, it can leave an information gap that must be filled in.

With regards to technology, the article brought about a good point that not everyone has the technological literacy and equipment needed for telehealth services. This problem brings forth a new category for a vulnerable population.

Aside from communication and technology, another factor to consider is the skill needed for healthcare. Patients can learn many skills, but some skills such as sharp debridement require training and knowledge. So it is up to the DPT (or other healthcare providers) to give good visual and auditory instructions to help the patient. It is also up to these professionals to get creative. For example, how to create an environment for a clean technique or how to dress wounds with easily accessible materials.

Telehealth opens doors and creates greater levels of access to healthcare. However, it is also the responsibility of companies and healthcare providers (some may even say the government), to educate the population in order to ensure quality healthcare that will be more beneficial than not.

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Imih Celainne Go

There is no doubt that during these times telehealth has become a significant form of health care delivery. As DPT students, we have heard of medical appointments and physical therapy through telehealth, however one does not hear about wound care through telehealth that often. Healthcare is very hands-on, so the adaptation of healthcare's many fields of study has definitely proven beneficial for many patients who otherwise would not have been prioritized during the pandemic. It also presented a way for the continuum of care can well...continue. Although telehealth sounds amazing and full of benefits, it does have its disadvantage.

The article states that "the current model implemented as part of the emergency response relies on a patient's ability to discuss their wound and symptoms with the clinician remotely without the use of a clinical liaison, to decrease close contact and movement outside the home." In healthcare, communication is essential for proper patient-centered care. In telehealth, patients may feel less comfortable talking through a screen and be less inclined to give information. Also, not only that, non-verbal communication may be harder to read. It is hard to ensure that the patient will be honest and will be able to properly and effectively communicate their concern. This is a unique challenge to telehealth when examining the wound's characteristics, but taking a patient history and noting their experience may be easier to receive given the proper questions.

In the Touro College Integumentary course, one can see that wounds can affect a patient's body, life, and functional abilities, so it is imperative that they be taken care of. Wound care and the necessary examinations are very important and extensive. Measurements of the wound, drainage (or lack thereof), and even odors can tell a DPT the needed information to determine what kind of wound it is and what steps need to be taken. In the article, photographs and videos were said to be insufficient to "provide accurate evaluation, and requires confidence in a patient's ability to articulate their symptoms." With the differing specs for technology and different levels of access to technology, it can leave an information gap that must be filled in.

With regards to technology, the article brought about a good point that not everyone has the technological literacy and equipment needed for telehealth services. This problem brings forth a new category for a vulnerable population.

Aside from communication and technology, another factor to consider is the skill needed for healthcare. Patients can learn many skills, but some skills such as sharp debridement require training and knowledge. So it is up to the DPT (or other healthcare providers) to give good visual and auditory instructions to help the patient. It is also up to these professionals to get creative. For example, how to create an environment for a clean technique or how to dress wounds with easily accessible materials.

Telehealth opens doors and creates greater levels of access to healthcare. However, it is also the responsibility of companies and healthcare providers (some may even say the government), to educate the population in order to ensure quality healthcare that will be more beneficial than not.

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Josh Keitz

The idea behind telehealth medicine is that you minimize exposure and patients are allowed to have therapy in the comfort of their own home. The idea is that it is safer for the patient and PT during the pandemic, and beyond. As this article alludes to, you are jeopardizing the health of the patient by doing this. When taking into consideration wound care, it is critical the therapist come in direct contact with the wound. This starts directly at the objective part of the exam. A picture can only show you so much. For example if a wound has hypergranulating tissue, this might be hard to appreciate over zoom. During the assessment part, it is critical to know the depth, length, width and overall measurement of the wound. You need this information to determine if things are getting worse, or healing properly. As the evidence shows, this cannot be done virtually. What also can’t be done virtually is any hands on treatment the therapist finds necessary. Right now telehealth is not advanced enough to provide proper care for chronic wound patients.

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With the COVID-19 virus, decreasing the amount of contact between individuals was vital to minimize the spread of the disease. Because of this, telehealth became widely popular among health care professions to provide treatment and care of patients while maintaining the safety of the staff. However, practices where direct care is vital for the best care for the patient, telehealth may not have been ideal as demonstrated by this article. In this integument class, I have been placed in a case study group where we only received a picture and basic information about the patient's wound. My group and I quickly learned how difficult it was to assess the wound with only the picture as we could not assess how deep the wound was or confirm the aspects of the wound. The authors of this article had demonstrated the same challenges and also made valid points on the quality of the patient's description as they may be limited in their articulation of their wound and symptoms. I also appreciated that the authors took into consideration about the psychological aspect of the patient's involvement in their wound assessment and care. Due to their stress and potential depression and anxiety from this injury, they not only might have difficulty describing their wound but completing the wound care themselves which, as the authors stated, will delay their recovery time. I do believe that telehealth is a great new way to implement care to patients, but it may not be the best approach for wound care. Ultimately, the article concludes that there is not enough validity and reliability in regards to the use of telehealth and/or pictures to assess and treat chronic wounds without the proper telehealth technology and resources. It is vital for wound care patients to have the proper assessment in order to receive the proper care in order to prevent any further complications.
Jasmine Huynh

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Miles Schuss

Despite its existence prior to the onset of the COVID-19 pandemic, telehealth was widely unknown to both the general public as well as healthcare providers. With the sudden crisis caused by the pandemic, the use of telehealth skyrocketed and became crucial for PTs and many other healthcare providers to see and treat their patients. However, not all forms of PT can equally be administered through telehealth. While PTs can demonstrate and supervise their patients completing exercises in a virtual setting, certain forms of PT such as chronic wound care, require a much more hands on approach for treatment and management from trained professionals. Even though PTs and other healthcare providers can educate patients on how to care for their wounds and equip them with necessary supplies to do so, telehealth is not an ideal setting for wound management. Chronic wound care needs hands on treatment and with the pandemic, I feel that extensive measures should be taken to protect both the patient and clinician so that telehealth is not relied upon for this treatment setting.

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The Covid pandemic has changed many of the systems we have in place, especially the healthcare system. The article has brought to our attention the predicament that has placed many patients with wounds care needs. I liked that the study looked into how others have used telehealth to care for this population group. In the reading, you would know that there were not a lot of them. They used three sources, two observation studies, and one literature review, which focused on the successful outcome of telehealth and wound care. This is not surprising, because like the article said, wound care needs to be a hands-on approach. In most interventions with patients, a "physical examination is required in the vast majority of wound and skin assessment." This is what complaints things. They had to teach or guide their patients and care providers to care for their wounds while they are at home. They did find some success and faster healing things. This part was interesting because I did not think this would be the case. It was to my understanding that the more critical patients were given a physical examination. But, the less critical patients were evaluated via telehealth. The data would have been slightly skewed. This is my assumption. Lastly, there were a lot of limitations to the article. Besides them not having most sources, most of the information and sources came from places in Australia. I believe that Australia at the time was not as affected by the pandemic as the rest of the world. So, there could be some bias to the article. I would like to see what they have been doing for wound care for a place like India, Brazil, or the United States. Besides the lack of data, I think that in the future, telehealth can be an option. But for right now, it does not seem like an effective route.

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Rafi Dym

There may not be many upsides to Covid 19, but it has certainly forced us to be creative and reimagine the way humans interact. When it comes to health care the challenges are particularly difficult.
This article explored the current state of wound care via telehealth by studying the literature on this subject. The researchers found that there is little evidence that direct patient-provider telehealth communication can be beneficial for a a patient’s wound.
Wound care by nature is something that requires close up observation by a trained caregiver to be able to diagnose and treat a wound. Factors such as color, depth, and texture are all details about a patient that must be well understood by a practitioner to properly heal a wound. Although today’s technology is certainly advanced, at this point it would be basically impossible for the average person to film their wound well enough for a praticioner to make a sound diagnosis.
I believe that in time it may become possible for a practitioner to properly assess and diagnose a wound remotely, but right now it does not seem feasible.

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The pandemic brought forward an increase in the use of telehealth as a way of providing care when people were unable to attend face to face visits. During the pandemic many health care practices were closed and relied heavily on the use of telehealth. However, as the pandemic dies down practices are opening back up again, and they are looking to see if telehealth should still be utilized.  I believe telehealth has been and can continue to be extremely beneficial in healthcare; however, regarding wound care I believe it is less than ideal.  It is hard to see the benefits in the use of telehealth regarding wound care with it being an extremely hands on process.  When utilizing telehealth, you are relying heavily on the patient’s ability to describe the wound and their symptoms along with trying to assess the wound through video, making the treatment more challenging.  The article discusses that screening should be conducted to determine if individuals are fit to conduct telehealth visits instead of in person, which I agree with completely.  I agree with this idea of screening because of what I mentioned before with relying on the patient’s description.  The article also discusses the presence of a clinical liaison and how if one is not present the patient would need to be educated on how to care for their wound.  This is something that would be extremely difficult to teach a patient in person let alone through a telehealth appointment and can lead to improper care of the wound.  Overall, I believe that that telehealth should be a last resort in regard to wound care.

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During the global pandemic, Telehealth has become the way of the medical world; all appointments that can be done over video were implemented in doing so. Luckily, this hectic transition that the medical field experienced at the start of this unprecedented time is over and normalcy is coming back. This means more wound care patients can be seen more in person in addition to other kinds of patients. However, this article discusses how wound care patients were/are affected over Telehealth. I believe there is a very fine line/gray area of what kind of wound care patients can be or cannot be seen over Telehealth. There are a lot of factors to consider when deciding if the patient can be seen over Telehealth. A wound care patient was required to describe pain, sensation and looks of the wound. With patient with diabetes, this can be impossible to do since they have decreased sensation. Also, trying to see a wound through a video can be very tricky. If no medical liaison was present, the patient was instructed/taught how to care for the wound themselves. Trying to rely instructions to a patient that are particular and difficult can lead to the patient improperly dressing or caring for the wound. Their wounds could also be located in a place that is extremely hard to reach. The article stated that there is a lack of reliability and validity regarding the use of Telehealth in the short amount of time that COVID came about. I agree, and I can not imagine how this was for wound care patients or fields similar to this, where it is hard and ineffective to see patients over Telehealth.

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Gillian Scherer

Telehealth has been a great way to continue to deliver healthcare during this unsure time of a global pandemic. With the pandemic starting to die down, practices are reverting back to in person treatments, but a lot of medical practices are continuing with Telehealth and I do not believe that wound care should be a part of the Telehealth community. According to the article, “Telehealth without the assistance of a clinical liaison at the remote site is not appropriate when a physical examination is necessary for clinical decision making. Telehealth resources need to be expanded for successful use in the future”. This conclusion was made based off a rapid literature review from the available literature regarding dividend of the current Telehealth wound care community. In the future, I believe that telehealth wound care could be a great development for those who struggle to leave the house, those who are at a higher risk of infection and those who have anxiety and/or are embarrassed to leave their homes with their wounds. Many improvements need to be made, maybe even implement in person evaluations and virtual treatments and follow ups. This would require a huge amount of patient education and its puts a lot of responsibility in the patients care and leaves a lot up to chance. If telehealth was to be implemented for wound care, many improvements need to be made and much more research needs to be done to find the most effective ways to provide effective care.

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The article reviews how telehealth has existed prior to the COVID-19 pandemic but was not widely used as it is now. Although it has come to the forefront of treatment today, it still stands to see some improvement and fine-tuning. As far as wound care, telehealth is being debated because it requires a “clinical liaison” to be present when performing a physical examination which makes sense because wound care is not something that can be handled by just anybody. If there is necessity for a clinical liaison at the remote site, the usefulness of telehealth has already decreased in that it requires interaction with a human being already. Unless the patient is unable to travel to a clinic or hospital for care, telehealth would not provide the resources needed for adequate care. I think, along with everybody, the biggest question I had was asking how a hands-on profession could be provided through a computer screen. It seems that some places have been able to implement it and have had a fine time transitioning through the pandemic into telehealth services, however it doesn’t seem like a long-term solution for something such as wound care. It seems that the best way to provide the wound care through telehealth is to have somebody there to provide it, but at that point they may as well participate in home-health instead of telehealth through a physical therapy clinic.

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Telehealth has seen a massive increase in use during the pandemic, which has allowed more widespread access for those with limited ability to travel and for those whose regular clinics were closed. Some areas of healthcare can be better adapted to that format than others. Wound care is one area that doesn’t translate as well to a remote format. Some people, especially the elderly, might have technological barriers that prevent telehealth from being as effective as it can be, or possibly impaired mentation. Still images were found to be of little diagnostic use, and video images might not be as clear as needed for an accurate assessment. In addition, factors like odor, skin temperature, and bacterial profile cannot be assessed over video calls. Telehealth also requires the patient to do the hands-on wound care themselves if they do not have another person to help them. Depending on where the wound is located, it can be harder for them to reach the wound in order to properly perform the wound care. In addition, procedures like debridement might be difficult for a patient to do on themselves, as it could be painful and/or unpleasant for them, which would make them reluctant to do it and perhaps not be as thorough as needed as a result. A patient may also not have the proper supplies on hand.

A benefit of telehealth is lowered stress levels from not having to travel, especially if the patient is already anxious about the pandemic or logistics that come with traveling to a clinic. It also provides access to care that a patient might not otherwise have, as well as interpersonal interaction they might otherwise be lacking, which can lower stress and depression levels. While telehealth might not be optimal in the case of wound care, it can have its merits if the alternative is no care at all. However, when possible, wound care should optimally be done in person.

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Telehealth for chronic wound care response

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Telehealth for chronic wound care response

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I think that using telehealth for chronic wound care has its place in our medical system in the future to be used as needed. Prior to reading this article, I feel like I had a decent understanding of what the results were going to be. And for the most part, I was right. I think one of the first things that everyone thought of just by looking at the title of this article was, "How is it possible to provide a treatment that is so hands-on in the clinic over the computer and have everything be safe and effective?" I was surprised to find out that in 2006 a hospital in Australia started implementing telehealth services for wound care. And it makes sense that the organizations that had protocols prior to Covid had an easier time during the pandemic compared to those who needed to make it up during the pandemic. I think that using telehealth in the future for follow-up treatments and patient education on how they themselves can take care and dress their own wounds is a great idea. However, I really don't see a way that patients can get top-of-the-line treatment when their initial assessment is over the phone.

All in all, at the end of the day it is better to have telehealthcare compared to not having any care at all. The pandemic was a scary time and I'm sure there are people that were glad to get some kind of help with their wound care even if that help was riddled with difficulties.

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Telehealth was commonly used throughout the heart of the pandemic and is still implemented today. Like the article stated, many health care professionals closed their outpatient offices for a time being and only saw patients through telehealth, to reduce the patient's and employee's risk of infection. After reading this article, I felt that chronic wound care should not be one of the professions to see their patients via telehealth. Although telehealth for wound care decreased the amount of hospitalizations, there are many negatives to it. These sessions rely heavily on the patient's ability to describe the wound and explain the sensation and pain they are experiencing. This can be very challenging for a patient to do and make the job more challenging for the clinician. The article also stated that if the patient did not have a medical liaison, the wound care is to be performed by themselves or a family member/caregiver. I feel that this could lead improper wound care and wound healing, since sometimes wound care can be painful, the person performing it may be apprehensive to do it correctly and cause pain.

Lastly, this article mentioned that 30% of patients with chronic wounds are also diagnosed with depression. Due to the lack of social communication during the pandemic, I assume the number of chronic wound patients with depression increased. I am interested to know if the telehealth visits created a better or worse experience for these patients, if they felt safer staying indoors, or if they felt their care was now inhibited due to the lack of face-to-face interactions with their doctors.

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Before COVID-19, telehealth, although heard of, was not widely considered in the field of medicine. Once the pandemic hit and the lockdown was enforced we were left with the question of what to do when it came to seeking medicine attention. Many were told to stay home and only attend appointments if it was absolutely necessary. Others were too afraid to leave their house or go to a hospital even if it was necessary. Telehealth helped this problem tremendously making it easier for people to stay in the safety of their homes while still receiving medical treatment. This article however, dove into the idea of telehelath for wound care. It explored the benefits along with certain limitations that can arise. I agree with what the article said about how it is important to screen individuals first to see if they are a fit for telehealth, and if a patient is receiving an initial evaluation telehealth may be too challenging as they should come to the evaluation in person. Other limitations include a patients comfortably with technology and the knowledge to properly operate a computer. The article explains how most patients in the studies looked at were over the age of 60 and lacked the technological literacy. There is also the issue of not being able get the same face to face assessment to evaluate mood, self care, mobility, as well as having to trust the patient to explain and asses their aliments verbally. Furthermore, telehealth lacks the physical hands on experience that wound care typically needs and patients can lack the proper tools and resources needed to take care of their wound on their own. When screened correctly, telehealth can be a great tool for certain patients who are suited for this type of communication and who don’t need the hands on care of a physician. Also, it does have the benefit of keeping the patient safe while keeping stress levels down in a time where people are mandated to stay home because of a virus. I believe there is more research to be done with telehelth and more studies to be executed since this is the first time we are experiencing a global pandemic while trying to deal with it as best we can.

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Prior to the pandemic, Telehealth for healthcare was practically unheard of. Then when the pandemic hit and "stay at home" orders were mandated, we turned to Telehealth as a primary way of treating in many areas of healthcare. While Telehealth has become a great asset in many different ways, I do believe it is hard to implement in wound care therapy even after reading the article. One of the primary reasons I feel this way is because of the importance of ensuring proper healing of wounds. Infection and other complications can cause serious, and life threatening side effects for patients, and is something that makes virtual wound care hard. Part of ensuring these complications do not occur is proper techniques of debridement and dressings, which could also be  complicated for patients.

However, the article did mention one of benefits of Telehealth for wound care could be keeping patients stress free in times such as a pandemic. Patients not having to go into a medical facility for wounds, and therefore not have to expose themselves to COVID is a benefit that is seen from Telehealth. As we know, maintaining stress levels for patients is crucial to ensure proper healing. Even with this benefit, I do think that wound care done virtually is something that leaves a lot of room for error to occur. Although Telehealth has had its space in physical therapy, I still think that wound care is something that needs to be primarily done in person.

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This article describes the complexity of Telehealth as it applies to the world of wound care. It discusses all the benefits that came along with it, especially during a pandemic, and also explores some limitations as well. Since the Covid pandemic, I believe Telehealth is one of the greatest innovations in that it has given health care providers the capability to continue giving care to patients during a time where seeing them face-to-face was simply not an option. It allowed us to educate and manage our patients wounds while also being cost effective, convenient, and not having to worry about spread of infection. The article states that this method of care has “had a positive impact on wound healing, including reduction in healing time and positive consumer feedback.” Even though wound care through Telehealth has been seen to be successful at times, there are many limitations that go along with it. First, it is harder for the PT to treat the patient as a whole and possibly find other lesions that may have gone unnoticed by the patient. Second, examining a wound over the phone does not always look the same as seeing it in person, lighting and camera quality can really throw off the severity of a wound. And finally, PT-client interactions are not always the same over the phone and certain nonverbal cues often go unnoticed. Briefly, I believe that Telehealth absolutely has a place in Physical Therapy and specifically wound care, often times a better quality of care will be seen when both individuals are physically present and actively engaged, but it recent situations, Telehealth has given us the ability to extend care at a time where it otherwise would of been impossible.

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Telehealth for Care of Chronic Wounds during the Coronavirus pandemic

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Telehealth for Care of Chronic Wounds during the Coronavirus pandemic

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Megha Amin

Although telehealth has become increasingly popular during the COVID19 pandemic, I don't think it is appropriate for chronic wound care. The article states that telehealth had a positive impact on wound healing. However, it also states that telehealth should not be used when a physical examination of the wound and patient is needed. In my opinion, chronic wounds should always be monitored by a healthcare professional rather than relying on what the patient says about the wound. The article also states that pictures and videos are not enough to make an accurate clinical diagnoses which further invalidates the use of telehealth with chronic wound patients. Lastly, the article expresses that a reliable telehealth visit requires the patient to be familiar and comfortable with technology. Since many patients being treated for chronic wounds are over 60, they most likely lack the knowledge and familiarity needed for a productive telehealth appointment.
The article says that these reasons shouldn't discount telehealth for chronic wound care completely but I believe it should. The benefits of wound care in person outweigh the costs.

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I believe telehealth is one of the greatest innovation to healthcare. Telehealth is efficient for both the patient and the medical professional. I had a doctors appointment earlier this year through telehealth and I thought it was convenient and saved me many hours of traveling and waiting in the doctors office. Telehealth is great for many aspects of health care overall and should be utilized as a tool by the patient and healthcare professionals.

I think telehealth can be used for certain aspects of wound care. Most notably, if the patient is on the right course towards a healing wound and does not have to perform any complicated procedures such as debridement. The article stated that some patients may have to perform their own wound care and receive minimal help from their care givers and family. I think this is where most people would have a problem with telehealth. If the healthcare provider does not feel comfortable with the patient performing certain self wound care task, this is the point where telehealth would not be  appropriate.

The article states the evidence does point towards a positive impact for wound care and consumer feedback but ultimately, the clinician needs to be the one to recognize when telehealth works and when the patient should be in person.

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Ever since the Covid pandemic the world of telehealth has become bigger than ever before. There are so many positives that have come from telehealth but can only be effective for certain aspects of health. For wound care I feel as if telehealth should not be a utilized unless absolutely necessary. If someone with a wound has tested positive for covid or has a reason to isolate then telehealth is appropriate. If able to see a physician then the in person health care should be prioritize.

As the article states physical examination is required in majority of wound care so telehealth is not possible for physical examinations. The article also states that patients will have to perform their own wound care which can lead to a lot of errors. I would not feel comfortable giving verbal instructions to a patient on how to proper treat and close their wound. They could have a nurse with them but I would still feel more comfortable being able to treat my patient myself since it is my responsibility to treat them properly. There are appropriate areas of health that is proper for telehealth but I feel wound care is not one.

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Telehealth is a very important service utilized by doctors, Physical therapists and more. It is amazing that nowadays we can obtain competent medical advice from the comfort of our couch at home. In the last year and a half   Telehealth use has risen exponentially due to the coronavirus. It allows people to receive proper medical care without risk of infecting others with this awful virus.
Before reading this article it seemed obvious that for the case of wound healing that it may be tough, to receive proper care via Telehealth. Wounds are very serious and as we have learned in our class on the integumentary system there are man issues that may arise, causing tissue death and possible amputation. It is clear that in-person cleaning and bandaging is essential in healing wounds as patients may not adhere to the strict guidelines in order for proper healing.

The article discussed this issue in depth, mentioning that in todays world we have to think about the risk of spreading Covid vs. the risk of improper wound healing via Telehealth. I believe that due to the possible risks such as tissue death and other medical concerns, Telehealth may not be the answer for patients dealing with chronic wounds. Especially due to the fact that there would be limited use of in-person nurses and GPs to help educate the patients on proper wound healing at home.
Other interesting factors mentioned in the article were old age, possible depression, and anxiety as possible factors for patients with chronic wounds. If we are able to mask up and keep as far away from others as possible, in person visiting may be the only option, and in my opinion is worth the risk for patients seeking medical care for wound healing.

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Over the past year, Telehealth has become instrumental in the way that medical care is provided to patients. However, I always imagined that wound care patients would have to find a way for an in person visit to be treated. Being treated over a camera sometimes leads to low quality images of wounds and poor internet service will disrupt the meeting entirely. I know just from being in school on zoom how frustrating and difficult it is when the wifi starts acting up and there is nothing you can do about it. Additionally trying to teach a patient, family member, or home health aid to perform wound care tasks can be very stressful. I will say that I did not take into account that Telehealth visits prevent patients from coming into contact with potential diseases and bacteria. I believe that Telehealth is a very important tool in medical care and hopefully advancements can be made to allow it to be successful in all field of care.

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Neema Fotoohi

When I first saw the title I thought to myself isn't obvious that it'd be difficult to administer wound care via telehealth since there's a lot of complications and intricacies involved? That being said, given how COVID and the lockdowns change the way healthcare was administered and thought of in the past year and a half, we do have to consider all aspects of patients in need regardless of what pathology is involved.

Just from the challenges that physical therapists in an outpatient setting had to deal with when everything shifted to telehealth, we can only imagine how daunting/difficult it can be if the case is more complex or more involved.

And this includes wound care. That's not to say wound care management and telehealth cannot be done in the future, but maybe it's more with a home care giver or there's an adjunct that is able to perform the skills necessary under the guise of a physician or PT.

The article mentions implementing the infrastructure and staff training and I'd be curious to know what this will entail in the future.

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Danielle Flugman

I found the article in question to be very eye-opening as I had never thought of the impact COVID-19 would have had on wound-care patients. Now knowing all the procedures and clinical intervention that is necessary in some cases, I cannot even begin to imagine how medical professionals had to adapt when treating these patients. The practices in wound care often involve dressing changes, applying medications, and even debridement multiple times a week at minimum. The idea of attempting to guide a family member or a nurse through these interventions over the phone seems like it would be overwhelming at the very least. I agree that having an experienced medical professional take the place of an inexperienced family member or nurse would be very beneficial and much safer.

As for utilizing telehealth in the future, I feel that in certain situations, it could be a very helpful tool. For example, using telehealth could reassure a patient that they are in fact caring for their wound properly after being sent home from the clinic/hospital. However, I believe that using telehealth with patients who are still in the acute stages of healing could be potentially dangerous. Experiencing a wound in-person is much different than over the phone and most likely gives more insight into a patient’s overall condition.

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Robert Worden

Due to the pandemic the healthcare field has been forced adjust and make changes to maintain the care of patients along with the safety of our health care workers. After reading the article I believe there could be many benefits to the practice of Telehealth, although treating chronic wounds is something that must be observed hands on in person. It is important to accurately take measurements, observe coloration and drainage, as well as assess scarring for wounds in person rather than through a picture. The use of pictures is something of a challenge as it would be difficult to accurately assess these wounds without missing a crucial sight. In conclusion I believe in the aspects of wound care it’d be very challenging, but telehealth overall can be of use for other needs of care. With the world we live in today I am confident that we will find a way to benefit from telehealth by figuring out ways to make it more reliable. The field of medicine is constantly changing therefore we must be ready to change and develop as much as possible.

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Having had the opportunity to observe some Telehealth appointments myself, I had some doubts with regards to its effectiveness regarding wound care prior to reading this article. Having mostly finished the wound care section of this class now, I uphold these doubts. Furthermore, now having read this article, my thoughts haven't changed much. While I am expecting Telehealth to become more common going forward due to its accessibility, I think for wound care specifically it is a tall task. With wounds, the ability to use all your senses as a provider is so important, and through Telehealth you are completely reliant on the quality of the technology of the patient and their ability to accurately describe what they are seeing, feeling, smelling, etc. Additionally, a greater stress is placed upon both patient and provider when it comes to instruction of wound care, as it is up to the provider to be able to convey accurate directions for taking care of the wound and for the patient to be able to understand and apply what they've just been told. These are just a few issues I see within the scope of wound care in the Telehealth setting, but it's enough for me to have a difficult time seeing this as a primary way of wound care treatment. However, seeing how things are going with the pandemic, there are ways such as making quality webcams easily available and making provider websites easy to navigate that would create a better starting point for Telehealth patients.

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Reflecting on how healthcare has changed in the past two years, it is daunting to think about the evolution we have witnessed/experienced firsthand. This shift, however,  draws criticism over the quality of care one can expect.  The article addresses these concerns in contrasting the benefits and limitations of telehealth — questioning its efficacy in the ability to pose a positive impact in treating, diagnosing, and healing patients. Some of the benefits included: convenience, prevention of exposure to COVID-19, cost effectiveness, and speed/delivery of healthcare accessibility. Some of the limitations included: inability to gauge extent of injury, communication between patient and clinician, and lack of technological literacy of patients. While the study writes: “All of the studies found the use of telehealth had a positive impact on wound healing, including reduction in healing time and positive consumer feedback” it is important to also highlight the “Evidence on the use of telehealth in wound care delivery is sparse.” Showing promising results—yet with a limited sample size. As the shift towards more virtual-based healthcare becomes more commonplace, we can better assess the efficacy of telehealth in years to come. At this very moment, however, I personally believe that telehealth is a fantastic tool in the healthcare experience, however, should not be the the first and only option. As the article mentions, “Face-to-face contact is also beneficial in gathering information about mood, self-care, mobility, social/familial support, sensory deficits (hearing/vision loss), and the patient's ability to communicate and follow instructions. These elements encapsulate a holistic assessment of patients presenting to the CWS, and enables clinicians to create a suitable management plan that may include pathology/imaging, referral to other disciplines, e.g. social work and/or dietetics, and takes into account the patient's health literacy and capability to complete their own wound care or access services if necessary.” It is important to recognize that healthcare does not solely exist in a vacuum. While the idea of telehealth, in theory, should be a quicker and easier pipeline between patient and clinician, there are far more variables that come in to play for diagnosis, treatment, and referrals.

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Due to COVID-19 the use of telehealth in the healthcare field has grown exponentially.  During the last two years telehealth has allowed patients to meet with healthcare workers remotely to reduce the spread of COVID-19 and keep themselves and their loves one safe.  Telehealth has allowed patients to meet with various healthcare professionals remotely and allowed for continued care, monitoring of diagnosis, and treatment plans to be carried out.  While there are many benefits to telehealth especially during these times, there area also many shortcomings.  The aspect of wound care using Telehealth seems to have many limiting factors which were listed throughout the study.  The attempted use of static imaging was deemed to have low diagnostic value, and the study also states "Face-to-face contact is also beneficial in gathering information about mood, self-care, mobility, social/familial support, sensory deficits (hearing/vision loss), and the patient's ability to communicate and follow instructions".  Assessment of wounds requires many aspects that seem unrealistic to perform through a telehealth service.  Crucial information such as depth of wound, skin temperature, moisture/exudate and smell would be missing from a telehealth consultation.  Also treatment would be carried  out by the patient who may be limited in the knowledge and skills needed to properly care for their wound.  I believe in the case of wound care Telehealth has too many shortcomings to be a viable option at this time.  Telehealth provided a great way to meet with patients during the height of COVID-19 and still to this day and will still be an amazing tool to use in many healthcare fields including Physical Therapy.  Continued improvements, research, and training will be needed to help make Telehealth reach its full potential.

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Initially, I thought Telehealth was a great innovation that would continue being useful for both healthcare professionals and patients. I have observed a physical therapist who used Telehealth for some of his patients who were unable to visit his clinic during the pandemic and saw potential with this option. However, this article challenged my perspective of Telehealth and makes me wonder how beneficial it will truly be for patients in the future. It highlights the limitations of Telehealth in wound assessment such as the conclusion that static images have low diagnostic value in both diagnosis and treatment decisions and the possible lack of quality in gathering information about the person’s well-being. This article helped me conclude that it is risky to utilize Telehealth for patients with chronic wound symptoms. However, I think it is valid to offer or consider Telehealth to other types of patients depending on how appropriate it is for that individual. I believe in person interaction between the physical therapist and patient is optimal for the patient recovery. It is the physical therapist duty to make sure the patient is getting better, but they also have the responsibility to ensure that the patient is comfortable with the process. By offering Telehealth to patients with good reason to use this type of service, besides the population with chronic wound symptoms, I believe the healthcare system have the opportunity to better learn how to provide for others.

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Due to the COVID-19 pandemic, telehealth services are giving chronic wound patients another way to see a doctor, through a virtual interface. The article dives into the question, whether or not telehealth can appropriately assess and deliver quality care to chronic wound patients. The literature review uses studies that found telehealth having a positive impact while also discussing challenges and barriers that many face. I like how telehealth can be an alternative way of delivering care, but I do not see how it can be a primary way of treatment, especially in wound care. Wound care in itself, requires specialized treatment and in certain situations can lead to infections, pain and bleeding episodes. With that being said, telehealth treatment can be possible as long as another healthcare provider is present (wound care nurse) and for the patient to be effectively communicating their symptoms with their clinician. Also understanding that, the patients of this population group aren’t as capable of properly utilizing technology which can negatively affect treatment. Overall, the article was an interesting read and I hope that telehealth, in regards to wound care patients, can continue to be used as a fall back rather than being the primary treatment option.

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The article was a fascinating look at how the medical field has had to adapt in the age of COVID19. The focus of the article was an exploration of the feasibility of using video calling as a medium for treating complex wounds. The article concluded that it was not possible to have clinically accurate information without the presence of a healthcare professional at the patients location during the consultation.
I believe that home heath PTs are uniquely qualified to fill this role. Throughout the pandemic home health PTs continued to visit their patients. Even if they were not experienced in wound care they could always liaise over video with PTs who were and they would have the knowledge to be able to assess and treat the patient according to the recommendations of the PT who was consulting via video.
As an Australian I am aware that the healthcare system is very different from America’s. It would interesting to note how it would be set up to ensure that the home care PT and the wound care PT would take the same insurance or be part of the same healthcare system.

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These past two years we have shifted into more of a digital world due to the COVID-19 pandemic. From education to healthcare systems everyone has had to adapt to this new world. This article did very well in highlighting one sector in healthcare as it explores the options between face to face consultations and care or telehealth to administer care. As soon as I saw that the topic or focus of the article was wound care I immediately thought of the difficulties of trying to provide a good quality of care to a patient suffering from a wound. The article mentioned many limiting factors but the one that stood out to me was not being able to be hands on with the patient. Without this we would not be able to properly assess the wounds condition in terms of skin temperature, the depth of the wound, if wound has an odor to it that the patient has missed and how much exudate is actually coming out of the wound. On top of this the population that will be most likely treated would be 60 or over. The odds that this population will have the capability of correctly using technology without any assistance is low and this would only make it more difficult for the patient to receive adequate care. In certain healthcare environments telehealth will be integrated and used widely but more research as to when in the patients rehabilitation and what kind of care they are receiving should determine how it should be used.

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Telehealth has become such a huge component to healthcare as a result of the Covid-19 pandemic. The article delves into the use of telehealth in wound care and its suitability when treating complex wounds. Upon reading the article, I was interested to learn that the rapid literature review revealed that the use of telehealth had a positive impact on wound healing. While the advantages of telehealth are clearly evident, I am unsure as to if it is something that can truly replace the traditional face-to-face contact form of care. Something that stuck out to me from the article was when it spoke of how face-to-face contact is beneficial in gathering information about one's mood, self-care, mobility, and sensory deficits. These pieces of information may be very difficult to obtain through a screen, however, are very important to have in order to properly assess patients so that they can receive the best form of care. Assessment of the wound itself over telehealth also comes with limitations as the camera or pictures may not be of the best quality to properly depict the state of the wound. However, this is not to say that there is no place for telehealth and that advancements cannot be made. As telehealth continues to grow, I am very interested to see its continual development and if it will advance into something even greater.

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During the past year we have seen how these unprecedented times have led to advancements in bringing healthcare from outpatient facilities and hospitals into the home. The way this has occurred is through the use of Telehealth appointments. This article discusses the use of Telehealth in the wound care field and how the examination and care of patients comes with both advantages and disadvantages. During the height of the pandemic some facilities had to be closed and using this Telehealth allowed continued care and monitoring of possible patients. With the world returning to a new type of normalcy it will be interesting to see how this remote healthcare program will be used. The article stated that “studies found the use of telehealth had a positive impact on wound healing, including reduction in healing time and positive consumer feedback” which is a great starting point because being able to get this feedback on a new program shows how there is potential in this field. However, I feel that in the physical therapy profession manual therapy hands on therapy is a crucial aspect to the rehab process. I also feel that not every patient is suitable to be a telehealth patient, this is dependent on the patient's degree of injury, medical history, level of understanding of the injury and their ability to use technology. The article also discusses how more research needs to be done about this topic to see if wound care patients benefit from this online treatment. Going forward I believe the use of Telehealth will continue to grow, but I believe it should continue to be used as a tool of the profession and assist in patient communication, not be the first option or only option when it comes to wound care or other injuries.

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Wound assessment and its treatment is very specialized, it requires the use of multiple senses such as sight, smell and touch. Unfortunately, this becomes challenging to do when it has to be performed through a screen, like in telehealth. Certain types of wound or specific scenarios could quality for a telehealth treatment session. However, wounds in late stages require in person treatment in order to receive the appropriate care to facilitate the healing process. The article talked about how in some instances, the patient received a telehealth treatment but there was another provider present with the patient such as the general practitioner or a nurse. In this case, I believe the patient is able to receive the treatment that will allow a speedy recovery with no interruption in the healing process as infection can be prevented or treated.  Even though, the evidence found in the article was very limited, I was surprised there was even literature about the use of telehealth for wound assessment and treatment. Now that a little over a year has passed since the pandemic started, there is probably more literature about the use of telehealth in wound care and I would be interested to learn more about it. 

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Wound assessment and its treatment is very specialized, it requires the use of multiple senses such as sight, smell and touch. Unfortunately, this becomes challenging to do when it has to be performed through a screen, like in telehealth. Certain types of wound or specific scenarios could quality for a telehealth treatment session. However, wounds in late stages require in person treatment in order to receive the appropriate care to facilitate the healing process. The article talked about how in some instances, the patient received a telehealth treatment but there was another provider present with the patient such as the general practitioner or a nurse. In this case, I believe the patient is able to receive the treatment that will allow a speedy recovery with no interruption in the healing process as infection can be prevented or treated.  Even though, the evidence found in the article was very limited, I was surprised there was even literature about the use of telehealth for wound assessment and treatment. Now that a little over a year has passed since the pandemic started, there is probably more literature about the use of telehealth in wound care and I would be interested to learn more about it. 

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This article talked about how a pandemic changed the way healthcare had to be performed. Evaluations and examinations have been strongly dependent on being in person with the patient and it has been difficult to accomplish this due to mandates placed to counter spread of the disease. One thing I really admired about this article is that the main goal was to compromise and rely more on Telehealth to manage patients while preventing them from coming into contact with potential infection. When reading the title of this article, at first I was not entirely in favor of shifting into a more video/phone call type of consultation, but upon reading the benefits that Telehealth can have in tackling this pandemic I have become more in favor. COVID has taken a toll on millions of people and finding alternative ways to ensure patients safety by preventing risks of exposure. Even though there was very little evidence found pertaining to the benefits of Telehealth at the time, I'm curious to research how many more articles there are available now that we are over one year into the pandemic and I have seen Telehealth used more often at the clinic I work at.

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This article compares telehealth with actual person to person physical therapy. I believe that telehealth is an amazing tool for therapists and that it came up very clutch during the trying times of a pandemic. During the heart of the pandemic, we werent allowed to leave our homes unless we really had too. People were afraid to be around others and being able to have sessions with a therapist throughout the hard times was crucial to some peoples health. The pandemic stopped alot of things but the people that absolutely needed musculoskeletal surgeries still got them. If they didnt have access to any therapist post op than they would not heal correctly. Even though telehealth is great under the circumstances we had. It is still no match for actual patient to therapist interaction. Manual therapy is a crucial aspect to the rehab process and telehealth makes it impossible to touch your patients. The therapists ability to evaluate gets diminished in a major way if they dont actually get to see and touch the patient. Alot of PT patients are the older population and they might not know how to work the new technology. All of these things are very big barriers to good care. Telehealth is a great tool if it is absolutely necessary, but it does not compare in the slightest bit to actual patient therapist interation.

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Overall, this article addressed many new, but critical concerns that COVID-19 brought upon wound care patients using Telehealth. Many aspects of this physical therapy field had to be reimagined and the article did a great job of highlighting the positives and the negatives. Above all, I agree with the article that safety, more than ever, should always remain the primary focus for both the patient and the practitioner. Telehealth is beneficial in the way that patients do not have to choose between risking COVID exposure and going to a clinic for physical therapy; it provides a good middle ground option for them. While Telehealth enables wound care patients to be safe and send their physical therapist pictures and instant messages from home, it may not be sufficient enough for all patients as described in the article. For now, it does create a good baseline for Telehealth use and a reference for improvements in the future.                                            I really appreciate the point the article brought up about how critical face to face interactions are in this profession. While PTs can still receive verbal information and talk to their patients through Telehath, it riddles the PT of that integral non-verbal communication that can be so helpful to them. Observing a patient’s mood, mannerisms, and most importantly for wound care, the wound itself, first hand can really help direct the PT’s treatment for that session. These barriers are limiting, but Telehealth is still new to many right now. It is currently laying the framework for new research and more efficient techniques for wound care patients in the years to come. 

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Overall, this article addressed many new, but critical concerns that COVID-19 brought upon wound care patients using Telehealth. Many aspects of this physical therapy field had to be reimagined and the article did a great job of highlighting the positives and the negatives. Above all, I agree with the article that safety, more than ever, should always remain the primary focus for both the patient and the practitioner. Telehealth is beneficial in the way that patients do not have to choose between risking COVID exposure and going to a clinic for physical therapy; it provides a good middle ground option for them. While Telehealth enables wound care patients to be safe and send their physical therapist pictures and instant messages from home, it may not be sufficient enough for all patients as described in the article. For now, it does create a good baseline for Telehealth use and a reference for improvements in the future.                                            I really appreciate the point the article brought up about how critical face to face interactions are in this profession. While PTs can still receive verbal information and talk to their patients through Telehath, it riddles the PT of that integral non-verbal communication that can be so helpful to them. Observing a patient’s mood, mannerisms, and most importantly for wound care, the wound itself, first hand can really help direct the PT’s treatment for that session. These barriers are limiting, but Telehealth is still new to many right now. It is currently laying the framework for new research and more efficient techniques for wound care patients in the years to come. 

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The onset of the Covid-19 pandemic forced the world to change. Shutdown protocols and stay at home orders dictated that all institutions needed to modify their business models to survive. In the health care system, this led to the boom of utilizing Telehealth as integral form of care. Telehealth went from a useful tool utilized by some institutions, to one of the main cogs in providing adequate healthcare to patients desperately in need, but who could not physically go to clinics due to heath concerns. What the study, conducted by Bondini et al, helped shed light on is the pros and cons of using Telehealth as the main tool to deliver care. The authors noted that, depending on the individual, their circumstances, and the diagnosis, telehealth can be used effectively to treat patients. Furthermore, they noted that, telehealth for wound care can and should be utilized, but only after careful assessment of its appropriateness for each individual patient. As they discussed, Telehealth can be employed when a patient is technologically literate and does not need a physical examination to aid in determining a diagnosis, prognosis and a plan of care. Thus, like a multitude of interventions used in health care, telehealth is a tool, one that has grown exponentially due to the pandemic, but nonetheless a tool that can aid in a patient getting the care they need and improving their health outcomes. However, this should only be after careful consideration of that particular patient, and if it will be the most effective way to treating their wound.

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The rapid literature review showed that there was little evidence regarding wound care outcomes via telehealth. In addition, it was stated how necessary it was for a professional to be physically present in order to make a decision concerning the wound. There was also discussion of a hospital in Australia using telehealth where the physician communicates through the device with the nurse who is in person with the patient. In my opinion, telehealth is not optimal for wound managment. I say this because given what we have learned thus far in our integumentary course, wound management is not only complex but a quality focused process. The quality of care is possible however the professional handling the wound management needs to be able to evaluate all aspects in order to continue the quality of care needed. The wounds must heal properly and it seems vital that a person who is trained is physically present with the patient. We have also discussed various odors associated with wounds which is not yet possible with our technology to communicate “smell” even though it can be documented. Furthermore the literature spoke of how the footage by video and or photo was not enough to allow the professional to evaluate accurately. Obviously with Covid-19, telehealth was necessary to prevent further infections but it seems that as soon as it is safe that most if not all wound care should be done in person rather than via telehealth.

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The rapid literature review showed that there was little evidence regarding wound care outcomes via telehealth. In addition, it was stated how necessary it was for a professional to be physically present in order to make a decision concerning the wound. There was also discussion of a hospital in Australia using telehealth where the physician communicates through the device with the nurse who is in person with the patient. In my opinion, telehealth is not optimal for wound managment. I say this because given what we have learned thus far in our integumentary course, wound management is not only complex but a quality focused process. The quality of care is possible however the professional handling the wound management needs to be able to evaluate all aspects in order to continue the quality of care needed. The wounds must heal properly and it seems vital that a person who is trained is physically present with the patient. We have also discussed various odors associated with wounds which is not yet possible with our technology to communicate “smell” even though it can be documented. Furthermore the literature spoke of how the footage by video and or photo was not enough to allow the professional to evaluate accurately. Obviously with Covid-19, telehealth was necessary to prevent further infections but it seems that as soon as it is safe that most if not all wound care should be done in person rather than via telehealth.

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I believe that Telehealth has many benefits but with this comes a lot of challenges as well. Face to face contact is crucial for providing best quality treatment but in unprecedented times like the pandemic, it is important to be able to adapt and keep moving forward. Wound care in itself can be tricky even when seeing the patient in person and more so through a screen. With its many limitations such as not being able to fully observe the wound in person, asses the sensation of the patient, locate pulses in extremities and observe any odors that the wound might produce, it can be difficult to be in support of Telehealth for wound care. As mentioned in the article it is important to choose who is good candidate for Telehealth because if people are still unwilling to leave their house due to risk of infection from Covid-19, some form of intervention is better than no intervention. Telehealth could also be a good way in giving those who have difficult time ambulating because of their wound a chance to be able to get treatment at home. If Telehealth is going to continue being used for wound care I would suggest having a first evaluation in person so that the therapist can have a thorough look at the wound and then have follow-ups through Telehealth for maintenance unless patient is not recovering and therefore would requires another in person evaluation.

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This article describes the complexity of Telehealth for wound care. It speaks on some of the benefits of Telehealth during the COVID-19 pandemic, as well as highlighting the many limitations. An important benefit of Telehealth has been that it allows patients to access care from the safety of their home, which has been invaluable in many areas of healthcare this past year. However, it also highlights some limitations to the Telehealth platform. For example, not all individuals in need of care have access to electronics. Additionally, some may not be proficient in navigating the platform independently, which limits their ability to receive proper care. One of the other limitations mentioned in the article that I found extremely noteworthy was that digital images and videos do not have the same diagnostic benefit as being able to physically see and assess the wound, which poses a major challenge for clinicians to determine an appropriate plan of care. The article says “the consequence of managing one hazard should not introduce an alternative hazard.” I thought this was an extremely important sentiment, emphasizing that healthcare workers should not compromise quality of their patients’ wound care simply in order to work around the COVID-19 guidelines. It is always of paramount importance for clinicians to provide appropriate and safe care to patients, and although there are some patients who are great candidates for Telehealth, not all patients fit that category. Ultimately, I think that as technology continues to advance, quality of electronic healthcare platforms will improve and possibly somewhere down the line we will see an improvement in some of the limitations of Telehealth practices, but ultimately it is important to assess each case individually in order to provide the best care for the patient.

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I believe the implementation of Telehealth in wound care is a very interesting and complex subject for discussion. At first glance, I was very skeptical of its usefulness with this population and thought to myself just how difficult it must be to receive proper healthcare with significant health conditions and injuries such as wounds. However, until I read the article, I was not aware of all the reasons why this is such a complicated process. The study found that telehealth has a limited place in chronic wound management and that standardization to determine suitability of each patient is required in order to solidify the usage of telehealth systems worldwide. I agree with the standpoint taken in this article that more research needs to be done to figure out which wound care patients would benefit from telehealth and which would not. It is significant that the use of telehealth on patients that require face-to-face consultations can have devastating consequences and could potentially cause more harm to the patient than the risk of contracting covid. I believe the usage of telehealth should be highly dependent on the patient, however. Every patient has a different situation, with their own comorbidities and own risks involved. Besides other health risks involved, there are many other limitations that telehealth has when it comes to wound assessment. Communication issues, technological skills and access, usage of photos without physical assessment, and lack of face-to-face psychosocial assessment are just some examples of problems that can lead to inconsistency of treatment of this population. I think there needs to be a significant process in determining effectiveness and safety of telehealth in each individual patient. For example, a patient who has a superficial wound may look as though they were suitable for a telemedicine consultation. A photo of the wound sent to their doctor may be more than enough for them to receive proper and safe treatment. However, this is not always true. This patient may be unknowingly suffering from another underlying condition that presents itself somewhere else on their body. Through a telehealth consultation, because the patient would not be present for a full physical, it would be difficult to catch such underlying conditions. This is just one example of how a seemingly simple diagnosis can turn into a larger issue without proper assessment of qualification for a face-to-face consultation. Depending on the patient and their overall health, the consequences of such a mistake can be more significant than the risk of contracting the virus.

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Alana L- I do not believe that incorporating telehealth into wound management would be the most appropriate use of primary treatment. According to the Australian study, the patient is required to state their signs and symptoms to their clinician over the computer. However, it is possible for the patient to leave out important information that can only be seen in physical form. Perhaps not meaning to leave out information, or feeling embarrassed about their situation. The article even points out that the quality of the video/pictures over the computer is not always clear enough to see the detail of the wound. It is also important to assess the actual feel of the wound along with the smell (sign of serious infection), which can not be done over a camera. Either way I think in person treatment should typically be the way to go, especially in severe wound care management. If a wound is not properly treated overtime it can lead to extremely bad cases, including death. Hopefully there will be further research on this and wounds can be treated in a safe and effective manner.

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Before I read this article I did not believe there would be any benefits for providing wound care treatment via telehealth. So far we have learned that the process of wound care consists of many objective and assessment measures which are done usually in person. This article shows that the wound care clinic in Australia was able to treat their patients effectively while also navigating the Covid-19 pandemic. They highlight that the process has to be inter professional as doctors, nurses, and therapists all have to be involved to provide the best care possible. The biggest challenge I learned about telehealth wound care is the lack of proper technology for the majority of patients. Majority are older then 60 and lack the technological literacy and equipment to undergo telehealth conferencing. Another challenge that presented was the ability for patients to discuss their symptoms and issues to clinicians. It is tough for patients to be honest and expressive of their symptoms through a camera. I know for myself and many others it is tougher to interact virtually then it is in person. It can be awkward and quite daunting at first. This is why I believe telehealth for wound care should be a default option moving forward and should not be encouraged as the primary option. There have been many positive outcomes and success stories in the PT field around telehealth. However, I think it makes the job of a therapist much more difficult as they can have a tougher time observing and assessing a patient. As the article states there should be an ongoing expansion of telehealth care models when there is adequate time and resources.

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Dovid Rosenzweig-  Zoom has definitely engraved itself in everyone's life but can it really takeover everything that used to be in person? I think with any new idea we must weigh the pro's and cons. Specifically in the wound care setting a patient might not have to travel (especially if they are immobile ), wait in a waiting room, risk of spreading or being infected with diseases. Instead, they can sit in the comfort of their own home and talk to the doctor. The cons that the article brought up would be that the doctor can only see the patients body if the camera is showing it. An example might be where a patient has multiple wounds but only tells the doctor of one. The article also brought up digital pictures of wounds cannot be compared to the direct trained eye of a physician. Telehealth is also harder to notice symptoms that may be easier in person. I like how the article points out that there is no official rule and every patient should asses what their own pro's and con's are of in person or Telehealth.

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Jolie Widawsky: A major takeaway I found from the reading was regarding the importance of face-to-face treatment in gathering information on patients. Face-to-face contact provides more than just the best quality viewing of a wound. Information such as a patient’s mood, the patient’s abilities to take care of themselves, mobility, communication, and abilities to follow instructions are all critical parts in health management. As we know, different patients need different levels of care, explanations, instructions, and follow up accountability and validations. Tele-health provides opportunities for some individuals to be seen, who may not be able to make a trip into a healthcare providers office and may provide eases for individuals to be seen who may not normally be willing to seek care in person. For patients who cannot negotiate public transportation or do not have a ride to appointments, telehealth in some cases could be lifesaving and extremely positive. Alternatively, folks who endure or suffer from anxiety and depression, may need the accountability of in-person healthcare appointments. Wound healing physical changes are correlated with anxiety and depression. The patterns of both of these psychological conditions encourage patients to avoid care and help, and the pressure of having an appointment out of the home may be socially beneficially. Getting a patient into the office paints a more full image for practitioners who in return can refer responsibly and help provide the best care for wound care patients.

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A major takeaway I found from the reading was regarding the importance of face-to-face treatment in gathering information on patients. Face-to-face contact provides more than just the best quality viewing of a wound. Information such as a patient’s mood, the patient’s abilities to take care of themselves, mobility, communication, and abilities to follow instructions are all critical parts in health managmenet. As we know, different patients need different levels of care, explanations, instructions, and follow up accountability and validations. Tele-health provides opportunities for some individuals to be seen, who may not be able to make a trip into a healthcare providers office and may provide eases for individuals to be seen who may not normally be willing to seek care in person. Alternatively, folks who endure or suffer from anxiety and depression, may need the accountability of in-person healthcare appointments. Wound healing physical changes are correlated with anxiety and depression. The patterns of both of these psychological conditions encourage patients to avoid care and help, and the pressure of having an appointment out of the home may be socially beneficially. Getting a patient into the office paints a more full image for practioners who in return can refer responsibly and help provide the best care for wound care patients. 

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I believe the implementation of Telehealth in wound care is a very interesting and complex subject for discussion. At first glance, I was very skeptical of its usefulness with this population and thought to myself just how difficult it must be to receive proper healthcare with significant health conditions and injuries such as wounds. However, until I read the article, I was not aware of all the reasons why this is such a complicated process. The study found that telehealth has a limited place in chronic wound management and that standardization to determine suitability of each patient is required in order to solidify the usage of telehealth systems worldwide. I agree with the standpoint taken in this article that more research needs to be done to figure out which wound care patients would benefit from telehealth and which would not. It is significant that the use of telehealth on patients that require face-to-face consultations can have devastating consequences and could potentially cause more harm to the patient than the risk of contracting covid. I believe the usage of telehealth should be highly dependent on the patient, however. Every patient has a different situation, with their own comorbidities and own risks involved. Besides other health risks involved, there are many other limitations that telehealth has when it comes to wound assessment. Communication issues, technological skills and access, usage of photos without physical assessment, and lack of face-to-face psychosocial assessment are just some examples of problems that can lead to inconsistency of treatment of this population. I think there needs to be a significant process in determining effectiveness and safety of telehealth in each individual patient. For example, a patient who has a superficial wound may look as though they were suitable for a telemedicine consultation. A photo of the wound sent to their doctor may be more than enough for them to receive proper and safe treatment. However, this is not always true. This patient may be unknowingly suffering from another underlying condition that presents itself somewhere else on their body. Through a telehealth consultation, because the patient would not be present for a full physical, it would be difficult to catch such underlying conditions. This is just one example of how a seemingly simple diagnosis can turn into a larger issue without proper assessment of qualification for a face-to-face consultation. Depending on the patient and their overall health, the consequences of such a mistake can be more significant than the risk of contracting the virus.

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I think that the idea of providing wound care treatment via telehealth is really interesting.  At first, I thought that this seemed entirely impossible.  After reading through the article, I have mixed feelings about the practice.

The authors brought up the fact that it is important for patients to be able to effectively communicate their wound symptoms with the clinician.  This makes sense, as most information gathered during a telehealth session comes from discussion with the patient, rather than from physically examining the patient.  This poses a challenge in communities with low health literacy because the patient may lack the vocabulary and knowledge to be able to thoroughly describe their wounds to the clinician.  This highlights the importance of the clinician being able to ask the right questions as well as the clinician’s ability to accurately observe a wound via photos and video calls.  Additionally, I would be concerned about patients in lower socioeconomic areas having access to clean and safe spaces to administer their own wound care.

A line from the paper that stood out to me was: “there is currently a lack of validity and reliability regarding the use of telehealth and/or static images to assess and treat chronic wounds within organizations that do not already have an established telehealth system.”  Because of this, I think it is too soon to draw conclusions about the effectiveness of telehealth delivered wound care treatment.  However, it is good to read that there has been some success that healthcare systems can continue to build upon in the future.

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As we all know, the COVID 19 pandemic has not only affected us individually, but society as a whole. This includes the way we seek medical attention. Due to the social distancing rule, healthcare providers used Telehealth as a safe, alternative method of treating patients through the computer and in the comfort of the patient's home. Although this was convenient for the patient and kept them safe from the corona virus, it limited healthcare providers in the way they would treat patients in a normal setting, especially something like chronic wounds. To me, I feel like Telehealth is okay when patient's describe their symptoms for maybe a cold, or fever, and other general illnesses. However, I do feel like something like wound care is difficult to treat through a camera. The proper way to assess a wound is through look, touch, and even smell, which are obviously very difficult to do when not physically with a patient. I am happy that these limitations were stated in the article, and I do believe Telehealth is a better option than not having access to a clinician all together, but it does seem difficult to treat everything just based on what the patient is describing to you or showing you through a screen. The article states that these chronic wound patients usually had a nurse in the home with them who were able to communicate and follow directions given from the other health care provider on the other side of the computer, which obviously is great for the safety and health of the patient. Yet, it makes me wonder if the patient would be able to do what the doctor is telling them on their own if they did not have access to an in-home nurse. There were many pros and cons listed in the article, and I understand using Telehealth to stay safe and social distance during these scary times in the pandemic, however, I do not feel it should now be the default way to seek treatment. If you have a safe option to see a doctor in their office physically, it may be better for the treatment and progress of a chronic wound injury.

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Sars CoV-2 has forced clinicians to expand medical practice beyond human to human contact. Telehealth has seemingly become the norm during this time. However, I am unsure if it is for the better. Though useful for basic care when it comes to wound care, watching someone on a camera seems far out of the realm of chronic wound treatment. Being that there is a potential for infection or even death, meticulous monitoring and re-evaluation of a wound up close seems imperative. The article did elaborate on the concerns I stated above in the limitations, so at least the authors acknowledged the flaws as well as plans for future research. The article did state these patients were normally with their primary care physician or a nurse,

which gave way for the different disciplines to communicate different aspects of treatment. Where this thrives in the pandemic scene is less likelihood of ending up with no care at all and better yet, not being exposed to potential COVID-19 infection. To conclude, this method of care is currently at a very basic level, but the pandemic has given an opportunity to change the medical field forever from optimizing this technology. One day patients might rarely receive care in person, that is scary to think about but there is always the lingering possibility.

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The world that we live in has drastically changed due to the COVID 19 pandemic. Healthcare was forced to adapt to the circumstances and with the help of the advancements in technology, telehealth has grown rapidly over the course of just a short year. This article did a great hob of exploring the pros and cons to telehealth when dealing with wound care and healing. While outpatient clinics were closed, telehealth was a great way for physical therapists to assist their patients with anything that they were able to. However, now that places are opening back up, it is a grey area as to what patients are a good fit for telehealth PT.  "The current model implemented as part of the emergency response relies on a patient's ability to discuss their wound and symptoms with the clinician remotely without the use of a clinical liaison, to decrease close contact and movement outside the home. Patients are then required to perform their own wound care independently or with minimal help from a care-giver/family member, while keeping in concordance with social distancing recommendations." The duties of a professional health care provider has transitioned and has been put into the hands of the patient or their caregiver. Subjective parts of an evaluation can be done virtually but it becomes difficult to perform an objective assessment on a patient without physically contacting them. I do not think there should be a total transition to telehealth, especially for evaluations because as a PT, you don't even know anything about your patient yet. I think telehealth can be a good alternative, but should not be a first option for the overall wound care population in rehab.

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The article very nicely sums up the issues and benefits relating to telehealth and wound care.  An obvious benefit that was particularly important during the pandemic is the ability to provide treatment without having to come into physical contact with the patient.  The quote from the article “All of the studies found the use of telehealth had a positive impact on wound healing, including reduction in

healing time and positive consumer feedback” seems to conclude that current research indicates the effectiveness of telehealth in treating wounds.  However, upon reading the table in the article regarding each individual study, I am not sure the studies support full scale telemedicine in wound care as an effective alternative to physical examination.  Perhaps with appropriate resources telemedicine can be effective, however, the resources seem to be an absolute necessity for effective treatment.  As the article notes, dressing a wound may require skills beyond what a patient has, and there may not be an additional caregiver who is capable of assisting.  Additionally, a virtual visit does not allow the clinician to fully evaluate a wound the way an in person examination does.  The severity of the wound may not be fully acknowledged, which can prevent an effective treatment plan, delaying or otherwise negatively affecting the healing process.  Telemedicine may have a role in wound care, for an appropriate patient who has the necessary resources.  However, to conclude that wound care will be just as effective for every patient would be too broad of a conclusion.

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I thought the article was well written and addressed many of the issues with the study done. It mentioned the lack of studies regarding telehealth and wound care with regards to outcomes, and touched upon issues that arise correlated to chronic wounds. It is important for patients to meet with healthcare providers to accurately assess wounds and manage their healing process. I noted that the article did not mention the feel of the skin in regards to healing that is many times an essential part of assessment. Overall, it was a good article and many good points were brought up. I believe they did a good job of explaining the benefits of telehealth and contrasting it to negative outcomes that could result from such treatment. While the article seemed to indicate some benefit to telehealth for chronic wound care, the article needed a lot more research. They mention that "[They] did not attempt to rate the quality of articles included in this review." While I understand the importance of expediting their publication due to current events like COVID-19, this may affect the quality of their article. In conclusion, I don't think I would rely on telehealth as a primary source of care for wound care, unless there is another health professional that could assess the wound hands-on at each session.

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"All of the studies found the use of telehealth had a positive impact on wound healing, including reduction in

healing time and positive consumer feedback". This quote, from the article results, is a good introduction to the tone of the article.  After reading the article, please let us know your thoughts and concerns regarding this topic ?