OT Research Article Spotlight: Systematic Review of Telerehabilitation in Occupational Therapy Practice.

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 ResearchResults
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 Therapy32(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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