Article
Effects of telerehabilitation in occupational therapy practice: A systematic review.
Authors
Goris Hung KN and Kenneth NK Fong
Journal
Hong Kong Journal of Occupational Therapy
Research Design
Systematic Review
Purpose
The purpose of this study was to review the current evidence on the application of telerehabilitation and its clinical outcomes in OT practice over the past 10 years.
Methods
Table 1: Inclusion Criteria for Articles
| Inclusion Criteria for Articles |
| All clinical trials (Class I–IV studies) were chosen. Articles where only full text was available. Full text published in English 1/2008–10/2017. Use of telerehabilitation to provide clinical OT services from a distance Any pathology and impairment Study population of all ages All types of occupational therapy intervention |
Table 2: Keywords used to search in databases
| Keywords used to search in databases |
| “Telerehabilitation” OR “Tele-rehabilitation” OR “Telemedicine” OR “Telehealth” AND “Occupational Therapy” |
Table 3: Databases Used.
| Databases Used |
| Medline = 84, SAGE = 31, CINAHL = 14, Science Direct = 88, Cochrane Library = 22, Web of Science = 14, EMBASE = 148 Total outcome: 401 abstracts |
Table 4: Exclusion Criteria.
| Exclusion Criteria—Excluded 386 of the 401 articles and included 15 articles for review. |
| Overviews of the application of TR in OT Systematic reviews Meta-analyses Duplicates Studies unavailable in full text Studies examining the development of technology systems Studies determining the reliability and validity of assessment Application in continuing professional development Treatment carried out by multidisciplinary teams |
Table 5: Article Strength Information.
| Article Strength Information |
| Included: 15 articles Class I—3 Randomized Control (RCT) Articles PEDro (Physiotherapy Evidence Database) Scale to analyze strength of RCT articles. PEDro score of 6-10 indicates a high methodological quality RCT. 1 article at 7/10=High 1 article at 6/10=High 1 article at 4/10=Fair Class II & III—8 quasi-experimental study; 1 trial with single group post-intervention. Class IV—3 single case studies |
Figure 1: Levels of Research Evidence
Results
Table 6: Effects of Telerehabilitation Summary
| Quality of Research | Results |
| Class I: RCT (3 articles) | Significant improvements in the telerehabilitation group compared to control group: In dexterity of children with unilateral cerebral palsy. (Ferrer et al., 2017) With quality of life among stroke survivors. (Hegel et al., 2011) Emotional status with breast cancer survivors receiving chemotherapy. (Linder et al., 2015) |
| Class II-IV (12 articles): quasi-experimental trial with single-group post-intervention single-case studies | All studies demonstrated the feasibility of applying telerehabilitation to deliver OT services across age groups and diagnoses. Six studies measured caregiver and client satisfaction and found: All participants and caregivers were satisfied with the quality of the program and had a positive view of telerehabilitation (Boehm et al., 2015; Criss, 2013; Hegel et al., 2011; Linder et al., 2015; Ng et al., 2013; Yuen & Pope, 2009). Research results showed improvements in: Functional performance post-stroke (Hermann et al., 2010) and TBI (Ng at al., 2013) Occupational performance with the following diagnoses/situations: Post-stroke (Boehm et al., 2015, Lawson et al.,2017); Autism (Gibbs & Toth-Cohen, 2011); Tetraplegia (Yuen & Pope, 2009). Carryover of home programs with the following diagnoses: Autism (Gibbs & Toth-Cohen, 2011); Breast Cancer (Hegel et al., 2011). Motivation with the following diagnoses: Stroke (Lawson et al., 2017); tetraplegia (Yuen & Pope, 2009) and with neurorehabilitation (Reifenberg et al., 2017). Home safety post stroke. (Breeden, 2016) Hand function with the following diagnoses: hemiplegia CP (Golomb et al., 2010); Stroke (Hermann et al., 2010, Lawson et al., 2017); and with neuro-rehabilitation (Reifenberg et al., 2017). Parental stress with children with Autism (Gibbs & Toth-Cohen, 2011) Engagement in daily life activities as a result of carry-on effect with participants with traumatic brain injury. (Ng et al., 2013) |
Limitations of study
There was a low number of randomized control trial (RCT) studies (3 total out of 15 selected articles) that pointed to higher levels of efficacy with telerehabilitation compared to face to face intervention. With such a low number of RCT research studies, generalizations cannot be made across all populations of the efficacy of telerehabilitation.
With the Class II-IV studies, the majority of changes seen in standardized assessments used in studies did not exceed minimum clinical levels. Therefore, though there were differences in outcomes between the intervention and control group, the results were not statistically significant for all studies, which impacts generalizability of study results.
Though necessary because of the variable way telehealth is defined by the researchers of the studies reviewed by the authors, the search terms for “telerehabilitation” were not uniform. Therefore, the differences seen in the study could be due to the delivery method of the specific intervention and not because of the overall provision of the intervention using a telerehabilitation mode of delivery. Also, though specified by the authors of this study, there was also variability in the hardware and software that was used in the studies that were analyzed.
Takeaways for Clinician
Utilizing these results as a baseline for what areas can be addressed by telehealth is important. The results point to efficacy with function, occupational performance, carryover of home programs, increased safety awareness, collaboration between caregiver and therapist and the feasibility of providing occupational therapy services using a telehealth model across age groups and diagnoses.
The outcomes consistently show that telehealth can be implemented in occupational therapy practice and positive outcomes are garnered with this method of service delivery. The positive outcomes: (1) are seen across age groups (2) observed with a multitude of diagnoses (3) use different telehealth hardware and software and (4) utilize varying assessments, all which support the modifiability of telehealth implementation to meet the therapeutic needs of clients.
Takeaways for student
From a research standpoint, this is an opportunity to look at the feasibility and efficacy of telehealth using stronger scientific methods for more generalizability of results. Future studies that can be done as part of a research study include completing a systematic review with more RCTs, modifying search terms to have more uniformity in what constitutes telerehabilitation. These studies can also be reviewed to make modifications to an experiment to determine the efficacy of an intervention provided using a telehealth model of practice.
Takeaway for academic instructors
With telerehabilitation becoming used more often due to the current health crises and most likely in the future to prevent further cases of COVID, it is important to understand research outcomes of interventions provided using a telehealth service delivery. It is also important to guides students with evidence-based methods to assess and provide intervention using this model of practice.
Citation: Hung KN, G., & Fong, K. N. (2019). Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong Journal of Occupational Therapy, 32(1), 3 21. https://doi.org/10.1177/1569186119849119
This is an open access article and the original article can be found using the doi information or this link: Effects of telerehabilitation in occupational therapy practice: A systematic review – Goris Hung KN, Kenneth NK Fong, 2019 (sagepub.com)
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