Challenges of Physical Therapists in Delivering Physical Therapy Services Utilizing

Telerehabilitation during the Pandemic

Physical Therapy Program

Maria Isabel F. Auditor, Shannen Ashley P. Cortez, John Carlo Delegero, MileaGionette M.

Jalosjos, Nessan Raphael H. Pinlac, Christian Kent R. Roferos

Silliman University Institute of Rehabilitative Sciences Physical Therapy Department

Physical Therapy Research 2

Asst. Prof. Raymond B. Esperida, MSPT, PTRP, FRIPOT, GDMT, CNMT, PhD

MAY 2023
 Silliman University

Institute of Rehabilitative Sciences

Dumaguete City

APPROVAL SHEET

This study entitled Challenges of Physical Therapists in Delivering Physical Therapy Services

Utilizing Telerehabilitation during the Pandemic has been satisfactorily defended by the group of

undergraduate students in partial fulfillment of the requirement for the course PT 53: PT

Research 2.

Panel of Experts:

Asst. Prof. Chester John B. Yocor, PTRP, DPT

Asst. Prof. Joshua Soldivillo, LPT, MASciEd-Physics

Dr. Lily Ann D. Bautista,PT, DPT, PTRP, COMT, CCVT

Research Adviser:

Asst. Prof. Raymond B. Esperida, MSPT, PTRP, FRIPOT, GDMT, CNMT, PhD

Accepted by:

Dr. Lily Ann D. Bautista, PT, DPT, PTRP, COMT, CCVT

Director, IRS-PT Program

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 Abstract

Amidst the unprecedented circumstances of the COVID-19 pandemic, physical therapists wanted
to explore and learn more about telerehabilitation. This study examined the limitations of
telerehabilitation particularly the challenges that physical therapists encountered while using
telerehabilitation to treat patients. In addition to a convergent mixed method research design, the
study used both quantitative and qualitative methodologies in order to achieve the objectives of
this study. Respondents were licensed physical therapists in whole Negros Oriental and had
telerehabilitation experiences between March 2020 and April 2023. The study gathered
responses about the problems encountered by using a self-made questionnaire that was based on
Blueprint for Telerehabilitation Guidelines. The said questionnaire consisted of two sections
dedicated to the collection of demographic data and the experiences of physical therapists
according to the challenges faced during the implementation of telerehabilitation and the
implementation of the five-point Likert scale in relation to the 4 key principles. Researchers were
able to gather 27 responses out of 58 prospect respondents for the study. Results showed that the
most encountered challenge among all four principles was technical followed by administrative
and clinical. Moreover, the participants did not experience any challenges in terms of the ethical
aspect as they were still able to practice ethical actions during telerehab sessions. The findings
indicated that despite the varying demographics of physical therapists in Negros Oriental, the
challenges they faced in treating patients through telerehabilitation showed no significant
differences.

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 Acknowledgement

First of all, we praise and thank the Almighty Father for the guidance and blessings that

He showered upon us throughout the research work to complete this research successfully.

The researchers cannot express enough thanks to the committee for their continued

support and encouragement, especially to our ever-supportive research director, Dr. Lily Ann

Bautista, for allowing us to conduct our research among physical therapists who underwent

telerehabilitation during the pandemic.

The researchers would also like to express their deep and sincere gratitude to their

research adviser, Asst. Prof. Raymond Esperida, for providing them with his support, invaluable

supervision, and guidance during the course of their research study. The researchers would also

like to thank him for his empathy, patience, and knowledge that he imparted. It was a great

privilege and honor to work and study under his direction.

To Mrs. Rhea Rheem A. Muarip-Bolodo, the researchers’ statistician who gave her time

and effort in guiding the researchers about the techniques and methods that are used for this

study, and for sharing her suggestion and wisdom during the fulfillment of this study.

Our thanks and appreciation also go to our respondents, who willingly helped with their

full cooperation, which has made the research study achieve its smooth completion.

Last but not least, to our dearest parents for their deep consideration for the finances and

underlying support throughout the making of this research study.

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 Table of Contents

Title page i
Approval sheet 1
Abstract 2
Acknowledgement 3
Introduction 6
Background of the study 7
Statement of the problem 8
Objectives of the study 9
Hypothesis of the Study 9
Significance of the study 10
Scope and limitations of the study 10
Operational definition of terms 11
Review of Related Literature 12
Review of Related studies 17
Theoretical Framework 18
Conceptual framework 20
Methodology 20
Research design 20
Research Environment 21
Research Respondents 22
Sampling Procedure 22
Research Instrument 23
Data Gathering Procedure 24
Data Analysis/Statistical Test 24
Ethical Consideration 25
Results and Discussion 26
Conclusion 36
Recommendation 37
References 38
Appendices 43
Curriculum Vitae 59

List of Tables

Table 1. Prospect Number of Respondents 22

Table 2. Total Number of Respondents 22
Table 3. Respondents’ Demographics 27
Table 4. Overall results of the challenges encountered according to the key principles of
telerehabilitation 28
Table 5. Specific Challenges faced by the respondents in utilization of telerehabilitation
based on the key principles 30
Table 6. Significant difference in the challenges based on Demographics 33
Table 7. Overall Qualitative Results according to Themes 34

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 List of Figures

Figure 1: Theoretical Framework 19

Figure 2: Conceptual Framework 20
Figure 3: Map of Negros Oriental 22
Figure 4: Data Gathering Procedure 24

5
 Challenges of Physical Therapists in Delivering Physical Therapy services Utilizing
Telerehabilitation during the Pandemic

COVID-19 had affected all the countries and nations as a global public health emergency.

The outbreak of the novel virus had caused damages on all aspects of society may it be

economical, political, environmental, educational, or health. The healthcare sector has taken the

greatest impact because they are the ones who are responsible for maintaining the health safety

of everyone and preventing the spread of the aforementioned virus (Hrynick et al, 2021).

Healthcare providers used current technological advancements as an alternative method to aid

them in providing services to their clients and patients without compromising the health and

safety of both parties and lessening the virus transmission. Due to the said innovation, online and

remote administration of healthcare services came to light and one of those is telerehabilitation.

(Ting et al, 2020).

Telerehabilitation or telerehab is the delivery of rehabilitation services remotely via

electronic communication and information technology such as telephones, mobile phones, or

anything that can connect to the internet with an accessible camera and microphone. It is a

component of telemedicine that involves experts who can synchronously or asynchronously

assess, monitor, and supervise users from a distance (Peretti et al, 2017). Telerehab has been

practiced in several developed countries in the world like the United States, Canada, Australia,

and New Zealand. In the New Zealand Journal of Physiotherapy, Signal et al (2020) stated that

Covid-19 had a great impact in terms of health response especially in providing

neurorehabilitation to patients with neurological disabilities. Since persons with disabilities are

likely to be vulnerable against the virus, healthcare professionals, especially physiotherapists,

sought and investigated alternatives to provide care services to their clients and patients without

jeopardizing their health and safety, thus utilizing telerehabilitation (Signal et al, 2020). In the

same study, Peretti (2017) stated that telerehabilitation had benefits it can offer such as lessening

the viral transmission and cutting the cost of travel for patients who live far from rehab clinics or

hospitals.

On the other hand, telerehab has its own drawbacks. According to the study of Torsney

(2013), on the advantages and disadvantages of telerehabilitation, patients had difficulty

operating computers and equipment used in telerehabilitation because of lack of instructions on

how to use the said equipment. Furthermore, patients specifically with neurological problems
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caused by brain injury may struggle to begin activities and may not use telerehabilitation

equipment unless physically aided. Finally, both PTs and patients in telerehab faced difficulties

due to interruptions in internet connectivity.

As a result, additional difficulties have been encountered, which this study discusses.

Background of the Study

To stop the further spread of the virus throughout the nation during the pandemic, the

government imposed nationwide lockdowns, and all general hospitals were converted into

quarantine areas resulting in the suspension of routine outpatient clinics, preventing patients with

non-Covid-related conditions from receiving their usual treatments. In the thick of the Covid-19

pandemic, health services had to adjust and emphasize safe care delivery while limiting out-

patient treatment (OECD, 2020).

In addition to that, telerehabilitation is the provision of rehabilitation services using

electronic communication technologies. This is considered a branch of telehealth and is a set-up

of systems used for controlling or monitoring remote rehabilitation using telecommunications

technologies such as telephones, smartphones, computers, etc. Telerehabilitation's nature entailed

the therapist providing patient care services, such as consultation, evaluation, diagnosis, and

treatment plan, from a distance. Video calls, audio calls, and audio and video recordings are

heavily used in telerehab (Chang, 2022).

According to study of Cottrell et.al (2017), there were several benefits of telerehab and

these were as follows: it expanded the access of patient especially those patients living in rural

areas or those who have limited access to physical therapy care, it can lower the rates of missed

appointments, there will be cost reductions, and telerehab can be carried out in variety of places

such as at home and at work. Several physiatrists and therapists in the Philippines adopt this

service in providing care to the patients.

Using technology to conduct rehabilitation services had several benefits for both

clinicians and patients. However, despite these benefits, telerehabilitation had a number of

downsides and challenges. In the study of Ganapathy (2020), the following were the challenges

in implementing telerehabilitation: the availability of dependable power, network and bandwidth;

suboptimal lighting; poor audibility; call drop; lag during conversation; difficulty in remote

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troubleshooting and shortage of multimedia devices; insufficient training; licensing; liability; and

malpractice issues. Ganapathy (2020) also stated that the limitations include a lack of virtual

connections with healthcare practitioners, which may be perceived as impersonal; a lack of

physical space at home to adequately exercise and relax; and, finally, the elderly may require

repeated instructions.

Moreover, Leochicho et al. (2021) found that human factors contribute to the challenges

encountered in implementing telerehab in the Philippines. The challenges encountered while

implementing telerehabilitation include stakeholders’ resistance towards accepting telehealth,

lack of knowledge and expertise in e-health, and concerns surrounding data privacy.

Furthermore, national e-health policies and laws, health information system frameworks,

governance, and data protection rules all acted as organizational barriers to telerehabilitation in

the Philippines. The biggest barriers to the execution of the telerehabilitation program in the

Philippines are slow internet connections and uneven coverage. (Leochico et. al, 2021).

The above-mentioned barriers and challenges published in several research studies

strengthen the objective of this study, which is to identify the different challenges encountered

by local PTs in Negros Oriental in utilizing telerehabilitation in delivering PT services.

Statement of the Problem

During the outbreak of the pandemic, all aspects of society were affected, especially in

healthcare. The healthcare sector used alternative methods to continue delivering their care

services to their clients and patients and one of those was telerehabilitation. As telerehabilitation

in the Philippines is newly implemented and adapted to the healthcare system, telerehab users,

specifically physical therapists, encountered challenges in delivering their services to their

patients through telerehabilitation. With this, the researchers sought to know the challenges faced

by the local PTs in Negros Oriental when delivering their services to their patients through

telerehabilitation during the pandemic and to determine whether there is a significant difference

between the respondents’ demographics and the challenges they faced.

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Objective of the Study

Generally, this study aimed to identify the challenges faced by the local PTs in delivering

their services to their patients through telerehabilitation during the pandemic.

Specifically, the study attempted to answer the following:

1. What is the demographic profile of the participants in terms of:

a. Age

b. Field of specialization

c. Years of experience

2. What are the challenges encountered by the participants in delivering PT services using

telerehabilitation during pandemic based on the four key principles according to the

Telerehabilitation Guidelines by Telerehabilitation Special Interest Group of the

American Telemedicine Association (2010) in terms of:

a. administrative

b. clinical

c. technical

d. ethical

3. Is there a significant difference in the challenges encountered by the participants in

delivering PT services using telerehab during pandemic, when grouped according to

demographics?

a. Age

b. Field of Specialization

c. Years of experience

Hypotheses

Ho: There was no significant difference in the challenges encountered by the local PTs

in delivering PT services using telerehabilitation during pandemic, when grouped according to

demographics.

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 Ha: There was significant difference in the challenges encountered by the local PTs in

delivering PT services using telerehabilitation during pandemic, when grouped according to

demographics.

Significance of the Study

The results of the study would be beneficial to the following:

Physical Therapy Practice.Information gathered in this study may be used as additional

evidence that helps further the knowledge and research about telerehab.

Telecommunication Companies. This could help telecommunication companies as it

opens potential revenue because their network would be utilized in the aspect of health. The

results of this study could be used as a basis for improving their quality in their services

provided.

Technology Companies. This would be helpful since the study's findings would advance

understanding about telerehabilitation. The study's respondents would only include physical

therapists working in Negros Oriental. The professionals listed above will be the included

participants in this study specifically to those physical therapists exclusively exposed to

telerehabilitation programs during the pandemic in Negros Oriental. The study's further

limitations were mentioned by the researcher, including the possibility of increased money

generation from inventions due to technology's application to healthcare.

Future Researchers. Future researchers may be able to utilize the information as a

reference to gather more information and knowledge in conducting similar research studies of

their own. This would also give them an overview of the different challenges encountered by

physical therapists in using telerehab.

Scope and Limitation of the Study

This study identified the challenges encountered by the local PTs in Negros Oriental in

utilizing telerehabilitation when delivering PT services during pandemic. The measured

components were the demographics of the respondents and the challenges that they faced when

doing telerehabilitation. In this study, the evaluated key areas concerning telerehabilitation were

the key principles stipulated in the Blueprint for Telerehabilitation Guidelines (Brennan et.al,

2010) namely: administrative, clinical, technical , and ethical principles. With regards to the

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respondents of the study, the key areas included were the respondents’ demographic

characteristics and the frequency of the challenges they encountered which was measured by a

Likert scale. The questionnaire used to gather the data was based on the Blueprint for

Telerehabilitation Guidelines.

The participants of this study were limited to physical therapists within Negros Oriental

who had experience utilizing telerehabilitation during the pandemic period from March 2020 to

April 2023. Data collection involved self-reported responses through an online questionnaire,

assuming that the participants would provide honest feedback. Moreover, the questionnaire given

to the participants was crafted by the researchers based on the Blueprint for Telerehabilitation

Guidelines and the responses reflected the participants’ telerehabilitation experiences within the

specified timeframe. Respondents were grouped according to their demographics; specifically

age, years of experience as a physical therapist, and field of specialization. The survey

questionnaire utilized by the researchers underwent face validity testing only. Further content

validity is recommended to measure the reliability of the questionnaire. Another limitation of the

study was, it only had a relatively small sample size, with only 27 out of 58 potential

respondents participating in this study.

Operational Definition of Terms

Administrative principles. Standards concerning the executive and management aspects of

telerehabilitation.

Age. How old a person is at a particular point in time

Challenges. Something that by its nature or character serves as a call to make special effort, a

demand to explain, justify, or difficulty in an undertaking that is stimulating to one engaged in it.

The hindrances that the respondents encountered during therapy sessions.

Clinical principles. Standards concerning the medical aspects of telerehabilitation.

Ethical principles. Standards concerning the moral aspects of telerehabilitation.

Pandemic. The period of time in which there was a global spreading of Covid 19 , nationwide

quarantine and physical distancing protocols were implemented, and restriction of face to face

interaction.

Patients: Individuals who underwent physical therapy.

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Physical Therapist: Respondents of the study; a person licensed to practice physical therapy; a

healthcare professional who provides therapy to preserve, enhance, or restore movement and

physical function that are impaired or threatened by disease, injury, or disability.

Physical TherapyServices: Services provided by physical therapists to individuals to preserve,

enhance, or restore movement and physical function impaired or threatened by disease, injury, or

disability and that utilizes therapeutic exercise, physical modalities (such as massage and

electrotherapy), assistive devices, and patient education and training.

Telerehabilitation/Telerehab: The method used by the respondents; The use of internet or

telecommunications such as phone calls, videoconference or zoom meetings to provide physical

therapy to patients in their homes.

Review of Related Literature

This chapter presented and offered some literature and studies closely related to or

associated with the present research study. Those included in this chapter aided in familiarizing

information that were relevant and similar to the present study. Review of the related literature

helped the researchers acquaint themselves with current knowledge in the field or area in which

they are going to conduct their research, and reviewing all related literature enabled the

researchers to identify the limits of their field. The literature and studies mentioned in this

chapter contribute a reservoir of ideas and provide what was then distinguished after the

exhaustive and in-depth search done by the researchers.

Pandemic and Telerehabilitation

Covid-19 pandemic had a significant impact on countries and territories worldwide,

leading to changes in public health and healthcare systems according to Laver et al. (2020). Due

to the pandemic, healthcare providers had to use the modern era's technological innovations to

continue delivering care services to their patients and clients to prevent the spreading of the virus

and to protect everyone's health and safety (Ting et al., 2020). This was utilized in order to

practice safety precautions in between physical therapists and patients as well.

In regards to that, telehealth was implemented which is the delivery of healthcare

remotely using electronic and technological information and telecommunications technologies

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(Capellan & Sineus, 2019). These technologies enabled communication between medical

personnel and patients as well as the transfer of imaging and other types of health data. It can be

used to speed up emergency medical care for illnesses with limited therapeutic windows, like

myocardial infarction and stroke, and to make access to medical services that aren't frequently

available in remote areas easier. (Tchero et al, 2018)

There are different types of telehealth and telerehabilitation (TR) was one of them.

Telerehabilitation specifically referred to clinical rehabilitation services with an emphasis on

assessment, diagnosis, and therapy and the delivery of rehabilitation services via

telecommunication technologies including two-way real-time or synchronous video or audio

visits, asynchronous consultation and therapy sessions, remote evaluations of previously

recorded videos or photos, and tele-assessment and management services (Bettger & Resnik,

2020).

Modes of Telerehabilitation

In regards to the modes of telerehabilitation used, delivery through telephone and

videoconference were the most common. Through the use of videoconferencing, individuals

could interact verbally and visually while receiving consultations, diagnostic evaluations, and

therapy interventions (Mallow et al, 2016). Problems, however, began with the inability to gauge

a participant's physical performance; for instance, in physiotherapy, this might entail gauging

range of motion and gait.

The impact of smartphones on medical communication has been significant in recent

years, greatly contributing to transformative changes. The modernization of communication

facilitated by smartphones has enabled the provision of medical assistance precisely when

individuals require it. Recent reports indicate that one out of every five smartphone users

actively utilizes health-related applications, while half of smartphone owners seek health

information using their devices. Various smartphone apps cater to healthcare workers, medical

students, patients, and the general public, offering a wide range of functionalities (Iyengar et al.,

2020).

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Telerehabilitation Principles

As telerehab is now considered as an alternative approach in providing rehabilitation

services, a blueprint was constructed by the Telerehabilitation Special Interest Group of the

American Telemedicine Association (2010) which served as a guideline for professionals and

organizations that will participate in this kind of rehabilitative approach (Brennan et al, 2010).

Indicated in the said blueprint are the four key principles of telerehabilitation namely

administrative, clinical, technical, and ethical principles. For the administrative principle,

telerehab providers are obliged to abide by state regulations and established health guidelines in

addition to ensuring all conditions for providing telerehab services are met. Furthermore,

providers must inform the clients of their rights and responsibilities as the recipients of the

telerehab services (Brennan et.al, 2010).

Discussed in the clinical aspect of the guideline, professionals must have the abilities

required to provide safe and high-quality healthcare. It is essential that they receive the

appropriate training, education, and ongoing professional development. Additionally, when

delivering telerehab services, it is crucial to follow professional standards of practice and the

principles of evidence-based practice. Moreover, disclosure of all individuals involved in the

telerehab should always be done prior to initiation of the session (Brennan et.al, 2010).

In a comparable context, the essential technical principles of telerehabilitation were

clearly outlined in the guideline. The recommendations were created to ensure that the telerehab

technology would be sufficient and successful in supporting diagnostic and therapeutic needs..

This emphasized the need to follow the laws governing technology and technical safety for all

equipment and trained personnel. Moreover, this also took into consideration the making

strategies that could address the client's possible impairments such as hearing, visual or language

impairments which could affect the effective delivery of telerehab services (Brennan et.al, 2010).

Similarly, the ethical principles stipulated that clients be informed of their rights and

obligations when receiving telerehab services and that all telerehab providers abided by

professional rules of ethics (Brennan et.al, 2010).

The principles mentioned above align with the classification of telerehabilitation factors

presented by Leochico et al. (2021) in their systematic review of challenges in a developing

14
country. Leochico et al. categorized the factors as follows: (1) human factors, which included

knowledge and skills as well as personal concerns; (2) organizational factors, which consisted of

available resources, regulations, and support; and (3) technical factors consisting of the software

and hardware of the technology itself.

Disadvantages and Challenges Encountered in Telerehabilitation

Telerehab in physical therapy consisted of several components that must be met in order

to have a successful telerehab, such as taking into account the patient's functional deficits, having

a good internet connection, having the necessary equipment for treatment, having physical

assistance while using said equipment, being knowledgeable enough to use said equipment

independently, and purchasing an equipment if the patient does not have access to one. With all

these factors taken into consideration, these things must be addressed before beginning

telerehabilitation for this may cause an impact towards the delivery and quality of

telerehabilitation (Torsney, 2013).

Administrative Principle

One of the main obstacles faced by therapists in telerehabilitation is patient

evaluation. Evaluating patients is crucial for establishing rehabilitation goals and

direction. However, physical touch is often necessary to assess impairments, making it

challenging for telerehab therapists to conduct thorough evaluations. Based on the

research of Cai et. al. (2017), most of the limitations in the virtual platform is the

inability to physically test balance or muscular strength which can result in potentially

tainted or inaccurate evaluation results.

Clinical Principle

Several challenges were identified regarding the adoption of telerehabilitation

(TR). Older patients often lack knowledge on how to use smart gadgets, which are

necessary for TR, as noted by Rabanifar and Abdi (2021). Difficulties in equipment setup

and complex instructions were reported by participants (Cai et al. 2017). Lack of

appropriate equipment and the limitations of a one-size-fits-all approach were also

identified as barriers to TR implementation. In relation to that, the research study of

Buabbas et al. (2022) emphasized that physical therapists tend to prefer traditional in-
15
person practice due to the need for personal presence and hands-on interventions. It is

recommended to conduct initial assessments in the clinic and continue with remote

follow-up sessions to address the challenges posed by certain evaluations and treatments

in telerehabilitation.

Technical Principle

According to Albahrough et al. (2021), the adoption of telerehabilitation (TR)

faces several challenges. Fischer et al. (2021) identified internet connectivity as a

significant hurdle in the implementation of telerehabilitation and highlighted the

limitations of remote communication in capturing fine details and nuances of movement.

Cardoso (2021) identified that healthcare professionals may have resistance to new

technology and lack telemedicine training, lack of defined telerehabilitation guidelines,

technological limitations, and lack of access to necessary equipment are additional

barriers. As highlighted by Hale and Kvedar (2014), data privacy concerns and security

risks pose significant issues. Other barriers as pointed out by Abdi (2021) include

technological challenges, lack of knowledge and participation in planning, and opposition

from high-cost providers and hospital location. Caughlin (2019) added that technical

issues and insufficient support on public networks can also disrupt TR sessions. This

notion is supported by the study of Wilson and Peterson (2022), where they emphasized

that disruptions, delays, and compromised audio or video quality can occur due to

unreliable internet connectivity during telerehabilitation sessions.

Overall, the limitations of TR include difficulties in diagnosis, privacy concerns,

lack of hands-on therapies, and perceived limitations in clinical progress. These factors

contribute to physical therapists' preference for in-person sessions.

Paz et al. (2021) stated that continuingoutpatient therapy is crucial to prevent

functional deterioration, hospital visits, and potential hospitalization for individuals not

affected by COVID-19. Discontinuing physical therapy sessions can lead to

complications, regressions, and hinder progress in achieving long-term rehabilitation

goals. Without physical therapy, the patient's body function and structure are likely to

decline at a faster rate, resulting in dysfunction in their participation or activity. Failure to

16
 implement preventive interventions through physical therapy would most likely increase

the risk of hospitalization

Review of Related Studies

In the study of Bezuidenhout et. al (2022), physical therapists in Sweden had faced

challenges in implementing telerehabilitation during the pandemic. The inability to do hands-on

examinations, which are essential for precise patient evaluation, was one of the biggest

challenges (Bezuidenhout et al., 2022). Furthermore, the physiotherapists were limited in their

ability to perform hands-on interventions including manual therapy and therapeutic exercises due

to the remote nature of telerehabilitation. According to Bezuidenhout et al.'s study from 2022,

connectivity problems and technological challenges like slow internet connections and

interruptions in video/audio transmission also made it difficult for physiotherapists and patients

to engage effectively. These difficulties highlighted the necessity for ongoing improvements and

modifications in telerehabilitation procedures to meet these restrictions and guarantee the

delivery of high-quality care during distant sessions.

In addition, D'Souza (2021) discussed the difficulties that telerehab faced, including

issues with data privacy, the cost of the equipment, a lack of user-friendly software, a lack of

perceived therapeutic advantage, a perception of increased effort, negative attitudes among the

staff involved, and a lack of felt therapeutic benefit. Several respondents mentioned a number of

barriers, including trouble connecting to the internet, a lack of face-to-face interaction, poor

patient compliance, a lack of technology knowledge, and increased stress from having to explain

and administer therapy via telerehabilitation.

According to Arzani et al. (2021), secrecy and privacy were crucial components of the

therapeutic process for patients who give their most private information to therapists. As part of

the primary guideline of medical ethics that should be applied to this method, it is critical to

consider the patients' comfort while the therapist keeps their information. However, if cyberspace

uses a foreign database, the possibility of hacking into the database's contents at any point may

render that environment inappropriate for sustaining these ethical ideals. Patients are also held

accountable for carefully examining therapy recommendations and refraining from disclosing

information to others because morality is not only the domain of the therapist but also of

patients.
17
 Furthermore, the study of Arzani et al. (2021) also mentioned that professional

commitment and failing to introduce a therapist with fake titles is another issue that requires

more attention from the judiciary. To gain access to all of the patients' health information,

including blood tests, imaging, past treatments, and patient history, the electronic health record

available to all certified therapists must be uploaded to national websites.

Telerehabilitation requires its own time and skills, but these services are currently not

primarily supported by insurance and often, the weakness in the introduction of electronic health

records and telerehabilitation is the result of a flawed organizational culture and user resistance

(Arzani et al., 2021).

In this paper, the researchers wanted to assess the challenges encountered by PTs in

delivering rehabilitative services through telerehab in the local setting. Existing studies about the

effectiveness of telerehab and its challenges were mostly conducted in first-world countries and

there are only limited studies regarding the subject matter in the Philippine setting. This study

could provide new information that could help in further defining the nature of telerehabilitation.

Theoretical Framework

The theoretical framework of this study was anchored on the Telerehabilitation

Guidelines by Telerehabilitation Special Interest Group of the American Telemedicine

Association (2010), with the following key principles administrative, clinical, technical and

ethical principles. These principles are first considered prior to delivery of telerehabilitation

services to secure a safe and efficient delivery of telerehabilitation.The guidelines are deemed

important for this study that would be conducted.

The administrative aspect of the guidelines stated that it is essential for the physical

therapist to be aware of their duties and accountabilities as providers in order to establish

effective documentation and monitoring, with that said there would be a need to access the

clients or patients records which could risk compromising the data privacy and confidentiality.

The physical therapist could be blamed due unauthorized use of client or patient information.

The problem could also fall under the technical aspect since the physical therapist was unable to

protect or ensure the safety of the information stored.

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 In terms of clinical principles, the physical therapists should have experience in using and

delivering telerehabilitative services. They must have undergone training or professional

development prior to delivery of telerehabilitation services in order to ensure that the therapist

has the necessary knowledge and skills to perform safe and efficient telerehabilitation. Lack of

the necessary knowledge and skills could critically affect the quality of telerehabilitation service

given.

On a related note, the blueprint had carefully listed and described the fundamental

technical tenets of telerehabilitation. These were designed to guarantee that the telerehab

technology would be adequate and effective in supporting diagnostic and therapy requirements.

All telerehab providers must be trained in operating the necessary equipment in telerehab such as

videoconferencing and data sharing tools and incorporate other treatment materials used to

address other existing impairments of patients and/or clients. They should also be able to

perform troubleshooting procedures when the telerehab equipment fails or malfunctions during

therapy sessions.

For the ethical aspects of telerehab, the guidelines indicated that all telerehab providers

must adhere to the professional codes of ethics and that clients be made aware of their rights and

obligations when receiving telerehab services. Every client or patient has a right to refuse.

Failure to acknowledge the decision of the client or patient may cause conflict and violation of

the ethical principles of telerehabilitation.

The aforementioned principles also have a considerable number of challenges

encountered along its process. A lot of considerations are to be taken care of prior to, during, and

after delivering telerehabilitation services. Telerehab providers must have complete awareness

and knowledge of the principles of telerehab.

Figure 1.

Theoretical Framework

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Conceptual Framework

The study is focused on gathering data related to the respondents’ demographic profile

and the challenges they faced in utilizing telerehabilitation in treating patients in accordance with

the key principles namely: administrative, clinical, technical, and ethical principles. The

collected results were used towards identifying the challenges faced by the respondents and the

relationship between the challenges and their demographic profile.

Figure 2.

Conceptual Framework. Demonstrate the paradigm of the blueprint for telerehabilitation

guidelines as presented by the American Telemedicine Association

Methodology

This chapter discussed and described the method of gathering important data which

would be needed to formulate solutions for the main problem of the study. This chapter showed

the description of research design, research environment, subjects of the study, research

sampling design, research instruments, research ethics, data gathering procedure and data

analysis procedure.

Research Design

The purpose of this study was to identify the different challenges encountered by PTs in

delivering physical therapy services utilizing telerehabilitation during the pandemic. This study

implored both quantitative and qualitative methodologies in order to achieve the objectives of

this study. Specifically, a convergent mixed method research design was utilized since it was

most appropriate for research that aimed to analyze different datasets and combine them in order

to either cross-validate or compare findings (Leavy, 2017). Aside from this, it would also

provide the researcher with a holistic or complete view of the situation (Creswell & Plano-Clark,

20
2018). The present study aimed to investigate the challenges encountered by PTs in delivering

physical therapy services through telerehabilitation. Hence, it was easier with the aid of this

method to “explore relationships between variables in depth, confirm or cross-validate

relationships discovered between variables'' (Fraenkel & Wallen, 2012).

For the quantitative part, measures of central tendencies were taken in order to be able to

establish the trends and properly identify the challenges in delivering physical therapy services

utilizing telerehab during the pandemic.

A qualitative approach was then utilized. The use of qualitative research methodologies

allowed for a systemic investigation of the shared experiences of participants, discovered

similarities and contrasts, and uncovered the mediating variables that comprised the spectrum of

experiences (Solomon, 2018). As such, semi-structured interviews were used to determine the

challenges encountered by the PTs in delivering physical therapy services through

telerehabilitation. Due to the fact that the qualitative approach was relational, contextualized, and

subjective, and the fact that this would also determine the impact and influence of the

researcher’s position, subjectively, and identity on the power dynamics that may emerge in the

responses of the participants, the researcher guaranteed that the opinions and experiences of the

participants were recognized and respected while acting as a neutral observer. The researcher

also avoided using evaluative language, leading questions, and nonverbal communication during

data collection.

For the present study, a convergence model of triangulation was utilized, with

quantitative data given greater emphasis over qualitative data. Data were collected and analyzed

concurrently, and the results from both were compared, contrasted, and merged for interpretation

(Cresswell & Clark, 2011). By selecting this model, it would provide a stronger foundation for a

holistic and comprehensive investigation.

Research Environment

The study was conducted in the different rehabilitation centers/hospital and among

freelance physical therapists in Negros Oriental, from Canloan City down to the Municipality of

Basay .

21
Figure 3.

Map of Negros Oriental

Research Respondents

The research work involved physical therapists among different rehabilitation

centers/hospitals and freelance physical therapists in Negros Oriental, from Canlaon City down

to the Municipality of Basay who participated in telerehabilitation programs during the

pandemic (March 2020 to April 2023) . In the data collection, the researchers were able to gather

responses from 27 out of the 58 prospect number of respondents for the study.

Table 1.
Prospect Number of Respondents

City No. of Physical Therapist

Dumaguete City 54
Valencia 2
Dauin 2

Total 58

Table 2.
Total Number of Respondents

City No. of Physical Therapist

Dumaguete City 25
Valencia 1
Dauin 1
Total 27

Sampling Procedure

The sampling procedure that was used in this study is the Purposive Sampling Method.

Purposive sampling is a kind of non-probability sampling where researchers collect data based

22
on the inclusion/exclusion criteria, research questions, and population. To be eligible for

inclusion in this study, the participants involved were physical therapists in different

rehabilitation centers/hospitals and freelance physical therapists in whole Negros Oriental who

underwent telerehabilitation programs during the pandemic. Exclusion criteria include those

physical therapists who had not participated in any telerehabilitation program and were outside

of Negros Oriental practicing PT. The goal of the study must be known to the researchers before

using this survey sample technique so that they could choose and contact eligible and appropriate

subjects for the study.

Research Instruments

The research instrument used was a self-made questionnaire that was based on the

Blueprint of Telerehabilitation Guidelines by Telerehabilitation Special Interest Group of the

American Telemedicine Association (Brennan et. al 2010). The said questionnaire consisted of

two sections dedicated to the collection of demographic data and the experiences of physical

therapists according to the challenges faced during the implementation of telerehabilitation

during the pandemic. Part I of the questionnaire consisted of the items which gathered

respondents' profiles such as their name, age, field of specialization, and years of experience and

a semi-structured interview. A semi -structured interview was used to collect essential data and

information from the participants who had been identified for the purpose of this research. A

Guide for Constructing and Conducting Semi-Structured Interviews was used to conduct this

research. The interview guide employed semi-structured interviews to elicit brief narratives and

comments from key informants and field specialists. Physical therapists were requested to

answer the open-ended questions stated in the questionnaire and indicate their experience

concerning the challenges encountered in delivering physical therapy services utilizing

telerehabilitation during the pandemic.

In the second part, participants were requested to answer specific questions in relation to

the challenges they encountered in delivering services through telerehabilitation in terms of:

administrative, clinical, technological, and ethical principles. A five-point Likert scale was

employed. The responses of respondents to a specific question or statement about the difficulties

in providing PT services via telerehabilitation for patients were gauged using Likert items. The

numbers varied from 1 to 5, with 5 denoting highly agree, 4 denoting agree, 3 denoting neither

23
agree nor disagree, 2 denoting disagree, and 1 denoting strongly disagree. In addition, letters for

validation were sent in order to proceed with the face validation of the questionnaire, evaluating

its clarity and comprehensibility. (See Appendix D)

Data Gathering Procedure

To gather the required data for the study, several steps were undertaken. A pre-prepared

questionnaire was administered to physical therapists in Negros Oriental who were involved in

telerehabilitation programs. The questionnaire, in the form of Google Forms, included mandatory

consent documents and was given to the participants with a one-week time frame to respond. In

cases where respondents had not completed the questionnaire, follow-up messages were sent by

the researchers. After data collection, the researchers analyzed the participants' answers.

Following the data analysis process, the results were interpreted, leading to the study's

conclusion based on the interpreted data.

Figure 4.

Data Gathering Procedure

Data Analysis Procedure / Statistical Tests

Data analysis was done after gathering necessary data. Researchers compiled all the data

that were collected through Google forms. As soon as the data had been collected, the

researchers immediately took down notes on all the responses from the participants.

24
 The questionnaire responses from the subjects were checked for anomalies and missing

information. After this, reduction of all the information gathered was tackled. This was for the

researchers to obtain the crucial information from the data gathered to arrive at a certain point of

the study.

The responses of each participant were coded and transcribed in order for the researchers

to further understand the challenges encountered by the respondents. Data analysis was

performed between subjects using numerical data from the Likert scale responses gathered from

the survey. Reverse coding was applied on the collected data for data consistency in relation to

the Likert scale. Upon interpretation of the weighted mean of the survey responses gathered

using Google Sheets, the intervals used for adjective rating were the following: 1.00-1.8 denoting

strongly disagree, 1.81-2.6 denoting disagree, 2.61-3.4 denoting neither, 3.41-4.2 denoting

agree, and 4.21-5.0 denoting strongly agree (Pimentel, 2010). After transcribing, their

statements were then interpreted. Their responses were extracted and were classified into themes.

Themes were derived from the pattern of responses from all the respondents in the study. (See

Appendix E)

Several statistical tools and procedures were used to analyze and interpret the obtained

data. The collected quantitative data were statistically analyzed using the descriptive statistics

and both parametric and nonparametric tests such as Kruskal-Wallis, Pearson correlations,

Spearman rho, and One-Way ANOVA. Ryan-Joiner Normality test was done to aid the

researchers in identifying the appropriate statistical tools to interpret the collected data.

Moreover, the total weighted mean of each component was calculated. Total weighted mean is a

useful tool for data analysis because it provides a more precise representation of the patterns and

trends that exist in the data, allowing for the extraction of new insights from the data.

Finally, the researchers then organized the interpreted data and formulated findings to

arrive at conclusions. Doing this, the researchers were able to make recommendations as the

study progressed.

Ethical Consideration

Prior to the implementation phase, the researchers obtained participants' informed

consent. They compiled and kept private the subjects’ demographic information. During the data

25
collection, the participants were given the ability to object at any time. All responders received

explicit verbal explanations regarding other ethical factors such as voluntary involvement and the

advantages of research participation.

The researchers were accountable for the conducted study. They reassured everyone

taking part in the study that the data collected were kept confidential. The researchers practiced

ethical standards towards the progress of the study. They were fully aware of the responsibility

and ethics of the study that should be followed.

The researchers reported the most reliable and trusted data which was presented in their

study. The findings of the study were presented truthfully. The information gathered by the

researchers were transcribed, translated, and interpreted with full knowledge of their

respondents. Therefore, the researchers were fully liable for the actions throughout the progress.

Requests for permission and consent were done before undertaking any necessary actions in

gathering data. Any information gathered from other sources were also credited in accordance

with the law.

The honesty, credibility, and trustworthiness were considered and observed. Therefore,

the researchers guarantee that they conducted their job honestly and adhere to the study's ethical

requirements.

Results and Discussion

This chapter presented the comprehensive analysis and discussion of the results which

were based on the participants’ responses on the conducted research survey concerning the

different challenges encountered by local PTs in delivering physical therapy services through

telerehabilitation during the pandemic. The data used in this chapter were collected from a

questionnaire made by the Level IV Physical Therapy Students which consisted of two sections

dedicated to the collection of demographic data and the challenges experiences of physical

therapists. Moreover, this discussed the analysis and interpretation of the data gathered done by

the researchers to extract the significant information.

Participants’ Demographic Profile

26
 The results of respondents’ demographic data are illustrated in Table 3. The researchers

were able to gather responses from 27 out of the 58 prospect respondents for the study. The

majority of participants fell within the age range of 22-25 years old. Fields of specialization in

physical therapy were gathered and 18 (66.67%) is in General Practice, 4 (14.81%) practices

Neuro, and 2 (7.41%) practices Musculoskeletal. Twenty-six (96.30%) have 5 years and under

experience of being a therapist and one (3.70%) has more than 5 years of experience. The

distribution of the respondents were mainly physical therapists in Negros Oriental who

experience telerehabilitation during the pandemic.

Table 3.
Respondents’ Demographics
Age of Respondents (in years) Number of respondents (n) Percentage %
22-25 26 96.30%
26-44 1 3.70%

Field of Specialization
General Practice 18 66.67%
Neuro 4 14.81%
MSK 2 7.41%
Others 3 11.11%
Work Experience of respondents
(in years)
5 and under 26 96.30%
5 and above 1 3.70%

Challenges faced by the respondents in Telerehabilitation in relation to Key Principles

The results of the survey questionnaire are found in Table 4, showcasing the overall

weighted mean of challenges encountered based on the key principles. Considering the results of

the survey, the findings showed that the respondents encountered challenges on three out of the

four principles namely: Administrative, Clinical, and Technical principles.

The respondents encountered most challenges under the technical principle with the mean

of 3.419 followed by administrative principle (mean: 3.189) and clinical principle (mean: 3.027),

respectively. Moreover, the results showed that the participants did not experience any

challenges in terms of the ethical aspect of telerehabilitation with the mean of 1.703. This is

affirmed by the response of respondent WP:

"I experienced no ethical challenges in telerehabilitation. I always uphold professional

ethics, respecting my patients' rights and obligations throughout the process."

27
Table 4.
Overall results of the challenges encountered according to the key principles of
telerehabilitation

Weighted Mean Interpretation

Administrative Principle 3.189 Neither Agree nor Disagree

Clinical Principle 3.027 Neither Agree nor Disagree

Technical Principle 3.419 Agree

Ethical Principle 1.703 Strongly Disagree

Specific Challenges faced by the respondents in utilization of telerehabilitation based on the

Key Principles

Presented on Table 5 were the weighted mean of the specific challenges encountered by

the respondents in utilizing telerehabilitation based on the key principles indicating the frequency

that the physical therapists experience the corresponding challenges through the Likert scale

interpretation. It should be noted that the data used in the weighted mean in Table 5 underwent

reverse coding for consistency purposes. Reverse coding is a technique used to ensure

consistency in data analysis, particularly when dealing with Likert scale responses to maintain

uniformity in the data interpretation (Suarez-Alvarez, 2018). Moreover, the idea on Table 5 is to

determine whether the respondents found the mentioned components as challenging or not.

Strongly Agree to Agree means they found it challenging, Neither agree nor disagree means that

it was challenging at some times, and Strongly Disagree to Disagree if it was not challenging.

In the Technical principle, the respondents identified that the internet connectivity was

the primary challenge that they encountered when delivering services through telerehab with the

mean of 4.629. This finding agreed with the statement given by respondent KA:

“The poor internet/data signal or connectivity from my end or my patient’s end affects

our session and causes delays.”

Maintaining the stability of the internet connection was identified by the respondents as

the second most challenging component under the technical aspect of telerehabilitation which is

supported by the response of respondent KS:

“One of the difficulties during telerehab is the unstable and unreliable internet

connectivity.”
28
 Alongside with the challenges encountered related to internet connectivity, the

respondents also stated that they had experienced difficulties concerning patient evaluation,

privacy and confidentiality. This is supported by respondent NE wherein they claimed that:

“It was hard to conduct tests needed for the patient's evaluation because I cannot closely

monitor the patient through the camera.”

In relation to the administrative principle, the most challenging component was about the

participation of patients residing in rural and remote areas during telerehab sessions with the

mean of 3.703 which is supported by the response of respondent NE:

“ It was difficult doing telerehab sessions when the patient is located in rural areas

because the reception and the internet connectivity there is poor and unstable.”

Difficulty maintaining mutual understanding between the patient and the therapist when

giving instructions about the exercises was identified as the second most challenging component

of the administrative principle(mean: 3.556).This coincided with the statement of respondent

PM:

“ I had trouble communicating with the patients, and I often had to repeat myself because

they misunderstood my instructions ”

Moreover, difficulty monitoring the patient’s compliance with the exercise program

ranked third among the challenges under the administrative principle.

In the Clinical principle, results showed that the respondents agreed that in-person

therapy sessions were preferred compared to telerehabilitation in terms of treating patients

(mean: 4.333). This is affirmed by the response of respondent TC:

“ It was much easier to treat patients face to face rather than through video call because

I can give instructions and directly monitor my patients ensuring they do the exercises

correctly.”

With regards to challenges related to the exercise performance of patients during

telerehab sessions under the clinical principle, results showed that the respondents were a bit

challenged on this aspect. One of the respondents that expressed that they were challenge was

respondent ML:

“I had a tough time giving instructions and demonstrating exercises to my patients. Some

patients need to be instructed multiple times for them to do the exercises properly. It was

29
 very time-consuming. Also, some patients have difficulty following the demonstrations

that I do.”

On another note, results showed that respondents did not experience any challenges on

the components in the ethical aspect as they were still able to practice ethical actions during

telerehab sessions. This is supported by the response of respondent WP:

“I experienced no ethical challenges in telerehabilitation. I always practice professional

ethics, respecting my patients' rights and obligations."

The findings aligned with a previous study by Leochico et al. (2021) mentioned in the

literature review, where the technical aspect of telerehabilitation was the most common

challenge faced.

Table 5.
Specific Challenges faced by the respondents in utilization of telerehabilitation based on the key
principles

Weighted SD Interpretation Ranking

Administrative Mean

It was difficult maintaining data 2.481 1.122 Disagree 7

privacy and high security control
on the sensitive data collected from
the patients

It was difficult to maintain mutual 3.444 0.801 Agree 3

understanding between the patient
and the therapist with regards to
instructing the patient to perform
the exercises

It was difficult to track the progress 3.296 1.137 Neither 4

of the patient throughout the
telerehab sessions.

It was difficult to monitor patient’s 3.556 1.086 Agree 2

compliance with the exercise
program given through telerehab.

Patient was fully engaged or 2.074 0.770 Disagree 8

participating during telerehab
session

Patients were able to easily 2.851 0.877 Neither 5

understand the instructions given
through audio and/or video call and
was able to perform exercises
correctly

30
Patient was able to provide a space 2.556 1.155 Disagree 6
at home where they can set up their
equipment for telerehab and can do
their exercises

Patients from remote and rural 3.703 1.068 Agree 1

areas can easily participate in
telerehab programs.
Total Weighted Mean 3.189

Clinical Weighted SD Interpretation Ranking

Mean

I have full knowledge and clinical 2.592 0.888 Agree 6

skill in delivering telerehabilitation

My patient had difficulty 3.222 0.847 Neither 2

performing the exercises given
through audio call and/or video
call.

Patient has a support staff or family 2.444 0.847 Agree 8

member that can assist in
performing the exercises given
through telerehab.

The patient has the sufficient 2.851 0.808 Neither 5

knowledge and information on how
to utilize smart gadgets used in
telerehab

It is difficult for the therapist to 3.111 0.934 Neither 4

maintain the patient's focus and
attention in performing exercises
during telerehab sessions.

Using a telerehab system can save 2.481 0.892 Neither 7

time and money.

Telerehab is not cost-effective in 3.185 0.681 Neither 3

terms of providing PT services to
patients.

In-person PT session is more 4.333 0.784 Strongly Agree 1

effective in treating patients
compared to telerehab
Total Weighted Mean 3.027

Technical Weighted SD Interpretation Ranking

Mean

It was difficult to maintain a stable 4.148 0.770 Agree 2

and fast internet connection

The internet connectivity is one of 4.629 0.492 Strongly Agree 1

the primary obstacles when 1
delivering services through
telerehab

31
The patient had the resources and 2.889 0.974 Neither 7
equipment needed to participate
effectively in telerehab session

It was difficult for both the physical 3.333 0.920 Neither 5

therapist and patient to setup the
equipment needed for telerehab

PT had complete tools needed to 2.667 1.038 Neither 8

demonstrate the exercises to be
performed by the patient on the
other end of the call (audio and/or
video)

It is the difficult to properly execute 3.481 0.893 Agree 4

and demonstrate to the patients the
exercises through video call

I did not experience any problems 3.629 1.115 Agree 3

regarding to internet connection,
patient evaluation, patient
confidentiality and privacy

PT was trained in operating the 2.889 1.251 Neither 7

necessary equipments in telerehab
such as video conferencing, data
sharing tools and incorporate other
treatment materials used to address
other existing impairments of
patients

PT was trained to perform 3.111 1.251 Neither 6

troubleshooting procedures when
the telerehab equipment fails or
malfunctions during therapy
sessions

Total Weighted Mean 3.419

Ethical Weighted SD Interpretation Ranking

Mean

I adhere to the professional codes 1.185 0.786 Strongly 2

of ethics and aware my clients of Disagree
their rights and obligations when
receiving telerehab services.

I respect the inherent dignity and 1 0.000 Strongly 5

rights of my patients. Disagree

I am trustworthy and 1.037 0.192 Strongly 3

compassionate in addressing the 5 Disagree
rights and needs of my
patients/clients.

I shall be accountable for making 1.111 0.320 Strongly 4

sound professional judgments. 3 Disagree

I demonstrate integrity in my 1.037 0.192 Strongly 3

relationships with my patients and 5 Disagree
their families.

32
Policies and regulations concerning 1.296 0.953 Strongly 1
adherence to the Code of Ethics and Disagree
practice of ethical actions when
doing telerehabilitation are
implemented and fulfilled at all
times

Total Weighted Mean 1.703

Significant difference in the challenges faced by the respondents according to

demographics

One of the main objectives of this study was to determine whether the demographic

characteristics of the respondents could affect or could cause a difference between the challenges

faced by the respondents when utilizing telerehabilitation. To know whether there were

significant differences between the challenges and the respondents’ demographics, the researcher

used statistical tools such as Kruskal-Wallis, One-way ANOVA, Pearson correlations, and

Spearman Rho. Ryan-Joiner Normality test was done to aid the researchers during data analysis

and interpretation (See Appendix A). Ryan-Joiner Normality Test measures how well the data

follow a normal distribution by calculating the correlations between the data and their normal

scores. (Ryan & Joiner, 1976)

The data presented in Table 6 indicated that there was no significant difference in the

challenges encountered by participants in relation to their demographic profiles (age, field of

specialization, and years of experience) with respect to the four key principles. All the p-values

were greater than 0.05, leading to the acceptance of the null hypothesis.This implied that

regardless of their age, field of specialization, or level of experience, participants encountered

similar challenges when using telerehabilitation with respect to the administrative, clinical,

technical, and ethical dimensions.

Table 6.
Significant difference in the challenges faced based on Demographics

Principles Admin Clinical Technical Ethical

p-value Deci p- Deci p- Deci p- Deci

sion value sion value sion value sion

Age 0.382 Accep 0.134 Accept 0.385 Accept 0.263 Accept

t null null null null

Field of 0.787 Accep 0.097 Accept 0.190 Accept 0.124 Accept

Specialization t null null null null
33
Years of 0.306 Accep 0.090 Accept 0.470 Accept 0.645 Accept
Experience t null null null null

Overall Qualitative Result according to Themes

The results of the survey were classified into themes found in Table 7, which derived

from the pattern of responses from all the respondents in the study. Considering the results, it is

evident that the technical dimension had the most challenges in telerehabilitation, with a total of

five challenges identified. These challenges included slow internet connection, lack of

equipment, poor setup, difficulty in demonstrating and giving instructions, and overseeing

patients during exercise.

While the technical dimension had the highest number of challenges identified, it is also

important to recognize the challenges in other dimensions as well: administrative and clinical. In

the administrative dimension, one challenge stands out, which is the difficulty overseeing and

ensuring patient’s safety. Furthermore in the clinical dimension, a total of four challenges were

identified, including lack of manual contact, inaccurate objective measurement, difficulty tracing

patients’ progress, and difficulty demonstrating and giving instructions. However, in relation to

the ethical dimension, there were no challenges identified by the respondents.

Table 7.

Overall Qualitative Result according to Themes

Themes Results

Administrative a. Difficulty overseeing and ensuring

patient’s safety

Clinical a. Lack manual contact

b. Inaccurate objective measurement
c. Difficulty tracking patients’ progress
d. Difficulty demonstrating and giving
instructions

Technical a. Slow internet connection

b. Communication problem
c. Lack of equipment
d. Poor setup
e. Overseeing patients during exercise

Ethical None

34
Discussion

The objective of this study was to determine the challenges faced by local PTs when

treating patients through telerehabilitation with respect to the key principles and to know whether

the demographic profiles of the respondents would affect the challenges they faced during

telerehabilitation in relation to the key principles of telerehabilitation.

In terms of the challenges faced by the participants when doing telerehab sessions in

relation to the key principles of telerehabilitation, results showed that the respondents

experienced challenges on three principles namely: Technical, Administrative, and Clinical

principles.

Among the three principles, the technical aspect ranked as the most challenging aspect,

followed by administrative and clinical aspects, respectively. This aligned with the results related

to the qualitative aspect of this study found in Table 7, wherein it was identified that internet

connectivity emerged as the primary obstacle encountered when delivering service through

telerehabilitation. This finding was consistent with the study conducted by Fischer et al. (2021) ,

which identified internet connectivity as a significant hurdle in the implementation of

telerehabilitation. In regards to that, the study of Leochico et al. (2021) also emphasized that the

poor quality of internet connection in the Philippines was the greatest challenge of

telerehabilitation. This supported the technical aspect wherein the respondents’ main challenge

during telerehabilitation was the internet connectivity.

Furthermore, the difficulty of maintaining a stable and fast internet connection during

telerehabilitation was another key technical challenge examined. This finding was consistent

with the research by Wilson and Peterson (2022), who emphasized that disruptions, delays, and

compromised audio or video quality can occur due to unreliable internet connectivity during

telerehabilitation sessions. To ensure effective remote therapy, it is crucial to address these

challenges and explore strategies for optimizing internet stability and speed.

On another note, the administrative aspect of telerehabilitation was the second most

challenging aspect based on the conducted survey. Stated on Table 5 were the specific challenges

the respondents encountered under the administrative principle namely participation of patients

residing in remote or rural areas, monitoring patient’s compliance, and maintaining mutual

understanding between the therapist and the patient during telerehab sessions. This finding

aligned with the collected data on the qualitative aspect wherein respondents identified that

35
overseeing and ensuring patient’s safety was a challenge found in Table 7. Along the same lines,

Fischer et al. (2021) highlighted the limitations of remote communication in capturing fine

details and nuances of movement.

Furthermore, respondents had encountered challenges under the clinical principle.

Among the specific components of clinical principle identified in Table 5 and 7 , results showed

that the participants had difficulty in terms of giving instructions and performing exercises

through video call, lack of manual contact, inaccurate objective measurements, and tracking

patient’s progress. In relation to this, Rodriguez and Gomez (2020) highlighted the importance

of providing clear and concise instructions, visual demonstrations, and effective communication

strategies. It is crucial for healthcare professionals to adapt their instructions and methods of

guidance to ensure patients can successfully perform exercises while receiving telerehabilitation.

Moreover, Hale and Kvedar (2014) discussed that tracking patients' progress was a common

challenge in telerehabilitation programs. They noted that it can be difficult to accurately assess a

patient's range of motion or strength remotely and that it may be necessary to supplement

telerehabilitation with in-person visits to ensure accurate monitoring of patient progress. In line

with this, the said results also coincided with the study conducted by Tyagi et.al (2018) stating

that connectivity issues , equipment setup, and patients’ assessments were identified by the

physical therapists as barriers in delivering services to patients.

In relation to the challenges on the ethical aspect, results showed that the participants had

not encountered any challenges.

In analyzing the results, it was found that there were no significant differences in the

challenges encountered by the participants in terms of their demographics presented in Table 6.

This implied that factors such as age, field of specialization, and years of experience showed no

significant differences concerning the four key aspects of telerehab based on the p-value

obtained from the statistical analysis.

Conclusion

Based on the results obtained from the investigation, the researchers came to the

conclusion that the most frequent challenges faced by physical therapist during telerehabilitation

were slow internet connection, difficulty demonstrating and instructing patients, inaccurate

objective measurement during patient assessment, communication issue, lack of manual contact

36
with patients, lack of equipment, poor setup, and difficulty monitoring the safety and progress of

patients.

The study revealed that participants encountered challenges in the administrative and

clinical aspects to a certain extent, while facing more significant challenges in the technical

aspect. In regards to the technical aspect, internet connectivity emerged as one of the most

challenging during the implementation of telerehabilitation during the pandemic. This was

supported by the study of Leochico et. al. (2021), that internet connection was the greatest

challenge here in the Philippines making it difficult for the physical therapists and patients to

have better communication and understanding during treatment sessions using telerehabilitation.

Respondents also encountered difficulties under the administrative concept, which included

participation of patients living in remote or rural locations, monitoring patient compliance, and

preserving mutual understanding between the therapist and the patient during telerehab sessions.

However, no notable challenges were reported in relation to the ethical aspects as the physical

therapists still practice ethical behaviors when treating their patients during the implementation

of telerehab.

In conclusion, the demographics of the physical therapists who used telerehabilitation in

delivering their services to patients and the challenges they encountered had no significant

difference with each other.

The findings of this study will help healthcare and technology organizations improve the

system and develop strategies that will benefit patients and the healthcare industry by easing the

difficulties they face in telerehab and ensuring the efficient provision of PT services to the

patients.

Recommendations

Based on the findings of the study, the researchers recommend that future investigators

should broaden the sample size of the respondents for this will give a better representation of the

study. As telerehabilitation in the Philippines has only recently surged due to the pandemic,

related studies should be conducted in the next three to five years documenting the growth of

telerehabilitation in the Philippine setting and what challenges are still encountered by the

physical therapists. Given the challenges faced in the technical and administrative principle,

physical therapists should consider collaborating with a patient’s significant other or caregiver in

37
order to monitor patient compliance as well as ensuring patient’s safety during treatment session.

In regards to the internet connectivity, physical therapists should consider investing in high mbps

internet to better deliver PT services through telerehabilitation or to prepare instructional

exercise videos as alternatives so that they can provide it to their patients in case there is a

connectivity problem during their session. Furthermore, it is essential that physical therapists

should undergo appropriate training, education, and ongoing professional development regarding

telerehabilitation to have enough knowledge regarding the said alternative in delivering PT

services to patients. In addition, it is recommended that physical therapists, technology and

telecommunication developers, and healthcare and business sectors should use the results and

information of this study to further investigate the effectiveness of telerehabilitation in the

Philippine setting.

References

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https://doi.org/10.47176/mjiri.35.100

Bezuidenhout, L., Joseph, C., Thurston, C. et al.Telerehabilitation during the COVID-19

pandemic in Sweden: a survey of use and perceptions among physiotherapists treating

people with neurological diseases or older adults. BMC Health Serv Res 22, 555 (2022).

https://doi.org/10.1186/s12913-022-07968-6

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telerehabilitation-services-elderly/296

Appendices

Appendix A. Ryan-Joiner Normality Test

43
44
Appendix B: University Research Ethics Committee

45
Appendix C: Survey Questionnaire

Good Day! We are the Physical Therapy Level 4 students from Silliman University and we

would like to interview you through this questionnaire regarding your experiences in doing

telerehab services with your patients and the challenges you encountered during your telerehab

sessions. The data collected will be used for our research study "Challenges in Delivering PT

Services Utilizing Telerehabilitation during the Pandemic". We assure you that the data gathered

will be treated as confidential and would be strictly used only in our study.

Part I

Name:

Age:

Sex:

Field of specialization:

Years of Experience:

Questions:

1. What are the challenges you encountered when doing therapy sessions with your patients

through telerehabilitation platforms?

2. How did you solve the challenges that you encountered when doing telerehab sessions

with your patients?

3. What is the most important factor when implementing telerehabilitation?

Part II

5 - highly agree

4 - agree

3 - neither agree nor disagree

2 - disagree

46
 1 - strongly disagree

Please check the box of your choice. (Note: The questions below are based on the Key

principles of Telerehabilitation (Administrative, Clinical, Technical , Ethical) formulated by the

Telerehabilitation Special Interest Group of the American Telemedicine Association.)

ADMINISTRATIVE 5 4 3 2 1

It was difficult maintaining data privacy and

high security control on the sensitive data

collected from the patients

It was difficult to maintain mutual

understanding between the patient and

therapist with regards to instructing the patient

to perform the exercises

It was difficult to track the progress of the

patient throughout the telerehab sessions.

It was difficult to monitor patient’s compliance

with the exercise program given through

telerehab.

Patient was fully engaged or participating

during telerehab session

47
Patients were able to easily understand the

instructions given through audio and/or video

call and was able to perform exercises

correctly

Patient was able to provide a space at home

where they can set up their equipment for

telerehab and can do their exercises

Patients from remote and rural areas can easily

participate in telerehab programs.

CLINICAL 5 4 3 2 1

I have full knowledge and clinical skill in

delivering telerehabilitation

My patient had difficulty performing the

exercises given through audio call and/or video

call.

Patient has a support staff or family member

that can assist in performing the exercises

given through telerehab.

The patient has the sufficient knowledge and

information on how to utilize smart gadgets

used in telerehab

48
It is difficult for the therapist to maintain the

patient's focus and attention in performing

exercises during telerehab sessions.

Using a telerehab system can save time and

money.

Telerehab is not cost-effective in terms of

providing PT services to patients.

In-person PT session is more effective in

rehabilitating patients compared to telerehab

TECHNICAL 5 4 3 2 1

It was difficult to maintain a stable and fast

internet connection

The internet connectivity is one of the primary

obstacles when delivering services through

telerehab

The patient had the resources and equipment

needed to participate effectively in telerehab

session

49
It was difficult for both the physical therapist

and patient to setup the equipment needed for

telerehab

PT had complete tools needed to demonstrate

the exercises to be performed by the patient on

the other end of the call (audio and/or video)

It is difficult to properly execute and

demonstrate to the patients the exercises

through video call.

I did not experience any problems regarding to

internet connection, patient evaluation, patient

confidentiality and privacy

PT was trained in operating the necessary

equipments in telerehab such as video

conferencing, data sharing tools and

incorporate other treatment materials used to

address other existing impairments of patients

PT was trained to perform troubleshooting

procedures when the telerehab equipment fails

or malfunctions during therapy sessions

ETHICAL 5 4 3 2 1

50
I adhere to the professional codes of ethics and

aware my clients of their rights and obligations

when receiving telerehab services.

I respect the inherent dignity and rights of my

patients.

I am trustworthy and compassionate in

addressing the rights and needs of my

patients/clients.

I shall be accountable for making sound

professional judgments.

I shall be accountable for making sound

professional judgments.

I demonstrate integrity in my relationships

with my patients and their families.

Policies and regulations concerning adherence

to the Code of Ethics and practice of ethical

actions when doing telerehabilitation are

implemented and fulfilled at all times.

51
Appendix D: Letter for Face Validity

SILLIMAN UNIVERSITY
Dumaguete City
Institute of Rehabilitative Sciences
Bachelor of Science in Physical Therapy

Jobelle Uriza, MBA

Master in Business Administration
Dumaguete City

Dear Jobelle Uriza

Greetings!

We, the BSPT level IV students of Silliman University undertaking a research project
entitled CHALLENGES OF PHYSICAL THERAPISTS IN DELIVERING PHYSICAL
THERAPY SERVICES UTILIZING TELEREHABILITATION DURING THE
PANDEMIC.

In this study, an online test questionnaire via google forms will be employed as an
instrument. In light of this, the researcher would want your assistance in validating the
accompanying researcher-made questionnaire in order to begin conduction of the data gathering
phase. Given your background in research, we’d like to enlist your assistance in validating the
attached instrument before distributing it to the study participants. We have the attached
validation sheet, questionnaire with specification table and research problem description.

We would appreciate hearing your suggestions and comments on how to enhance the
instrument. We are hopeful that our request will merit a favorable response from you. Your
enthusiastic response is much appreciated as this will greatly help us in the completion of the
study.

Thank you very much, and God bless.

Respectfully Yours,

Maria Isabel F. Auditor

Researcher

Shannen Ashley P. Cortez

Researcher

John Carlo Delegero

Researcher

MileaGionette M. Jalosjos
Researcher

52
Nessan Raphael H. Pinlac
Researcher

Christian Kent R. Roferos

Researcher

Noted by:

Raymond B. Esperida, MSPT, PTRP, FRIPOT, GDMT, CNMT, PhD

Research Adviser

53
 SILLIMAN UNIVERSITY
Dumaguete City
Institute of Rehabilitative Sciences
Bachelor of Science in Physical Therapy

Beberley Eleazar Polinar, BSEntep

Open University Department
Silliman University
Dumaguete City

Dear Beberley Eleazar Polinar,

Greetings!

We, the BSPT level IV students of Silliman University undertaking a research project
entitled CHALLENGES OF PHYSICAL THERAPISTS IN DELIVERING PHYSICAL
THERAPY SERVICES UTILIZING TELEREHABILITATION DURING THE
PANDEMIC.

In this study, an online test questionnaire via google forms will be employed as an
instrument. In light of this, the researcher would want your assistance in validating the
accompanying researcher-made questionnaire in order to begin conduction of the data gathering
phase. Given your background in research, we’d like to enlist your assistance in validating the
attached instrument before distributing it to the study participants. We have the attached
validation sheet, questionnaire with specification table and research problem description.

We would appreciate hearing your suggestions and comments on how to enhance the
instrument. We are hopeful that our request will merit a favorable response from you. Your
enthusiastic response is much appreciated as this will greatly help us in the completion of the
study.

Thank you very much, and God bless.

Respectfully Yours,

Maria Isabel F. Auditor

Researcher

Shannen Ashley P. Cortez

Researcher

John Carlo Delegero

Researcher

MileaGionette M. Jalosjos
Researcher
54
Nessan Raphael H. Pinlac
Researcher

Christian Kent R. Roferos

Researcher

Noted by:

Raymond B. Esperida, MSPT, PTRP, FRIPOT, GDMT, CNMT, PhD

Research Adviser

55
 SILLIMAN UNIVERSITY
Dumaguete City
Institute of Rehabilitative Sciences
Bachelor of Science in Physical Therapy

Marian B. Langley, PhD

Department of Education
Silliman University
Dumaguete City

Dear Marian B. Langley, PhD,

Greetings!

We, the BSPT level IV students of Silliman University undertaking a research project
entitled CHALLENGES IN DELIVERING PHYSICAL THERAPY SERVICES
UTILIZING TELEREHABILITATION DURING THE PANDEMIC..

In this study, an online test questionnaire via google forms will be employed as an
instrument. In light of this, the researcher would want your assistance in validating the
accompanying researcher-made questionnaire in order to begin conduction of the data gathering
phase. Given your background in research, we’d like to enlist your assistance in validating the
attached instrument before distributing it to the study participants. We have the attached
validation sheet, questionnaire with specification table and research problem description.

We would appreciate hearing your suggestions and comments on how to enhance the
instrument. We are hopeful that our request will merit a favorable response from you. Your
enthusiastic response is much appreciated as this will greatly help us in the completion of the
study.

Thank you very much, and God bless.

Respectfully Yours,

Maria Isabel F. Auditor

Researcher

Shannen Ashley P. Cortez

Researcher

John Carlo Delegero

Researcher

MileaGionette M. Jalosjos
Researcher
56
Nessan Raphael H. Pinlac
Researcher

Christian Kent R. Roferos

Researcher

Noted by:

Raymond B. Esperida, MSPT, PTRP, FRIPOT, GDMT, CNMT, PhD

Research Adviser

Appendix E. Thematic Analysis Coding

57
 CURRICULUM VITAE
Auditor, Maria Isabel F.

Phone #: 0965-361-9893
Email: [email protected]
Address: Lalawan, Dicayas , Dipolog City, Zamboanga del Norte

EDUCATION
June 2018-Present BS Physical Therapy, Silliman University
June 2016-April 2018 Zamboanga del Norte National High School
June 2009-March 2016 St. Mary’s Academy, Dipolog City
June 2006-March 2009 St. Theresa’s College, Quezon City

AWARDS

2018-2019 SU Class Honors, Academic Scholarship

Recipient
2017-2018 With High Honors
2009-2017 With Honors

CERTIFICATION AND PARTICIPATIONS

June 12, 2022 COVID 19: How to put on and remove PPE
June 12, 2022 WHO Infection Prevention and Control (IPC in
June 16, 2022 the context of COVID 19
June 25, 2022 Basic Life Support Training
August 6-7, 2022 The Stroke Society of the Philippines - Stroke
Rehabilitation Workshop
February 5, 2023 PAOMPT Lecture Series: Manual Therapy
Mechanisms and Clinical Outcomes
February 5, 2023 PAOMPT: Lecture Series: Concussion:
Assessment and Management
February 12, 2023 PAOMPT Lecture Series: Clinicians as
Researchers: Publishing Case Reports
February 12, 2023 PAOMPT Lecture Series: Parkinson’s Disease
and overview of LSVT BIG

WORKING EXPERIENCE

August 2022 Negros Oriental Provincial Hospital (Intern)

September 2022 Rehab Solutions Inc. (Intern)
October 2022 Cebu South Medical Center (Intern)
November 2022 Allied Care Experts Dumaguete Doctors Inc. 58
(Intern)
December 2022 Silliman University Valencia-CBR (Intern)
January 2023 Chonghua Rehab Medics (Intern)
February 2023 Vicente Sotto Memorial Medical Center (Intern)
March 2023 Vicente Sotto Memorial Medical Center (Intern)
April 2023 AMOSUP-Seamen’s Hospital
May 2023 AMOSUP-Seamen’s Hospital

EXTRACURRICULAR ACTIVITIES
2018-Present SUPTSA Member

SKILLS SUMMARY

Language: Bisaya, Tagalog and English

Interest: Designing, Sketching, Singing

59
 CURRICULIM VITAE
Cortez, Shannen Ashley P.

Phone #: 0975-342-1798
Email:[email protected]
Address:Sta. Monica Road, Banilad, Dumaguete City, Negros Oriental

EDUCATION
June 2019-Present BS Physical Therapy, Silliman University
June 2007-March 2019 Saint Louis School of Don Bosco Dumaguete

AWARDS
2017-2019 With Honors
2019 Student Athlete of the Year
2021 Class Honors

CERTIFICATION AND PARTICIPATIONS

June 14, 2022 COVID 19: How to put on and remove PPE
June 17, 2022 WHO Infection Prevention and Control (IPC in
the context of COVID 19
June 16, 2022 IPC Seminar and Workshop
March 27, 2022 Basic Life Support Training
June 13, 2022 Acute Care Workshop
June 6, 2022 Sports Emergency Webinar
March 26, 2022 Blood Flow Restriction 101 & ACL Rehab
Pearls and Pitfalls
January 22, 2023 PAOMPT Lecture Series: Integrating Pilates-
Based Movements to home programs
February 5, 2023 PAOMPT Lecture Series: Manual Therapy
Mechanisms and Clinical Outcomes
PAOMPT Lecture Series: Concussion:
Assessment and Management

WORKING EXPERIENCE
August 2022 Cebu Rehab Medics (Intern)
September 2022 Silliman University Marina Mission Clinic-
Community-Based Rehabilitation (Intern)
October 2022 Rehab Solutions Inc. (Intern)
November 2022 Allied Care Experts Dumaguete Doctors Inc.
(Intern)
December 2022 Silliman University Medical Center (Intern)
January 2023 Institute of Rehabilitative Sciences Free Clinic
(Intern) 60
February 2023 Bacolod Adventist Medical Center (Intern)
March 2023 Allied Care Experts Dumaguete Doctors Inc.
(Intern)
April 2023 Allied Health Academics – SPHERE (Intern)
May 2023 Allied Health Academics – SPHERE (Intern)

EXTRACURRICULAR ACTIVITIES
2019-Present SUPTSA Member
College Varsity – Basketball Girls
SKILLS SUMMARY

Language: Bisaya, Tagalog and English

Interest: Fitness, Sports, Adventure, Travel

61
 CURRICULUM VITAE
Delegero, John Carlo

Phone #: 0916-567-7256
Email: [email protected]
Address: Poblacion, Santa Catalina, Negros Oriental

EDUCATION
June 2019-Present BS Physical Therapy, Silliman University
June 2017-April 2019 Senior High School, Silliman University
June 2013-March 2016 St. Augustine Academy of Bayawan, Inc.
June 2007-March 2012 Santa Catalina Central Elementary School

AWARDS

CERTIFICATION AND PARTICIPATIONS

June 14, 2022 COVID 19: How to put on and remove PPE
June 17, 2022 WHO Infection Prevention and Control (IPC in
the context of COVID 19
June 16, 2022 IPC Seminar and Workshop
March 27, 2022 Basic Life Support Training
June 13, 2022 Acute Care Workshop
June 6, 2022 Sports Emergency Webinar
March 6, 2022 Blood Flow Restriction 101 & ACL Rehab
Pearls and Pitfalls
January 22, 2023 PAOMPT Lecture Series: Individualized
Rehabilitation for Flexor Tendon Repair
January 29, 2023 PAOMPT Lecture Series: Vestibular Disorders:
Central versus Peripheral Pathologies
PAOMPT: Lecture Series: Differential
Diagnosis in Physiotherapy: Screening for
referral of the Cervical Spine

WORKING EXPERIENCE
August 2022 ACE Dumaguete Doctors, Inc. (Intern)
September 2022 Rehab Solutions Inc. (Intern)
October 2022 Chonghua Rehab Medics (Intern)
November 2022 Negros Oriental Provincial Hospital (Intern)
December 2022 Allied Health Academics – SPHERE (Intern)
January 2023 Allied Health Academics – SPHERE (Intern)
February 2023 Silliman University Medical Center Foundation, 62
 Inc. (Intern)
March 2023 Silliman University Marina Mission Clinic –
CBR (Intern
April 2023 Bacolod Adventist Medical Center (Intern)
May 2023 Institute of Rehabilitative Sciences Free Clinic
(Intern)

EXTRACURRICULAR ACTIVITIES
2019-Present SUPTSA Member

SKILLS SUMMARY

Language: Bisaya, Tagalog and English

Interest: Sports, e-Sports, Technology

63
 CURRICULIM
VITAE
Jalosjos, Milea Gionette M.

Phone #: 0946-502-9569
Email: [email protected]
Address: Near Gamalinda, Rd 21, Banonong Lawaan, Dapitan
City, Zamboanga del Norte

EDUCATION
June 2019-Present BS Physical Therapy, Silliman University
August 2017-May 2019 Jose Rizal Memorial State University-Main
June 2013-March 2017 Campus
August 2011-June 2013 PISCO Private School – Abu Dhabi, UAE
June 2007-March 2011 Dapitan City Central School

AWARDS
2013-2017 With Honors
2016-2017 Gerry Roxas Leadership Award

CERTIFICATION AND PARTICIPATIONS

June 14, 2022 COVID 19: How to put on and remove PPE
June 17, 2022 WHO Infection Prevention and Control (IPC in
the context of COVID 19
June 16, 2022 IPC Seminar and Workshop
March 27, 2022 Basic Life Support Training
June 13, 2022 Acute Care Workshop
June 6, 2022 Sports Emergency Webinar
June 21, 2022 Sports Emergency Webinar
February 5, 2023 PAOMPT Lecture Series: Manual Therapy
Mechanisms and Clinical Outcomes
February 5, 2023 PAOMPT: Lecture Series: Concussion:
Assessment and Management

WORKING EXPERIENCE

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August 2022 Negros Oriental Provincial Hospital (Intern)
September 2022 Rehab Solutions Inc. (Intern)
October 2022 Cebu South Medical Center (Intern)
November 2022 Allied Care Experts Dumaguete Doctors Inc.
(Intern)
December 2022 Silliman University Valencia-CBR (Intern)
January 2023 Chonghua Rehab Medics (Intern)
February 2023 Vicente Sotto Memorial Medical Center (Intern
March 2023 Vicente Sotto Memorial Medical Center (Intern)

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April 2023 AMOSUP-Seamen’s Hospital
May 2023 AMOSUP-Seamen’s Hospital

EXTRACURRICULAR ACTIVITIES
2019-Present SUPTSA Member

SKILLS SUMMARY

Language: Bisaya, Tagalog and English

Interest: Community Service, Sports – Lawn Tennis, Dancing

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 CURRICULU
M VITAE

Pinlac, Nessan Raphael H.

Phone #: 0918-273-4929
Email: [email protected]
Address: 104 Tubod Springville, Hibbard Avenue, Baranggay Looc,
Dumaguete City, Negros Oriental

EDUCATION
January 2018-Present BS Physical Therapy, Silliman University
June 2017-November 2017 BS Nutrition & Dietetics, Silliman University
June 2015-March 2017 Silliman University Senior Highschool
June 2012-March 2015 Silliman University Junior Highschool
June 2007-March 2012 ABC-Learning Center, Bantayan Dumaguete

AWARDS
2017 With Honors, Silliman University Senior
Highschool

CERTIFICATION AND
PARTICIPATIONS
June 14, 2022 COVID 19: How to put on and remove PPE
June 17, 2022 WHO Infection Prevention and Control (IPC
in the context of COVID 19
June 16, 2022 IPC Seminar and Workshop
March 27, 2022 Basic Life Support Training
June 13, 2022 Acute Care Workshop
June 6, 2022 Sports Emergency Webinar
June 21, 2022 Sports Emergency Webinar
February 5, 2023 PAOMPT Lecture Series: Manual Therapy
Mechanisms and Clinical Outcomes
February 5, 2023 PAOMPT: Lecture Series: Concussion:
Assessment and Management

WORKING EXPERIENCE

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August 2022 Negros Oriental Provincial Hospital (Intern)
September 2022 Cebu South Medical Center (Intern)
October 2022 Bacolod Adventist Medical Center (Intern)
November 2022 Allied Care Experts Dumaguete Doctors Inc.
(Intern)

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December 2022 Institute of Rehabilitative Science Free Clinic
(Intern)

January 2023 Rehab Solution Inc. (Intern)

February 2023 Silliman University Valencia-CBR (Intern)
March 2023 Silliman University Valencia-OPD (Intern)
April 2023 AMOSUP-Seamen’s Hospital (Intern)
May 2023 AMOSUP-Seamen’s Hospital (Intern)

EXTRACURRICULAR ACTIVITIES
2019-Present SUPTSA Member

SKILLS SUMMARY

Language: Bisaya, Tagalog and English

Interest: Music, Animals, Videogames

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 CURRICULU
M VITAE
Roferos, Christian Kent R.

Phone #: 0917-144-7696
Email: [email protected]
Address: P7 San Vicente Bajo, Oroquieta City, Misamis Occidental

EDUCATION
June 2019-Present BS Physical Therapy, Silliman University
June 2017-April 2019 Silliman University Senior High School
June 2007-March 2017 Firm Foundation Christian Academy, Oroquieta
City

AWARDS

CERTIFICATION AND PARTICIPATIONS

June 6, 2022 Sports Emergency Webinar
June 12, 2022 COVID 19: How to put on and remove PPE
June 13, 2022 Acute Care Workshop
June 16, 2022 Infection and Prevention Control Seminar and
Workshop
March 25, 2022 Basic Life Support Training
February 5, 2023 PAOMPT Lecture Series: Manual Therapy
Mechanisms and Clinical Outcomes
February 12, 2023 PAOMPT Lecture Series: Clinicians as
Researchers: Publishing Case Reports
February 12, 2023 PAOMPT Lecture Series: Parkinson’s Disease
and overview of LSVT BIG

WORKING EXPERIENCE

August 2022 Negros Oriental Provincial Hospital (Intern)

September 2022 Cebu South Medical Center (Intern)
October 2022 Bacolod Adventist Medical Center (Intern)
November 2022 Allied Care Experts Dumaguete Doctors Inc.
(Intern)
December 2022 Institute of Rehabilitative Sciences Free Clinic
(Intern)
January 2023 Rehab Solutions Inc. (Intern) 70
February 2023 Silliman University Valencia-CBR (Intern)
March 2023 Silliman University Valencia-OPD (Intern)
April 2023 AMOSUP-Seamen’s Hospital (Intern)
May 2023 AMOSUP-Seamen’s Hospital (Intern)

EXTRACURRICULAR ACTIVITIES
2019-Present SUPTSA Member
2022-Present Silliman University Camera Club Member
SKILLS SUMMARY

Language: Bisaya, Tagalog and English

Interest: Sports and Photography

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