Preferences for In-person, Telehealth, or Hybrid Rehabilitation Services for Individuals with Diverse Disabilities

Research Objectives: Determine service delivery preferences for individuals with different disabilities, as well as from rural and urban areas.

Design: This study employs concurrent mixed methods utilizing quantitative t-tests and regression with qualitative thematic analysis.

Setting: Data was collected from an online survey sent to patients following telehealth sessions at Shepherd Center, a disability rehabilitation center, April-July 2020 (N=300).

Participants: Of the 309 respondents, most were female (64.7%) and White (69.2%) with an average age of 51.57 (range=12-83, SD=13.63).

Interventions: none

Main Outcome Measures: preferences related to telehealth

Results: Respondents lived an average of 65.04 miles (SD=89.06) from Shepherd Center with 9.7% in rural counties. Respondents experienced various disabilities: 21.0% ABI, 10.7% SCI, 61.3% MS, and 8.7% with other disabilities.

Patients who lived farther from Shepherd Center preferred telehealth (β=0.07, p< 0.05), as did patients who live in rural versus urban counties (β=0.39, p< 0.05). Patients in rural areas travel more than twice as many miles as non-urban patients (rural: M=112.53, SD=54.91; non-rural: M=39.28, SD=42.07) (t=8.32, p< 0.001, d=1.69), with a higher estimated cost of $82.04 round trip ($0.56/mile).
No statistical differences for preference in service delivery methods were identified between disability type. Preferences for delivery of healthcare services according to qualitative methods were as follows:
Telehealth. Patients who preferred telehealth services indicated it was primarily for convenience, with most comments from patients in rural areas indicating that time/cost savings associated with less travel were key.

In-person. Overall, patients who preferred in-person services indicated it was due to benefits of personal interactions with the care team.

Hybrid. Several patients preferred receiving a hybrid model because it combined benefits of telehealth and in-person services.

Conclusions: The results suggest: 1) individuals from rural areas and who live farther away prefer telehealth services; 2) telehealth was similarly preferred by and is appropriate for individuals of all disability types; and 3) hybrid models of care should be considered for future service delivery, with telehealth offered for basic services and in-person services offered for intensive/detailed services.

Author(s) Disclosures: none