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Organizational, clinical, administrative and legal aspects

Organizational, clinical, administrative and legal aspects

This part of the project aimed at collecting and providing detailed information on how implementation of the telerehabilitation service occurs at the different clinical centres involved in the CLEAR Project in order to trace a road map for implementing the CLEAR service from the organizational, clinical, administrative and legal point of view (from the Hospital perspective). Within this road map all the professionals involved in the service provision can find clear and precise details and procedures to drive them along the service activities.
Main topics of the investigation can be summarized as:

  • users characterization
  • information on Current Rehabilitation Service
  • motivation for the onset of the telerehabilitation service
  • Target Patient Group:
    • Criteria for belonging to the TPG;
    • Selection and assessment Procedures;
  • organizational issue:
    • staff (staff involved; skill and roles; time dedicated to the treatment);
    • location;
    • equipment (hw; sw; further equipment);
  • patient management procedures (During the stay in the Centre; remotely);
  • data security issues;
  • safety issues;
  • legal issues (e.g. procedures for treating personal data );
  • administrative issues
    • Convention/contracts with external organizations
    • Reimbursement procedures;

At the end of the project a validation and a generalization of the above information and procedures will provide useful contribution to the preparation of service guidelines.


Briefly, 4 clinical centres are involved in the project:

  1. Roessingh Rehabilitation Centre (RCR)is a rehabilitation hospital in the eastern part of the Netherlands. At RCR the CLEAR service is implemented with the aim to partly replace or in addition to traditional rehabilitation care for patients with Chronic Obstructive Pulmonary Diseases (COPD) and chronic pain (low back pain (CLBP) and whiplash (WAD)). With this implementation they aim on making rehabilitation care more cost-effective.
  2. Fundació Privada Institut de Neurorehabilitació Guttmann (FPING)is a leading hospital in the medical treatment, surgery and full rehabilitation of patients with spinal cord injury, acquired brain damage or any other serious neurological disability, sited in the region of Catalunya, Spain. With the CLEAR service they aim on making cognitive rehabilitation care more effective for patients suffering from cognitive impairment following acquired brain injury, such as traumatic brain injury (TBI) or stroke.
  3. Azienda Unità Sanitaria Locale 11 (AUSL11)department of rehabilitation and frailties organizes and coordinates services for rehabilitation and geriatric medicine for the Tuscany region in Italy. They will use the CLEAR service for more effective rehabilitation of impairments of the upper paretic limb after stroke. Arm functions play a fundamental role for manipulation, reaching, and interaction with the environment.
  4. The medical university of Warsaw (MUW), Poland, the chair and Department of Orthopedics and Traumatology of Locomotor System, Center of Excellence "TeleOrto" serves as specialized unit for Orthopedic and Trauma University Hospital treating adults and children with a musculoskeletal injuries and disorders. Here, the CLEAR Service will be implemented both preoperative and postoperative for those patients with a total hip and knee replacement. The aim is to make treatment more cost-effective and to make the expert centre services accessible for a broader region.

Relevant outcomes of the study are summarized here below.

Target Patient Group

The target patient groups that will differ among the centres: i) at RCR patients will be treated with Chronic Obstructive Pulmonary Diseases (COPD), chronic pain (low back pain (CLBP) and whiplash (WAD); ii) MUW will treat patients with total knee or hip replacements; FPING will treat patients with acquired brain injury due to TBI or Stroke; AUSL11 will treat patients with chronic stroke. Also the content of the CLEAR treatments are very different: RRC and MUW want to focus on physical exercises in terms of general condition, mobility, strength, coordination and propioceptive controls of patients; FPING focuses on cognitive training; AUSL11 focuses on physical training of the upper limbs of Stroke patients.


The places where the CLEAR treatment will be provided are more or less the same. All clinical centres start with exercising at the clinic before using CLEAR in the daily environment. The daily environment is home for RCR-COPD, RCR-Chronic pain and FPING. FPING also foresees application in care centres where patients go to after rehabilitation. For AUSL11 the place in the daily environment will be two ‘kiosks’.


The equipment is standard for every centre: a (tablet) computer for professionals and patients. FPING requested technical adaptations for a proper use of the equipment.


The staff of every centre is different but most of the time physical therapists are involved with the CLEAR treatment (RCR and AUSL11). At FPING a neurophysiologist is involved too, and at RCR patients have the possibility to contact a vocational therapist by the CLEAR platform.

Patient management

At each centre the patient will be monitored during the CLEAR treatment. Patients receive feedback about their performance in difference ways but in any case patients don’t lose contact with their therapist. All patients of the three centres are assigned by inclusion criteria. Their physical or cognitive level is measured by different assessment and questionnaires. At each centre each participant is asked to sign an informed consent.

Security Issues

Clinical centres stress the importance of having personal IDs, encryption of data and rules for access control. The centres have consensus about the privacy of the participants. All personal data will be looked and linked to a patient personal ID (not traceable to the identity of the individual). The data will be stored at every country separately and only members of the CLEAR project have access of this information.

Legal Aspects

Concerning the legal aspects, information consent procedures are considered important as well as a user license agreement signed by the patient for receiving the CLEAR equipment and proper handling of it. In all involved countries rehabilitation treatment is covered by Health Insurance companies of national Health insurance. It is expected that the CLEAR Service will also be covered by the Health insurances but the way how to do/arrange this needs to be sort out during the project.