What is the Evidence for Telehealth?

Transcription

1 Assessment in Telehealth: What is the Evidence for Telehealth? (see the following chart for a summary of each study) Baker, N. & Jacobs, K. (in press). The feasibility and accuracy of using a remote method to assess computer workstations. Human Factors. Dreyer, N.C., Dreyer, K. A., Shaw, D. K., & Wittman, P. (2001). Efficacy of telemedicine in occupational therapy: A pilot study. Journal of Allied Health, 30(1), Durfee, W. K, Savard, L., & Weinstein, S. (2007). Technical feasibility of teleassessments for rehabilitation. IEEE Transactions of Neural Systems and Rehabilitation Engineering, 15, Hoffman, T. & Russell, T. (2008). Pre-admission orthopaedic occupational therapy home visits conducted using the internet. Journal of Telemedicine and Telecare, 14, Jacobs, K., Blanchard, B., & Baker, N. (2012). Telehealth and ergonomics: A pilot study. Technology and Health Care, 20(5), Hoffman, T., Russell, T., Thompson, L., Vincent, A., & Nelson, M. (2008). Using the internet to assess activities of daily living and hand function in people with Parkinson s disease. Neuro 23, Palsbo, S. E., Dawson, S. J., Savard, L., Goldstein, M., & Heuser, A. (2007). Televideo assessment using Functional Reach Test and European Stroke Scale. Journal of Rehabilitation Research & Development, 44, Sanford, J. A., Jones, M., Daviou, P., Grogg, K., & Butterfield, T. (2004). Using telerehabilitation to identify home modification needs. Assistive Technology, 16(1), Schein, R. M, Schmeler, M. R., Holm, M. B., Pramuka, M., Saptono, A., & Brienza, D. M. (2011). Telerehabilitation assessment using the Functioning Everyday with a Wheelchair-Capacity instrument. Journal of Rehabilitation Research & Development, 48(2), Intervention in Telehealth: Chumbler, N. R., Quigley, P., Li, X., Morey, M., Rose, D., Sanford, J.,... Hoenig, H. (2012). Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke, 43(8), doi: /STROKEAHA Germain, V., Marchand, A., Bouchard, S., Drouin, M.S., & Guay, S.. Effectiveness of cognitive 1

2 behavioural therapy administered by videoconference for posttraumatic stress disorder. Cognitive Behavioral Therapy, 38(1), Harada, N., Dhanani, S., Elrod, M., Hahn, T., Kleinman, L., & Fang, M.. Feasibility study of home telerehabilitation for physically inactive veterans. Journal of Rehabilitation Research and Development, 47, Hegel, M.T., Lyons, K.D., Hull, J.G., Kaufman, P., Urquhart, L., Li, Z., & Ahles, T.A. (2011). Feasibility study of a randomized controlled trial of a telephone-delivered Problem Solving-Occupational Therapy intervention to reduce participation restrictions in rural breast cancer survivors undergoing chemotherapy. Psycho-oncology, 20, Hermann, V. H., Herzog, M., Jordan, R., Hofherr, M., Levine, P., & Page, S. J.. Telerehabilitation and electrical stimulation: An occupation-based, client-centered stroke intervention. The American Journal of Occupational Therapy, 64, Jang, S. H., Jung, H. Y., Jang, D. H., Kim, Y. T., Seo, J. P., & Jang, W. H. (2013). The Effect of a Memory Training Application for a Patient with Traumatic Brain Injury. Journal of Physical Therapy Science, 25(1), Kairy, D., Lehoux, P., Vincent, C., & Visintin, M.. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and 31 (6), Lai, J. C., Woo, J., Hui, E., & Chan, W. M. (2004). Telerehabilitiation A new model for community-based stroke rehabilitation. Journal of Telemedicine and Telecare, 10, Neubeck, L., Redfern, J., Fernandez, R., Briffa, T., Bauman, A., & Freedman, S.B.. Telehealth interventions for the secondary prevention of coronary heart disease: A systematic review. European Journal of Cardiovascular Preventive 16, Ng, E. M., Polatajko, H. J., Marziali, E., Hunt, A., & Dawson, D. R. (2013). Telerehabilitation for addressing executive dysfunction after traumatic brain injury. Brain Injury, 27(5), Redzuan, N. S., Engkasan, J. P., Mazlan, M., & Freddy Abdullah, S. J. (2012). Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial. Arch Phys Med Rehabil, 93(12), doi: /j.apmr Russell, T., Buttrum, P., Wootton, R., & Jull, G. (2003). Low-bandwidth telerehabilitation for patients who have undergone total knee replacement: preliminary results. Journal of Telemedicine and Telecare, 9(2), Russell, T., Buttrum, P., Wootton, R., & Jull, G.. Internet-based outpatient telerehabilitation for 2

3 patients following total knee arthroplasty: A randomized controlled trial. Journal of Bone and Joint Surgery, 93(2), Steele, K., Cox, D., & Garry, H. (2011). Therapeutic videoconferencing interventions for the treatment of long-term conditions. Journal of Telemedicine and Telecare, 17, Tuerk, P.W., Yoder, M., Ruggiero, K.J., Gros, D.F., & Acierno, R.. A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. Journal of Traumatic Stress, 23, Satisfaction with Telehealth: Cason, J.. A pilot telerehabilitation program: Delivering early intervention services to rural families. International Journal of Telerehabilitation, 1(1), Cason, J., Behl, D., & Ringwalt, S. (2012). Overview Of States'use Of Telehealth For The Delivery Of Early Intervention (Idea Part C) Services. International Journal of Telerehabilitation, 4(2). Criss, M. J. (2013). School-Based Telerehabilitation In Occupational Therapy: Using Telerehabilitation Technologies To Promote Improvements In Student Performance. International Journal of Telerehabilitation, 5(1). Harper, D. C. (2006). Telemedicine for children with disabilities. Children s Health Care, 35(1), Hermann, V. H., Herzog, M., Jordan, R., Hofherr, M., Levine, P., & Page, S. J.. Telerehabilitation and electrical stimulation: An occupation-based, client-centered stroke intervention. The American Journal of Occupational Therapy, 64, Kairy, D., Lehoux, P., Vincent, C., & Visintin, M.. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and 31 (6), Kelso, G., Fiechtl, B., Olsen, S., & Rule, S.. The feasibility of virtual home visits to provide early intervention: A pilot study. Infants & Young Children, 22, Russell, T., Buttrum, P., Wootton, R., & Jull, G.. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: A randomized controlled trial. Journal of Bone and Joint Surgery, 93(2), Steele, K., Cox, D., & Garry, H. (2011). Therapeutic videoconferencing interventions for the treatment of long-term conditions. Journal of Telemedicine and Telecare, 17, Self-efficacy with Telehealth: Sanford, J. A., Griffiths, P. C., Richardson, P., Hargraves, K., Butterfield, T., & Hoenig, H. (2006). The effects 3

4 of in-home rehabilitation on task self-efficacy in mobility-impaired adults: A randomized clinical trial. Journal of the American Geriatrics Society, 54, Suter, P., Suter, W.N., & Johnston, D. (2011). Theory-based telehealth and patient empowerment. Population Health Management, 14(2), Other: Rogante, M., Grigioni, M., Cordella, D., & Giacomozzi, C.. Ten years of telerehabilitation: A literature overview of technologies and clinical applications. Neurorehabilitation, 27, Vismara, L., Young, G., Stahmer, A., Griffith, E., & Rogers, S.. Dissemination of evidence-based practice: Can we train therapists from a distance? Journal of Autism and Developmental Disorders, 39, Study Practice Area/ Population Research Question/Method Results Baker & Jacobs (in press) Cason Cason et. al. (2012) Chumbler et. al. (2014) Work and Industry/ Office workers Children receiving early intervention services and their families Early Intervention services Veterans with stroke Feasibility of remote assessment of computer workstations using photographs taken by a research assistant and the self-report Computer Workstation Checklist (CWC) Determine benefits/strengths, challenges/weaknesses, and recommendations for program improvement Utilization of early intervention services in telehealth within states IDEA Part C programs Determined different improvement in function at 6 months for patients with stroke telerehabilitation versus usual care. 92% of mismatches between computer workstation and user were correctly identified using remote method. Research suggests that remote assessment is a feasible alternative to in person assessment and offers increased access to computer workstation ergonomic assessments. Results revealed that families were highly satisfied with the additional telerehabilitation visits which supplemented their monthly traditional occupational therapy sessions. Participants believed that their children benefited from participation. Representatives from 26 states participated in the telehealth survey. Results revealed that 30% are currently using telehealth as an adjunct service delivery model or plan to incorporate it within the next 1-2 years. Primary outcomes improved at 6 months for the stroke telerehabilitation group and declined for the usual care group, but the differences were not statistically 4

5 significant. Criss (2013) Dreyer et al. (2001) Durfee et al. (2007) Germain et al. Harada et al. Harper (2006) Hegel et al. (2011) school-based occupational therapy for children ages 6 to 11 years Individuals having difficulty with independent living skills Health and Wellness/ Healthy Mental Health/ Posttraumatic stress disorder (PTSD) Health and Wellness/ Outpatient veterans who are physically inactive Children with special needs Patients Determined use of telerehabilitation technologies in occupational therapy for school-based practice. Efficacy of using the KELS and COPM through telemedicine Are results of standard assessments for motor function conducted remotely the same as those conducted in person? Compare the effectiveness of cognitive behavioral therapy (CBT) for PTSD administered either in person or by videoconferencing. Also explored the relationship among three variables specific to videoconferencing: comfort with remote communication, sense of presence felt during videoconferencing, and initial perception of therapy by videoconference. Determining feasibility of a text messaging program to monitor exercise behavior in the home for physically inactive older adults Perceived effectiveness of telemedicine; satisfaction with telemedicine Telephone delivered problemsolving and OT intervention Outcomes revealed improvements in handwriting performance for most students who participated in the program and high satisfaction rates reported by all participants. No significant differences between scores assigned by the in person and remote therapists when administering the Kohlman Evaluation of Living Skills and Canadian Occupational Performance Measure evaluations. No statistically significant differences between in-person and remote assessment for manual muscle testing, Berg sit-to-stand, Berg forward reach, and timed up and go tests. The results of this study do not show any significant differences in the effectiveness of CBT administered by videoconference or in person to individuals with PTSD. Participants in both conditions improved significantly between the beginning and the end of their therapy with regard to PTSD symptoms, anxiety and depression. The effectiveness of CBT administered by videoconference appears to be comparable to that of standard in person treatment. Exercise adherence rates ranged from 78% to 95% indicating that a text messaging monitoring device can be effective at remote patient monitoring. Telemedicine evaluations were generally rated as good as in person consultations. 88 to 90% of participants noted their telemedicine experience as good or excellent. Observed treatment effects all favored the treatment condition across the realms of function, 5

6 Hermann et al. Hoffmann & Russell (2008) Hoffmann et al. (2008) Jacobs et al. (2012) Jang et al. (2013) Kairy et al. with breast cancer undergoing chemotherapy Stroke (case study) Orthopedic (hip/knee replacement) Parkinson s disease Work and Industry/ Office Workers Adults with Traumatic Brain Injury Physical deficits (systematic Intervention (electrical stimulation); client satisfaction Feasibility and accuracy of telehealth for conducting home visits Level of agreement between in person and telerehabillitation assessment of FIM, grip and pinch strength, Nine hole peg test; inter-rater reliability Determine benefit of computer workstation evaluations using the telerehabilitation computer ergonomics system or tele- CES. The effect of a memory training application in a patient with TBI was investigated. Effectiveness of intervention on clinical outcomes; costs emotional status, and quality-of-life scales. The control group was more likely than the treatment group to require physical therapy. Ninety-two percent of participants reported being satisfied/very satisfied with the therapy. Signification improvement in upper extremity function. Also, patient reports of satisfaction of task performance significantly improved following telerehabilitation intervention. 22 out of 27 questionnaire items achieved 100% agreement between the in-person and remote therapist, whereas the remaining five questions had agreement ranging from %. Ten of the 12 items on the FIM achieved perfect agreement within plus or minus one point between face-to-face and telerehabilitation measures. There were no differences between face-to-face and remote measure values for grip and pinch strength. High levels of inter-rater were found for all measures (greater than 0.80). Ergonomic recommendations were given based on photographs and video recordings of the participants work stations. Overall, 88% of all ergonomic recommendations were implemented and although significant improvements in pain or comfort were not observed, the study demonstrated the feasibility of assessing pain and comfort levels remotely. Significant improvement of memory function after memory training using this application was observed. This application could be useful for improving memory impairment of patients with TBI. Clinical outcomes for telerehabilitation intervention were similar or better than traditional. Patients and therapists, overall, 6

7 Kelso et al. Lai et al. (2004) Neubeck et al. Ng et. al. (2013) - et al. (2013) Palsbo et al. (2007) review of 28 articles) Early Intervention History of stroke Health and Wellness/ Coronary heart disease (CHD) (systematic review) Adults with Traumatic Brain Injury Individuals with Multiple Sclerosis History of stroke Usability and feasibility of virtual home visits (VHV); satisfaction, parent knowledge of outcomes, cost and time savings Evaluate the feasibility, efficacy and acceptability of a community-based stroke rehabilitation program conducted via videoconferencing To determine whether telehealth interventions for patients with CHD provide effective secondary prevention Investigated the feasibility of implementing the Cognitive Orientation to daily Occupational Performance approach in a telerehabilitation format and examine its impact on community integration and executive dysfunction for adults with TBI. Potential improvements in postural control among patients with MS who complete a telerehabilitation program when a conventional program was not available Effect of using televideo equipment to direct patients through assessment exercises reported positive perceived benefits, convenience, and usefulness when describing their experience with telerehabilitation. Insufficient evidence to determine if telerehab is a cost-saving or cost-effective solution. Results indicated a high level of satisfaction among the interventionists and families, however there were some concerns about audio and video quality. Costbenefit analysis indicated that VHVs resulted in an average savings of $42.52 per visit. Following intervention, significant improvement was observed in the results of the Berg Balance Scale, Stroke Knowledge Test, and the SF-36 as compared to baseline scores. Authors concluded that telehealth interventions provide effective risk factor reduction. Although not significant, a 30% improvement in survival was seen in intervention groups. The approach was found to be feasible. All participants indicated self-reported improvement in both trained and untrained goals. Trends toward fewer symptoms of executive dysfunction and greater community integration were demonstrated. Telerehabilitation program based on a virtual reality system allowed utilization of sensory information processing and integration systems needed to maintain postural control among patients with MS. No significant differences were found between face-to-face and remote assessment when measuring Functional Reach Test and European Stroke Scale scores. 7

8 Reger et al. (2011) Rogante et al. Russell et al. (2003) Russell et al. Sanford et al. (2004) Sanford et al. (2006) Mental Health/ Active duty soldiers with posttraumatic stress disorder Varying Total knee replacement Total knee replacement Mobility limitation due to spinal cord injury Productive Aging/ Community-dwelling adults with a prescription for a new mobility aid Effectiveness of virtual reality exposure (VRE) therapy with active duty soldiers Systematic review to provide an overview of technologies and clinical applications in telerehabilitation Effectiveness of telerehabilitation methods in orthopedic treatment Effectiveness of treatment and patient satisfaction between face-to-face and telerehabilitation Use of televideo to provide remote home modification assessment prior to discharge Examined the effects of a usual care group (UCG) and an intervention group (IG) on self-efficacy of the participants. Half of the IG received the home-based, in person intervention, while the other received intervention through a remote virtual method 8 Patients receiving an average of seven sessions of VRE reported statistically and clinically significant reductions in self-reported symptoms of PTSD. Identified impairments and pathologies that have been addressed by telerehabilition among 146 articles. There was a significant improvement in all outcomes between the pre- and post- intervention assessment for both groups. Although they were not significant, the mean score differences showed a trend towards more improvement in the telerehabilitation group on most outcome measures (e.g., pain, stiffness, gait, knee extension, limb girth measurement, straight leg raise). Although 7 out of 21 participants had never used a computer before, the telerehab program received high ratings for perceived benefit. Results of the study indicate that telerehabilitation was not inferior to traditional intervention, and with some measures, were clinically superior. Satisfaction was high for all questions (contentment, audio clarity) with the exception of visual quality. However this did not interfere with overall perceived benefits of the intervention. Remote assessment correctly identified 51 out of 59 problems that were identified by an in-home assessment, but also identified five problems that were not identified in the on-site assessment. The IG had a statistically significant greater increase in overall selfefficacy when compared to the UCG. The IG revealed greater positive change in self-efficacy when compared to the UCG for all tasks except getting in and out of a chair. When comparing the two IG groups, there was a medium standard effect size in both groups, but the

9 Schein et al. (2011) Steele et al. (2011) Tuerk et al. Vismara et al. Health and Wellness/ People using wheeled mobility and seating (WMS) devices Individuals with longterm conditions (Systematic review of 35 articles) Mental Health/ Combat veterans with posttraumatic stress disorder Therapists with experience treating autism spectrum disorders Interrater reliability between in person (IP) vs. telerabilitation (TR) administration of the Functioning Everyday with a Wheelchair-Capacity Patient satisfaction and evidence of clinical effectiveness of telerehabilitation Effectiveness of exposure therapy delivered remotely as compared to in person Is telehealth technology as effective a training medium as live instruction telerehabilitation group did not reach statistical significance. Showed excellent IP-TR interrater reliability. Researchers concluded that an expert practitioner can assess an individual s functional status remotely and with as much accuracy as a general practitioner who is inperson. The best, most recent evidence indicates that clinical outcomes are equivalent between in person and videoconference-delivery modes. Videoconferencing commonly results in high satisfaction levels in patients. In some cases remote care was preferred over in person care. Prolonged Exposure(PE) therapy via telehealth technology was associated with large reductions in symptoms of PTSD and depression for veterans diagnosed with combat-related PTSD. The high acceptance rate (12 out of 12) of telehealth PE suggests that some aspects of telehealth services may be especially well suited for and attractive to veterans with PTSD. Findings clearly demonstrated that teaching via telehealth technology was as effective as using live interaction. 9