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Conklin JP, Wallace T, McCauley KL, Breitenstein J, Gore RK. Level of Evidence of Telehealth Rehabilitation and Behavioral Health Services for Traumatic Brain Injury: A Scoping Review. J Clin Psychol Med Settings 2024; 31:379-402. [PMID: 37903966 DOI: 10.1007/s10880-023-09981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023]
Abstract
Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50-80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs.
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Affiliation(s)
- Jessica P Conklin
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA.
| | - Katherine L McCauley
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Jackie Breitenstein
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Russell K Gore
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
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Maggio MG, Baglio F, Arcuri F, Borgnis F, Contrada M, Diaz MDM, Leochico CF, Neira NJ, Laratta S, Suchan B, Tonin P, Calabrò RS. Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective. Front Neurol 2024; 15:1338873. [PMID: 38426164 PMCID: PMC10902044 DOI: 10.3389/fneur.2024.1338873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.
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Affiliation(s)
| | | | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Marianna Contrada
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Carl Froilan Leochico
- University of the Philippines Manila, Manila, Philippines
- St. Luke’s Medical Center, Quezon City, Philippines
| | | | - Stefania Laratta
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Boris Suchan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
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Boulos ME, Colella B, Meusel LA, Sharma B, Peter MK, Worthington T, Green REA. Feasibility of group telerehabilitation for individuals with chronic acquired brain injury: integrating clinical care and research. Disabil Rehabil 2024; 46:750-762. [PMID: 36855274 DOI: 10.1080/09638288.2023.2177357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. OBJECTIVES To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. METHODS Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. RESULTS High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. CONCLUSIONS The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs.
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Affiliation(s)
- Mary E Boulos
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Liesel-Ann Meusel
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Bhanu Sharma
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - Marika K Peter
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Thomas Worthington
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robin E A Green
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
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Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Kusec A, Murphy FC, Peers PV, Bennett R, Carmona E, Korbacz A, Lawrence C, Cameron E, Bateman A, Watson P, Allanson J, duToit P, Manly T. Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): results from a randomised controlled pilot feasibility trial for low mood in acquired brain injury. BMC Med 2023; 21:445. [PMID: 37974189 PMCID: PMC10655452 DOI: 10.1186/s12916-023-03128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Acquired brain injury (ABI) is linked to increased depression risk. Existing therapies for depression in ABI (e.g., cognitive behavioural therapy) have mixed efficacy. Behavioural activation (BA), an intervention that encourages engaging in positively reinforcing activities, shows promise. The primary aims were to assess feasibility, acceptability, and potential efficacy of two 8-week BA groups. METHODS Adults (≥ 18 years) recruited from local ABI services, charities, and self-referral via social media were randomised to condition. The Activity Planning group (AP; "traditional" BA) trained participants to plan reinforcing activities over 8 weeks. The Activity Engagement group (AE; "experiential" BA) encouraged engagement in positive activities within session only. Both BA groups were compared to an 8-week Waitlist group (WL). The primary outcomes, feasibility and acceptability, were assessed via recruitment, retention, attendance, and qualitative feedback on groups. The secondary outcome, potential efficacy, was assessed via blinded assessments of self-reported activity levels, depression, and anxiety (at pre- and post-intervention and 1 month follow-up) and were compared across trial arms. Data were collected in-person and remotely due to COVID-19. RESULTS N = 60 participants were randomised to AP (randomised n = 22; total n = 29), AE (randomised n = 22; total n = 28), or re-randomised following WL (total n = 16). Whether in-person or remote, AP and AE were rated as similarly enjoyable and helpful. In exploring efficacy, 58.33% of AP members had clinically meaningful activity level improvements, relative to 50% AE and 38.5% WL. Both AP and AE groups had depression reductions relative to WL, but only AP participants demonstrated anxiety reductions relative to AE and WL. AP participants noted benefits of learning strategies to increase activities and learning from other group members. AE participants valued social discussion and choice in selecting in-session activities. CONCLUSIONS Both in-person and remote group BA were feasible and acceptable in ABI. Though both traditional and experiential BA may be effective, these may have different mechanisms. TRIAL REGISTRATION Clinicaltrials.gov, NCT03874650. Protocol version 2.3, May 26 2020.
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Affiliation(s)
- Andrea Kusec
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Fionnuala C Murphy
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Polly V Peers
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Ron Bennett
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Patient and Public Involvement Representative, University of Cambridge, Cambridge, UK
| | - Estela Carmona
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Aleksandra Korbacz
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Cara Lawrence
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Emma Cameron
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Judith Allanson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pieter duToit
- School of Health and Social Care, University of Essex, Colchester, UK
- The Disabilities Trust, Fen House, Ely, UK
| | - Tom Manly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Kornblith E, Schweizer S, Abrams G, Gardner R, Barnes D, Yaffe K, Novakovic-Agopian T. Telehealth delivery of group-format cognitive rehabilitation to older veterans with TBI: a mixed-methods pilot study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-13. [PMID: 37044120 DOI: 10.1080/23279095.2023.2199160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist. Goal Oriented Attentional Self-Regulation (GOALS) is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults. Our objectives were to adapt GOALS for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS). Six Veterans 69+, with multiple TBIs completed the 10-session intervention in groups of 2. One participant withdrew, and another completed the remaining sessions alone (total n enrolled = 8). Required adaptations were noted; questionnaire responses were quantified; and feedback was analyzed and coded to identify themes. Quantitative and qualitative methods were used to examine feasibility (i.e., recruitment and retention) and participant-rated acceptability. Minimal adaptations were required for IVT delivery. Key themes emerged: (a) the importance of telehealth logistics, (b) facilitators' roles in prioritizing interpersonal connection, and (c) telehealth's capability to create opportunities for community reintegration. Thematic saturation (the point at which feedback from respondents is consistent and no further adaptations are required) was achieved. Participants stated they would likely recommend TeleGOALS to other Veterans. Although further study with a larger, more diverse sample is required, the adapted TeleGOALS intervention appears highly feasible and acceptable for older Veterans with TBI able and willing to participate in a group-format IVT intervention.
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Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sara Schweizer
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Raquel Gardner
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Deborah Barnes
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Kristine Yaffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Tatjana Novakovic-Agopian
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
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Conklin JP, McCauley KL, Breitenstein J, Edelman L, Gore RK, Wallace T. Implementation of telehealth and hybrid service delivery of interdisciplinary rehabilitation for military populations with traumatic brain injury. NeuroRehabilitation 2023; 53:535-545. [PMID: 38143391 DOI: 10.3233/nre-230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic necessitated the implementation of telehealth and hybrid service delivery models and provided an opportunity to study the impact of this care model in military populations with history of traumatic brain injury (TBI). OBJECTIVE To present telehealth service utilization rates across rehabilitation specialties, treatment outcome indicators, and patient satisfaction outcomes from a retrospective clinical sample. METHODS The study sample consists of 34 patients who underwent telehealth/hybrid Intensive Outpatient Programming (IOP) at a major rehabilitation hospital. Retrospective chart review and clinical data extraction were performed. A historical cohort receiving in-person care was used as a comparison group. Statistical analyses included partial correlations, mixed method analysis of variance (ANOVA), and independent sample t-tests. RESULTS Medical, behavioral health, physical, occupational, and speech-language therapy providers exhibited similar rates of telehealth service delivery (35 to 41% of all sessions). No significant association was found between percent telehealth sessions and the global treatment outcome indicator. Comparison of treatment effects across cohorts revealed similar benefits of IOP. No between-group differences were noted in satisfaction ratings. CONCLUSION The comparable treatment-related gains and reports of positive patient experience support the use of a telehealth and hybrid delivery model for military service members and veterans with TBI.
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Affiliation(s)
| | | | | | - Lyndsey Edelman
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, USA
| | - Russell K Gore
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, USA
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Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
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Wallace LM, Falla D, Rushton A, Heneghan NR. Group and individual telehealth for chronic musculoskeletal pain: A scoping review. Musculoskeletal Care 2021; 20:245-258. [PMID: 34668312 DOI: 10.1002/msc.1594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND CONTEXT Musculoskeletal (MSK) pain presents a global challenge. Individual and group pain management programmes (PMPs) are recommended approaches for patients with chronic MSK disorders. With advances in remote healthcare capability, telehealth, and the recent COVID-19 pandemic, the importance of telehealth PMPs has become even more evident. Nevertheless, it is not known how patients perceive PMPs for their MSK complaint when delivered via telehealth. OBJECTIVE To synthesise the evidence of patients' experiences of group and individual telehealth PMPs for chronic MSK pain. DESIGN A scoping review informed by the PRISMA extension for scoping reviews. DATA SOURCES Based on a planned search strategy, modified following initial searches, an electronic search was conducted of key databases: Cochrane Library, Medline, CINAHL, EMBASE, AMED, SportDiscus and APA PsychInfo from 2010 until 11 May 2021. STUDY SELECTION Any qualitative or mixed methods study reporting patient experiences of telehealth PMPs for patients with MSK disorders. DATA EXTRACTION AND DATA SYNTHESIS Data were extracted and synthesised using thematic analysis. RESULTS From 446 identified studies, 10 were included. Just two studies investigated group telehealth PMPs for patients with MSK disorders, with eight delivered individually. Four main themes emerged: (1) Usability of the technology, (2) Tailored care, (3) Therapeutic alliance and (4) Managing behaviour. The findings highlight patient acceptability of telehealth to support self-management for chronic MSK disorders, with appropriate clinical and technical support. Group telehealth has the potential to empower patients with peer support. Remote delivery of PMPs also impacts on how patients and providers interact, communicate and develop a therapeutic relationship. CONCLUSIONS AND IMPLICATIONS Barriers and enablers to engagement in telehealth PMPs for patients with chronic MSK disorders have been identified. Peer support and group cohesiveness can be achieved remotely to enhance the patient experience. There is a critical need for further research in this area.
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Affiliation(s)
- L M Wallace
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - D Falla
- Chair in Rehabilitation Science and Physiotherapy, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A Rushton
- School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - N R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Fisher LB, Tuchman S, Curreri A, Markgraf M, Nyer MB, Cassano P, Iverson G, Fava M, Zafonte R, Pedrelli P. Conducting Clinical Research Remotely for Individuals with Traumatic Brain Injury (TBI) and Depression during the COVID-19 Pandemic: Transitioning from In-Person to Remote Implementation. JMIR Form Res 2021; 5:e28734. [PMID: 34662285 PMCID: PMC8638786 DOI: 10.2196/28734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/18/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070
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Affiliation(s)
- Lauren B Fisher
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Sylvie Tuchman
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US
| | - Andrew Curreri
- Center for Anxiety and Related Disorders, Boston University, Boston, US
| | - Maggie Markgraf
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US
| | - Maren B Nyer
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Paolo Cassano
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Grant Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, US.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, US.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, US
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, US.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, US.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, US.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, US
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
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11
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Pike KE, Chong MS, Hume CH, Keech BJ, Konjarski M, Landolt KA, Leslie BE, Russo A, Thai C, Vilsten JS, Kinsella GJ. Providing Online Memory Interventions for Older Adults: A Critical Review and Recommendations for Development. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12339] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Mei San Chong
- School of Psychology and Public Health, La Trobe University,
| | | | | | | | | | | | - Adrian Russo
- School of Psychology and Public Health, La Trobe University,
| | - Christine Thai
- School of Psychology and Public Health, La Trobe University,
| | | | - Glynda Jane Kinsella
- School of Psychology and Public Health, La Trobe University,
- Department of Psychology, Caulfield Hospital,
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12
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Stubberud J, Løvstad M, Solbakk AK, Schanke AK, Tornås S. Emotional Regulation Following Acquired Brain Injury: Associations With Executive Functioning in Daily Life and Symptoms of Anxiety and Depression. Front Neurol 2020; 11:1011. [PMID: 33013668 PMCID: PMC7512052 DOI: 10.3389/fneur.2020.01011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: To examine whether a questionnaire measuring emotional regulation after acquired brain injury adds clinical information beyond what can be obtained with a comprehensive executive function questionnaire and an anxiety and depression measure. Method: Seventy adult persons (age 19–66 years, Mage = 43, SDage = 13) with acquired brain injury in the chronic phase and executive function complaints. All were recruited to participate in a randomized controlled trial (NCT02692352) evaluating the effects of cognitive rehabilitation. Traumatic brain injury was the dominant cause of injury (64%), and mean time since injury was 8 years. Emotional regulation was assessed with the Brain Injury Trust Regulation of Emotions Questionnaire (BREQ). Executive function was assessed with the Behavior Rating Inventory of Executive Function Adult Version (BRIEF-A). The Hopkins Symptom Checklist 25 (HCSL-25) was employed to measure anxiety and depression symptoms. Results: Overall, significant correlations were found between reports of emotional regulation (BREQ) and executive function in daily life (BRIEF-A). Furthermore, our analyses revealed a significant relationship between self-reported scores of emotional regulation (BREQ) and symptoms of anxiety and depression (HSCL-25). Conclusion: The significant associations between the BREQ and most of the other clinical measures indicate that, for patients with acquired brain injury, the BREQ does not add substantial information beyond what can be assessed with the BRIEF-A and the HSCL-25.
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Affiliation(s)
- Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Marianne Løvstad
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, University of Oslo, Oslo, Norway.,RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Olso, Norway.,Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Sveinung Tornås
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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13
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Hewitt KC, Rodgin S, Loring DW, Pritchard AE, Jacobson LA. Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings. Clin Neuropsychol 2020; 34:1335-1351. [DOI: 10.1080/13854046.2020.1811891] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kelsey C. Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandra Rodgin
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alison E. Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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14
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Predictors of Homework Engagement in CBT Adapted for Traumatic Brain Injury: Pre/post-Injury and Therapy Process Factors. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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16
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O'Neil J, van Ierssel J, Sveistrup H. Remote supervision of rehabilitation interventions for survivors of moderate or severe traumatic brain injury: A scoping review. J Telemed Telecare 2019; 26:520-535. [PMID: 31148489 DOI: 10.1177/1357633x19845466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Individuals with moderate or severe traumatic brain injury (TBI) often have persistent impairments upon discharge home. In rural communities, specialized rehabilitation services to address impairments can be difficult to access. The purpose of this scoping review is to examine how remote supervision is currently being used in TBI rehabilitation to identify gaps in knowledge that need to be addressed to facilitate access to and implementation of these services. METHODS The main objective for this review is to identify the methods being used to deliver remote supervision for rehabilitation in a moderate or severe TBI population. The aim of this review was to document the implementation characteristics of remote supervision used including: (1) type of supervision such as synchronous, asynchronous supervision or mixed; (2) frequency and intensity of remote supervision; and (3) outcomes used to measure intervention delivery as well as effectiveness within this population. This scoping review follows EQUATOR Network recommendations for screening and extracting data. RESULTS Twenty-six studies using a variety of remote supervision technology and outcome measures were included. Supervision frequency and intensity are poorly reported with no standardization. One hundred and six outcome measures were reported in this review showing large diversity in the areas being explored. DISCUSSION Different types of remote supervision have been used with this population; however, there are no clear guidelines on clinical implementation. Future studies must better define implementation parameters of remote supervision. Benefit on physical activity, balance and mobility outcomes also need to be further explored.
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Affiliation(s)
- Jennifer O'Neil
- School of Rehabilitation Sciences, University of Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
| | | | - Heidi Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,School of Human Kinetics, University of Ottawa, Canada
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17
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Neumann D, Malec JF, Hammond FM. Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial. J Head Trauma Rehabil 2018; 32:286-295. [PMID: 28060205 PMCID: PMC5498277 DOI: 10.1097/htr.0000000000000277] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING An outpatient rehabilitation hospital. PARTICIPANTS Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.
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Affiliation(s)
- Dawn Neumann
- Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254, , Phone: 317-329-2188
| | - James F. Malec
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Flora M. Hammond
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Chief of Medical Affairs, Rehabilitation Hospital of Indiana, Indianapolis, IN
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18
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Gentry MT, Lapid MI, Clark MM, Rummans TA. Evidence for telehealth group-based treatment: A systematic review. J Telemed Telecare 2018; 25:327-342. [DOI: 10.1177/1357633x18775855] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Interest in the use of telehealth interventions to increase access to healthcare services is growing. Group-based interventions have the potential to increase patient access to highly needed services. The aim of this study was to systematically review the available literature on group-based video teleconference services. Methods The English-language literature was searched using Ovid MEDLINE, PubMed, PsycINFO and CINAHL for terms related to telehealth, group therapy and support groups. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open-label, qualitative and randomised controlled trial study designs. Data were compiled regarding participants, study intervention and outcomes. Specific areas of interest were the feasibility of and satisfaction with telehealth technology, as well as the effect of video teleconference delivery on group dynamics, including therapeutic alliance. Results Forty published studies met the inclusion criteria and were included in the review. Six were randomised controlled trials. Among the studies, there was a broad range of study designs, participants, group interventions and outcome measures. Video teleconference groups were found to be feasible and resulted in similar treatment outcomes to in-person groups. However, few studies were designed to demonstrate noninferiority of video teleconference groups compared with in-person groups. Studies that examined group process factors showed small decreases in therapeutic alliance in the video teleconference participants. Conclusions Video teleconference groups are feasible and produce outcomes similar to in-person treatment, with high participant satisfaction despite technical challenges. Additional research is needed to identify optimal methods of video teleconference group delivery to maximise clinical benefit and treatment outcomes.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, USA
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19
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Telehealth in Physical Medicine and Rehabilitation: A Narrative Review. PM R 2018; 9:S51-S58. [PMID: 28527504 DOI: 10.1016/j.pmrj.2017.02.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022]
Abstract
Telehealth refers to health care interactions that leverage telecommunication devices to provide medical care outside the traditional face-to-face, in-person medical encounter. Technology advances and research have expanded use of telehealth in health care delivery. Physical medicine and rehabilitation providers may use telehealth to deliver care to populations with neurologic and musculoskeletal conditions, commonly treated in both acute care and outpatient settings. Patients with impaired mobility and those living in locations with reduced access to care may particularly benefit. Video-teleconferencing has been shown to be effective for management of burn patients during acute rehabilitation, including reduced health care use expenses and less disruptions to care. Telehealth can facilitate developing interprofessional care plans. Patients with neurologic conditions including stroke, spinal cord injury, traumatic brain injury, and amyotrophic lateral sclerosis may use telehealth to monitor symptoms and response to treatment. Telehealth also may facilitate occupational and physical therapy programs as well as improve weight management and skin care in patients with chronic conditions. Other applications include imaging review in sports medicine, symptom management and counseling in concussion, traumatic brain injury, and pain management programs. Limitations of telehealth include barriers in establishing relationship between medical provider and patient, ability to perform limited physical examination, and differences in payment models and liability coverage. The expansion of telehealth services is expected to grow and has potential to improve patient satisfaction by delivering high quality and value of care.
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20
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Banbury A, Nancarrow S, Dart J, Gray L, Parkinson L. Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review. J Med Internet Res 2018; 20:e25. [PMID: 29396387 PMCID: PMC5816261 DOI: 10.2196/jmir.8090] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/10/2017] [Accepted: 11/02/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Group therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions. OBJECTIVE The aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional-led group videoconferencing to provide education or social support or both, into the home setting. METHODS Electronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings. RESULTS Of the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and skills. Videoconference groups were able to replicate group processes such as bonding and cohesiveness. Similar outcomes were reported for those comparing face-to-face groups and videoconference groups. CONCLUSIONS Groups delivered by videoconference are feasible and potentially can improve the accessibility of group interventions. This may be particularly useful for those who live in rural areas, have limited mobility, are socially isolated, or fear meeting new people. Outcomes are similar to in-person groups, but future research on facilitation process in videoconferencing-mediated groups and large-scale studies are required to develop the evidence base.
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Affiliation(s)
- Annie Banbury
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Australia
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Susan Nancarrow
- Office of the Deputy Vice Chancellor (Research), Southern Cross University, Lismore, Australia
| | - Jared Dart
- Faculty of Health Sciences, Bond University, Gold Coast, Australia
| | - Leonard Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Lynne Parkinson
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Australia
- School of Medicine and Public Health, Newcastle University, Newcastle, Australia
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21
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Reliability of Videoconferencing Administration of a Communication Questionnaire to People With Traumatic Brain Injury and Their Close Others. J Head Trauma Rehabil 2017; 32:E38-E44. [DOI: 10.1097/htr.0000000000000282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Improving Emotion Regulation Following Web-Based Group Intervention for Individuals With Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:354-365. [DOI: 10.1097/htr.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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23
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Benham S, Gibbs V. Exploration of the Effects of Telerehabilitation in a School-Based Setting for At-Risk Youth. Int J Telerehabil 2017; 9:39-46. [PMID: 28814993 PMCID: PMC5546560 DOI: 10.5195/ijt.2017.6215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study explored the efficacy and feasibility of a motion-capture program that may be utilized for telerehabilitation purposes. Two children attending a school for at-risk children received 20 sessions of Timocco, with sessions lasting for 30 minutes, under the guidance of research assistants. The researchers employed a mixed methods design to analyze quantitative data and qualitative interviews. Both children improved their fine and gross motor coordination, as measured on the Bruininks-Oseretsky Test of Motor Proficiency Short Form. To explore feasibly, qualitative verbal reports of the child participants and research assistants were obtained. The children and research assistants reported positive experiences with the utilization of this platform. A collaborative, consultative telerehabilitation model may be a promising delivery mode of services for improving motor skills in children, with frequent input from the child, aide or teacher, and clinician. Further exploration is needed for telerehabilitative service delivery for at-risk children.
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Affiliation(s)
- Sara Benham
- DEPARTMENT OF OCCUPATIONAL THERAPY, UNIVERSITY OF THE SCIENCES IN PHILADELPHIA, PHILADELPHIA, PA, USA
| | - Varleisha Gibbs
- DEPARTMENT OF OCCUPATIONAL THERAPY, WESLEY COLLEGE, DOVER, DE, USA
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24
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Brunner M, Hemsley B, Togher L, Palmer S. Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI). Brain Inj 2017; 31:1028-1043. [DOI: 10.1080/02699052.2017.1292429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Brunner
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Bronwyn Hemsley
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Stuart Palmer
- Faculty of Science, Engineering & Built Environment, Deakin University, Geelong, Australia
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Klaassen B, van Beijnum BJF, Hermens HJ. Usability in telemedicine systems-A literature survey. Int J Med Inform 2016; 93:57-69. [PMID: 27435948 DOI: 10.1016/j.ijmedinf.2016.06.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/30/2016] [Accepted: 06/07/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The rapid development of sensors and communication technologies enable the growth of new innovative services in healthcare, such as Telemedicine. An essential ingredient in the development of a telemedicine system and its final acceptance by end users are usability studies. The principles of usability engineering, evaluations and telemedicine are well established, and it may contribute to the adoption and eventually deployment of such systems and services. An in-depth usability analysis, including performance and attitude measures, requires knowledge about available usability techniques, and is depending on the amount of resources. Therefore it is worth investigating how usability methods are applied in developing telemedicine systems. Our hypothesis is: with increasing research and development of telemedicine systems, we expect that various usability methods are more equally employed for different end-user groups and applications. METHOD A literature survey was conducted to find telemedicine systems that have been evaluated for usability or ease of use. The elements of the PICO framework were used as a basis for the selection criteria in the literature search. The search was not limited by year. Two independent reviewers screened all search results first by title, and then by abstract for inclusion. Articles were included up to May 2015. RESULTS In total, 127 publications were included in this survey. The number of publications on telemedicine systems significantly increased after 2008. Older adults and end-users with cardiovascular conditions were among largest target end-user groups. Remote monitoring systems were found the most, in 90 publications. Questionnaires are the most common means for evaluating telemedicine systems, and were found in 88 publications. Questionnaires are used frequently in studies focusing on cardiovascular diseases, Parkinson's disease and older adult conditions. Interviews are found the most in publications related to stroke. In total 71% of the publications were trial-orientated and the remaining process orientated. An increase in telemedicine research, development and applications is found worldwide, with the majority of publications conducted in America. DISCUSSION AND CONCLUSION Monitoring patients in their homes can lead to better healthcare at lower costs which implies an increased demand of new healthcare strategies like telemedicine. We expected that with the increase in telemedicine research and development, a greater range of usability methods would also be employed in the included publications. This is not the case. Researchers employed questionnaires as a preferred usability method for each type of telemedicine system and most end-users. However, in process-orientated studies a greater range of usability evaluations were applied, with fewer differences found in the amount of publications for each evaluation method. Questionnaires enable researchers to evaluate a system quickly on end users, as it requires less expertise on the evaluation method compared to the other methods. They are easily distributed and are customizable. The use of questionnaires is therefore an evaluation method of choice for a variety of telemedicine systems and end-users.
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Affiliation(s)
- B Klaassen
- Biomedical Signals And Systems group, University of Twente, Enschede, The Netherlands; Centre for Telematics and Information Technology, University of Twente, The Netherlands.
| | - B J F van Beijnum
- Biomedical Signals And Systems group, University of Twente, Enschede, The Netherlands; Centre for Telematics and Information Technology, University of Twente, The Netherlands
| | - H J Hermens
- Biomedical Signals And Systems group, University of Twente, Enschede, The Netherlands; Centre for Telematics and Information Technology, University of Twente, The Netherlands; Roessingh Research and Development, Roessingh Rehabilitation Hospital, The Netherlands.
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26
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Rayner M, Muscara F, Dimovski A, McCarthy MC, Yamada J, Anderson VA, Burke K, Walser R, Nicholson JM. Take A Breath: study protocol for a randomized controlled trial of an online group intervention to reduce traumatic stress in parents of children with a life threatening illness or injury. BMC Psychiatry 2016; 16:169. [PMID: 27234569 PMCID: PMC4884427 DOI: 10.1186/s12888-016-0861-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/12/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND A substantial proportion of parents whose child is diagnosed with a life-threatening illness, experience high levels of distress that can lead to long-term difficulties in mental health, family functioning and child adjustment. This study evaluates the efficacy of an Acceptance Commitment Therapy-based group intervention designed to reduce distress symptoms in these parents. The program is delivered using videoconferencing to overcome factors that prevent participation in traditional face-to-face therapy. METHOD/DESIGN The study is a randomized control trial of the Take A Breath group intervention for parents demonstrating elevated symptoms of acute stress, delivered via videoconferencing in six 90 min group sessions. Participants are the primary caregivers of children aged 0 to 18 years admitted for a life threatening illness or injury to the Oncology, Cardiology, Neurology or Intensive Care Departments of a tertiary pediatric hospital. Parents will be randomized to intervention or waitlist control 4-10 months after their child's diagnosis. Measures will be collected prior to and immediately post intervention for intervention and waitlist parents to assess program efficacy. Intervention parents will be followed up at 6 months to assess the maintenance of program effects. We predict that intervention parents will show fewer symptoms post intervention than waitlist parents (primary outcomes: traumatic stress, depression, anxiety, stress symptoms), reflecting improvements in the psychological skills addressed in the intervention (mediating factors). It is anticipated that reductions in mental health difficulties for intervention parents will be maintained up to 6 months post-intervention and will be associated with broader improvements in parents' adjustment, child adjustment and child wellbeing (secondary outcomes). DISCUSSION This study is unique in evaluating a group intervention delivered to parents of children affected by of a diverse range life-threatening illness or injury. Online communication technology is employed to reduce participation barriers. If proven efficacious, this trans-diagnostic approach offers the potential for broad use as part of the suite of psychosocial services provided to families through tertiary pediatric settings. TRIAL REGISTRATION ACTRN12611000090910 . Trial Registration Date: 14/09/2011 Protocol Date/version: September 2015, version M Study Status: Ongoing.
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Affiliation(s)
- Meredith Rayner
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Frank Muscara
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Anica Dimovski
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Maria C McCarthy
- Children's Cancer Centre, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Jackie Yamada
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Vicki A Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Kylie Burke
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Robyn Walser
- University of California, Berkeley and TL Consultation Services, Menlo Park, California, USA
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, Victoria, 3000, Australia
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Imam B, Miller WC, Finlayson HC, Eng JJ, Payne MW, Jarus T, Goldsmith CH, Mitchell IM. A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2014; 3:e80. [PMID: 25533902 PMCID: PMC4376145 DOI: 10.2196/resprot.4031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/25/2014] [Indexed: 11/27/2022] Open
Abstract
Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Results Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Conclusions Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial Registration Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP).
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Affiliation(s)
- Bita Imam
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
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