Remote rehabilitation program gives rural patients an arm up on shoulder injuries

Telerehabilitation technology broadens access to specialized care.


Students Mahtab (standing) and Javad (seated) practise a telerehabilitation procedure using markerless motion capture to measure a patient’s shoulder range of motion. (Photo: Supplied)

After Landon Charlton broke his shoulder, he faced a five-hour trip to Edmonton from Peace River, Alta., every time he needed to receive specialized treatment. To make matters worse, the injury was exacerbated until he learned of his diagnosis.

“I thought it was just sore, and I wasn’t aware it was broken, leading to further complications,” he says.

Traditional avenues to address his shoulder pain in Peace River, a town with a population of fewer than 7,000, offered limited relief.

Lauren Beaupre, a professor in the University of Alberta’s Faculty of Rehabilitation Medicine and David Magee Chair in Musculoskeletal Research, points out that Charlton’s experiences aren’t unusual for rural Albertans who face significant challenges with access to specialized health care.

“There is a scarcity of specialists in rural areas, and residents like Landon are expected to travel long distances for medical care, incurring substantial costs,” explains Beaupre.

Charlton is among the 20 per cent of Canadians who live in rural areas, where only about eight per cent of the country's doctors are available, as reported by the Canadian Institute for Health Information.

To help meet these challenges and ensure no one is left behind because of geographical or financial limitations, her team recently received a Transforming Health with Integrated Care (THINC) CIHR Team Grant worth nearly $2 million, with a focus on assessing and treating shoulder pain and instability through specialized remote support called telerehabilitation.

Her research centres on improving treatments for musculoskeletal injuries, encompassing care before and after surgery, and improving patient experiences by enhancing care delivery.

The project, called ARMS UP (Alberta’s Remote Management of Shoulders Program), combines two key components, says Beaupre: applying well-established evidence to practice and encouraging its adoption.

“This involves two main areas of recent research. The first focuses on a streamlined shoulder screening process for patients. The second element, spearheaded by (rehabilitation medicine professor) Martin Ferguson-Pell and his team, focuses on expanding access to rural health care.”

Using robots to connect patients with professionals

Ferguson-Pell, who has expertise in biomedical engineering, says, “A major practical challenge of the project is the installation of specialized equipment in remote areas. Once set up, this telerehabilitation equipment allows rural patients to connect with urban specialists, creating a clinic-to-clinic model that enhances the safety and effectiveness of clinical assessments.”

A fascinating aspect of the technology is the use of telepresence robots, says Ferguson-Pell.

“By controlling these robots remotely, urban clinicians can perform thorough assessments as if they were physically present. This enhances the interaction quality and strengthens the trust between patients and distant health-care providers.”

“This system not only improves diagnostic accuracy but also helps in building the expertise of rural health-care providers, reducing their professional isolation and fostering a community of practice where there is mutual learning and collaboration between urban and rural practitioners,” adds Beaupre.

The power of personalized therapy

Charlton admits he was at first doubtful about this form of treatment, but his skepticism vanished when he saw the results for himself.

“It was amazing. I started doing the proper exercises instead of just generic shoulder movements, which made all the difference.”

Under the watchful eye of specialists from Edmonton, Charlton’s rehabilitation was meticulously mapped out over two months. Weekly video sessions focused on assessing and adjusting his exercise regimen.

“I had one-hour sessions where I had to stand against a wall and there’s a person on a screen in front of me who can see me through a camera. The therapist would ask me to move in certain ways and check my movements using the camera. For example, if I lift my arms, she can see whether it’s my shoulder or arm moving and if I’m in pain. If I don’t understand something, a nurse in the room can help me. The nurse and staff were there to explain physio terms to me in a way I can understand,” Charlton explains.

“The aim is to ensure the program uses resources judiciously,” Beaupre says, noting that many older patients with shoulder issues might have common conditions like rotator cuff tears, which often don’t need surgery to treat.

“The screening clinics play a pivotal role in directing patients towards specialists only when necessary and in reducing unnecessary MRIs, as seen in the dramatic reduction of MRI referrals in the Lethbridge clinic,” she adds.

Ferguson-Pell adds that “only about 25 per cent of patients with shoulder issues require surgery, while most can benefit from non-surgical care. The project aims to implement a virtual rapid access clinic program to expedite the process of determining the appropriate treatment pathway.”

Improving access, reducing costs

The technology is not limited to shoulder assessments, Ferguson-Pell notes.

“Our team is also working on protocols for assessing other musculoskeletal conditions, including hips, knees and backs, and expanding into areas like stroke recovery.”

Charlton says early intervention of this kind would have been a game-changer for his father.

“My dad’s knee is in terrible shape; he struggles immensely with walking up and down stairs. Financial constraints prevented him from travelling to Calgary or Edmonton for regular physiotherapy sessions. As a result, he’s resigned to waiting until his knee deteriorates enough to warrant a replacement.”

Ferguson-Pell highlights this disparity, noting that while urban residents might have to deal with parking fees and travel time to hospitals, the cost for a rural Albertan to make a single trip for health care can average around $420 — and for many rural patients the out-of-pocket cost is considerably more.

The ARMS UP initiative represents a substantial advance toward achieving health-care equity, says Beaupre.

“We hope to gradually shift more responsibilities to rural clinics, thereby enhancing local health-care capabilities and reducing dependence on urban-based specialists. The hope is that these initiatives, once proven effective, will continue beyond the scope of the research, becoming an enduring part of health care.”

As for Charlton, he says the ARMS UP program was life-changing.

“I went from being unable to use my right arm; I couldn’t lift it or do anything with it. Now I have almost full range of motion. I went from being in pain all the time to having my life back. I can do everything, like playing hockey again.

“I’ll definitely be sharing my experience with everyone in my community.”