Feedback from the MEMORehab Trial in New Zealand

We are happy to provide a summary of the findings from the MEMORehab trial across several sites in New Zealand.  Feedback was based on experience by 11 clinicians (Occupational Therapists, Neuropsychologists and Speech/Language Therapists) and 1 student who tried out the program with a total of 28 participants.   There was one patient with a CVA and one with a spinal cord injury, but all the others had either a TBI or concussion. They ranged in age from 20 to 77.  During this trial, 96% of patients who were considered appropriate for the program were successfully engaged. 

Main points:

• MEMORehab works in NZ!

  
  

• The majority of clinicians praised the program and recommended it for hospital, private practice, and university training clinic settings

  
  

• Minor changes were requested, which have been addressed in the latest round of development.

  
  

• Some therapists and patients had difficulty with or did not like the digital nature of the program/videoconferencing component.  As a result, we now offer an off-line version as well.

  
  

• All billed for the provision of the six guided MEMORehab sessions through the ACC

Further details:

Some clinicians chose to run the six interactive sessions in-person and others used the built-in videoconferencing option.  All the participants were run one-on-one (rather than in groups) – mainly for billing purposes.  The ACC provided funding for participants in this trial (covering the costs of the interactive sessions whether they were run in person or over videoconferencing). 

Two clinicians commented that clients with cognitive impairment not funded by ACC (e.g. post CVA or other neurological condition) would also greatly benefit from MEMORehab. They suggested that it might be appropriate for clinicians working for District Health Boards funded by Health New Zealand.

Clinicians’ specific comments included:

• Overall, a useful resource, especially for higher-level clients due to increased complexity levels; however also good for lower-level clients.

  
  

• Content was relevant.

  
  

• I found the program great. I only used it 1:1 though and so I found it easy to modify to my client. I think if I was running it as a group I would find it really hard to fit the sessions into one hour.  

  • NB: each videoconferencing session can use up to 105 min for the meeting.  15 min is provided for setting up and greeting prior to start and 30 min is available after the scheduled stop time.)

  • NB: Suggestions are made over the course of each session (in the Slide Notes) as to where cuts can be made to shorten the session time.

    
    

• My clients really enjoyed using the app and enjoyed the challenge of the exercises.

  
  

• As a speech language therapist there could probably be a little more added to the word retrieval section of the app.

  • NB: Because the focus of MEMORehab is on improving “memory”, content related to word retrieval (other than memory for people’s names) is limited to a pre-session video and its discussion within the related session.  However, note that information and strategies can be added by a therapist when it is appropriate.

    
    

• There were some difficulties with clients understanding the logging in process,  screen-freezing technical difficulties for one client (possibly related to limited internet bandwidth) and some navigation issues through the program, but these were rare.

  • NB: screen freezing might also have been caused by using a browser other than Chrome, as advised in the manual.

  • NB, as noted above, if using a computer presents a major barrier, MEMORehab now offers a version that can be run completely off-line.

    
    

• Some clinicians expressed a desire for even more of the program to be self-guided by participants

  • Note: this would mean a reduced ability to bill for this service. 

Suggestions for making the content more appropriate to the NZ context

• Creating some videos of places in NZ for the Computer-based Exercise involving memory for a route.

  • Response: As the computer-based exercise involving videos to practice sustained attention uses professionally made videos filmed in Europe and bought from the producer on the internet, MEMORehab has no immediate plans to add a video filmed in NZ to the app – though these would likely be lovely!

    
    

• Adding an optional karakia (Maori prayer) to start and end an interactive session and including some Maori words throughout would be culturally appropriate.

  • Response:  This advice will be added to the manual, but because the slides for the sessions need to be more generally appropriate across English-speaking countries, such content will not be added there. Clinicians can also adapt the slides to their context.

Future Plans:

Overall, larger organisations with a steady stream of ACC-funded patient referrals were more likely to say they would buy an annual (Organisation level) license.  Some individuals in private practice or with hospital positions were interested in the annual (Clinic level) licenses.  One individual in private practice with relatively little time devoted to delivering rehabilitation was tempted by the individual participant license option, though noted that ACC would not pay the cost of such a license.

It was suggested that the ACC might be interested in finding out more about the group approach offered through MEMORehab, as this might be cost-saving for them and we are looking into this.

We are also very interested in exploring whether hospital rehabilitation wards and/or university training programs in NZ would be keen to try MEMORehab.