Accessibility, safety, and effectiveness of telerehabilitation for public safety personnel with posttraumatic stress injuries: an interpretive description study

Public safety personnel (PSP) are regularly exposed to stress which can result in the development of posttraumatic stress injuries (PTSIs) and leave them unable to work. The COVID-19 pandemic caused a shift in the delivery of PTSI rehabilitation to telerehabilitation (mainly videoconference, but some telephone-based care). The present study employed an Interpretive Description design to explore the lived experiences of PSP, clinicians, and decision-makers regarding the safety, accessibility, and effectiveness of PTSI telerehabilitation. We used purposive and convenience sampling techniques, aiming to maximize variation. Interview data were generated using semi-structured interviews and analyzed using an integrated, team-based approach to Braun and Clarke’s reflexive thematic analysis. Our final sample consisted of 34 participants: 12 PSP, 14 clinicians, and eight decision-makers. Three themes were generated: (1) Responding to the uniqueness of individuals and their contexts; (2) Prioritizing different elements of safety at different times; and (3) Facets of care that lead to perceptions of credibility. While telerehabilitation offers accessibility and flexibility, its application necessitates a nuanced, person-centred approach. Clinicians need to tailor the mode of delivery to PSP and be aware of the potential limitations in observing subtle cues and fostering the therapeutic alliance virtually. Decision-makers should consider policies that support a hybrid model of care, balancing PSP preference and the potential need for in-person interventions to address avoidance and facilitate crucial components of care. Ultimately, for PSP, telerehabilitation presents a valuable option for accessing timely, comfortable care, but open communication with clinicians about preferences and any challenges experienced with virtual modalities is paramount.