A while ago I had the idea to start a little OT Journal Club where I would read an open access article, summarize it briefly and share my insight. My first one was something I was super proud of (read here) but then I fell off the wagon and haven’t been able to finish another one until now! So here is OT Journal Club number two! If you have reviewed an article recently please share with me as I am always looking for new info to learn and share with my clients (of all ages)
This article is titled “Effects of telerehabilitation in occupational therapy practice: A systematic review (nih.gov)“, published in the Hong Kong Journal of Occupational Therapy. (the link above is accessible to the public).
This article falls into the category 1 level of evidence as seen in the above table, which is based on the effectiveness rating system by Ackley, Swan, Ladwig, Tucker (2008).
With COVID-19 pushing companies to pivot to become more safe, many things are being moved to be accessed virtually. Some things have already been virtual for a while and are just becoming more popular, such as grocery delivery, ordering take out, and online shopping. Workouts are being done virtually as studios move online, or at home via Youtube videos, and for many places, school is being run virtually for the time being. Telerehabilitation is also a current trend and need of the time. I have started a new job with a large home health company in my area, and they shared that they had plans to move virtual over the next 10 years, but with COVID this sped up to be a reality in 2020.
In 2020, COVID 19 pushed therapeutic services to find a way to provide therapy through telerehabilitation in order to help people maintain their health and livelihoods. Where I live, we shut down March 2020 and since then I have been working with my pediatric OT clients virtually. So this article really interested me when I came across it. This study will provide evidence and an overview as to how effective telerehabilitation is so that we can back our virtual therapy up when speaking to clients and families about it.
Telerehabilitation was first used in 1998 and refers to the use of information and communication technologies to provide rehabilitation services at a distance. These techbologies can include internet based programs, computers, phones, emails, etc. These services can be synchronous or asynchronous (terms I am sure we are all familiar with now because of virtual schooling), but essentially services can be provided in real time (synchronous), or through recorded videos, digital photos etc (asynchronous). Research has shown that telerehabilitation can improve access to services, prevent unnecessary delays in care and has been found to have similar outcomes to in person interventions.
This article aims to review the evidence on the application of telerehabilitation in the occupational therapy practice and its clinical outcomes over the past 10 years.
For people who are more research inclined, I will review briefly the methods of this search. Systematic literature search was limited to articles published between January 2008 and October 2017 (this is outside of the COVID push for virtual strategies), and from the 401 articles that were identified, 15 articles met all selection criteria. There were 3 randomized control trials, 3 single case studies, 8 quasi experimental studies and one trial with single group post intervention.
198 participants were included in this review with their ages ranging from 2 years and 6 months old to over 70 and pathologies varying. Studies varied in the technology used, and the duration of therapy varied from once a week to multiple days a week, for weeks to months.
The studies highlighted in the article showed increased carryover of home programmes, increased motivation in clients, enhanced hand functions and home safety, as well as improved cognitive function. The results also categorized studies looking at satisfaction of parents, caregivers and participants showing that they have expressed satisfaction with the program and had a positive perception of telerehabilitation.
The review concluded that using telerehabilitation in occupational therapy has positive therapeutic effects and is a beneficial alternative service delivery model. Few clients and caregivers expressed a preference for face to face intervention over telerehabilitation. The studies also indicate that it is important to provide training prior to OT intervention through telerehabilitation, and to ensure that equipment and technical support is up to par in order to provide a successful service. In the big company that I work for, they actually have a team of people who you can contact to provide yourself (the service provider) as well as you clients, with training on the virtual platform to ensure a smoother virtual visit. Clients can also be connected with this service to learn how to log in and navigate the services during the virtual visit if they are having trouble. From my experience, the necessity of this varies with the population you are working with and the therapist. When the private pediatric practice I work with shifted to virtual services earlier this year, we were all quite savy already with the platform for services, and parents were familiar as well from their own jobs/virtual schooling. A back up plan is always a good idea when it comes to setting up a session, whether that be having the client’s cell number if you get disconnected, or an email that you can check in to ensure the client just lost connection and didn’t get hurt.
From my experience working with telerehabilitation with kids, adults and older adults, this can be an incredible alternative to face to face therapy, and can save travel time and putting clients at risk of illness. Service delivery will definitely look different than if you were going into someone’s home, as with children you have to consider what materials they have in their home (ex: if I was going into someone’s home I would bring a toolbox of trinkets to work on fine motor, handwriting etc, whereas you’re relying on what the family has at home), and with a more physical population, you will have to ensure that you can complete your full assessment in a modified way. For my adult phys med clients, it is necessary to be doing the assessment on a device that the client or family member can move around with them so I can see their bathrooms, transfers, mobility etc.
Overall, I definitely have been enjoying my experience with teletherapy and think that it can be a way to make services more accessible and safe for many clients. I have considered writing a couple posts about the activities I have been doing with my pediatric clients virtually, I’m not sure if anyone would be interested in that?
Do you have experience with telerehabilitation/virtual therapy? What population do you work with and what have your experiences been like? I am always interesting in learning other people’s experiences and how I can improve my services so please share in the comments!
The article can be accessed by the link below:
Kn, G. H., & Fong, K. N. (2019). Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong Journal of Occupational Therapy,32(1), 3-21. doi:10.1177/1569186119849119 . Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560836/