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Skiba MB, Wells SJ, Brick R, Tanner L, Rock K, Marchese V, Khalil N, Raches D, Thomas K, Krause KJ, Swartz MC. A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability. Telemed J E Health 2024; 30:901-918. [PMID: 38010811 DOI: 10.1089/tmj.2023.0224] [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: 11/29/2023] Open
Abstract
Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.
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Affiliation(s)
- Meghan B Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Stephanie J Wells
- Division of Pediatric, Pediatrics-Research Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
| | - Lynn Tanner
- Physical Medicine and Rehabilitation, Children's Minnesota Hospital, Minneapolis, Minnesota, USA
| | - Kelly Rock
- Physical Therapy Department, University of Florida, Gainesville, Florida, USA
- Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victoria Marchese
- Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nashwa Khalil
- Rusk Rehabilitation, NYU Langone Health, New York, New York, USA
| | - Darcy Raches
- Psychology Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kristin Thomas
- Laboratory Howard Heads Sports Medicine, Vail Health, Edwards, Colorado, USA
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria C Swartz
- Division of Pediatric, Pediatrics-Research Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Su WC, Cleffi C, Srinivasan S, Bhat A. A Pilot Study Comparing the Efficacy, Fidelity, Acceptability, and Feasibility of Telehealth and Face-to-Face Creative Movement Interventions in Children with Autism Spectrum Disorder. TELEMEDICINE REPORTS 2024; 5:67-77. [PMID: 38558955 PMCID: PMC10979681 DOI: 10.1089/tmr.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 04/04/2024]
Abstract
Aims We compared the efficacy, fidelity, acceptability, and feasibility of a creative movement (CM) intervention for children with autism spectrum disorder (ASD), delivered face-to-face (F2F) or through telehealth (TH). Methods Fifteen children with ASD received the CM intervention F2F or through TH. Motor assessments were used to evaluate effects of F2F and TH interventions on children's motor skills, while video coding was used to assess affect, socially directed verbalization, interpersonal synchrony, and motor coordination during training. Stakeholder feedback and training fidelity data on the intervention were also collected. Results Children in both subgroups showed similar baseline performance and training-related improvements in motor skills, positive/interested affect, socially directed verbalization, interpersonal synchrony, and dual/multilimb coordination. Parents in the TH subgroup considered the intervention feasible and acceptable; however, they reported greater effort to supervise and redirect their child's attention compared to the F2F subgroup. Trainers for the TH subgroup reported more communication difficulties, technological issues, and longer session lengths, but found greater parental involvement compared to the F2F subgroup. Conclusions CM interventions are consistent, acceptable, feasible, and effective in improving social, behavioral-affective, and motor skills of children with ASD, regardless of the method of delivery. Clinicians should make efforts to reduce communication/technological issues and parental burden when delivering CM interventions through TH. ClinicalTrials.Gov Study ID-NCT04258254.
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Affiliation(s)
- Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Corina Cleffi
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Anjana Bhat
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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Norman K, French A, Lake A, Tchuisseu YP, Repka S, Vasudeva K, Dong C, Whitaker R, Bettger JP. Describing Perspectives of Telehealth and the Impact on Equity in Access to Health Care from Community and Provider Perspectives: A Multimethod Analysis. Telemed J E Health 2024; 30:242-259. [PMID: 37410525 DOI: 10.1089/tmj.2023.0036] [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: 07/07/2023] Open
Abstract
Introduction: The rapid adoption of telehealth as a result of the COVID-19 pandemic provided the opportunity to examine perceptions of health care access and use of telehealth for delivery of effective and equitable care in low-income and historically marginalized communities. Methods: Focusing on communities with high social vulnerability, a multimethod analysis of combined perspectives, collected February through August 2022 from 112 health care providers, obtained from surveys and interviews, and 23 community members via 3 focus groups on access to care and telehealth. Qualitative data were analyzed using the Health Equity and Implementation Framework to identify barriers, facilitators, and recommendations for the implementation of telehealth using a health equity lens. Results: Participants perceived that telehealth helped maintain access to health care during the pandemic by addressing barriers including provider shortages, transportation concerns, and scheduling conflicts. Additional benefits suggested were improved care quality and coordination attributed to convenient avenues for care delivery and communication among providers and patients. However, many barriers to telehealth were reported and considered to limit equitable access to care. These included restrictive or changing policies regarding allowable services provided via telehealth, and availability of technology and broadband services to enable telehealth visits. Recommendations provided insight into care delivery innovation opportunities and potential policy changes to address equitable access to care. Conclusion: Integration of telehealth into models of care delivery could improve access to health care services and promote communication among providers and patients to improve care quality. Our findings have implications that are critical for future policy reforms and telehealth research.
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Affiliation(s)
- Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Ashley Lake
- Department of Rehabilitation Services, Duke Physical Therapy Sports Medicine at Center for Living, Duke University, Durham, North Carolina, USA
| | | | - Samantha Repka
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Karina Vasudeva
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia Dong
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Rebecca Whitaker
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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Morgan S, Weir KA, Mulligan K, Jacobs S, Hilari K. Impact of COVID-19 on clinical practice of UK-based speech and language therapists working with school-aged children with neurodisability and oropharyngeal dysphagia: A survey. Child Care Health Dev 2024; 50:e13159. [PMID: 37555626 DOI: 10.1111/cch.13159] [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: 07/18/2022] [Revised: 03/17/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic and response changed clinical service delivery and practice for speech and language therapists (SLTs) in the United Kingdom. SLTs work with children with neurodisability regarding both difficulties with their communication and eating and drinking skills (oropharyngeal dysphagia). This survey aimed to specifically explore the impact of the COVID-19 pandemic on SLT practice for school-aged children with dysphagia. METHODS UK-based SLTs working with school-aged children with neurodisability and oropharyngeal dysphagia were recruited to share their perceptions on the impact of COVID-19 on practice. Four questions focusing on COVID-19 impact were part of a larger online survey exploring SLT clinical practice regarding mealtime management of children with neurodisability and oropharyngeal dysphagia, which included demographic information, service delivery, assessment and intervention practices. COVID-19 impact questions were a mixture of multiple choice and free text responses. The survey was disseminated using professional networks and social media, between 14 May and 30 July 2021. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS One hundred and two participants answered at least one of the four COVID-19 questions. Eighty-two per cent of SLTs either agreed or strongly agreed that COVID-19 impacted on service delivery to children and families. Negative impacts on service delivery included school absences/closures, home visiting restrictions, families declining input and/or having barriers to telehealth use and the impact of mask wearing on interactions. Positive impacts included increased telehealth access and skills, increased contact with families and focus on children's eating and drinking function within the home environment. Participants aimed to maintain the increased contact with families alongside a hybrid service delivery approach of in-person and virtual appointments. CONCLUSIONS This survey provides novel information capturing SLT practice change across two waves of COVID-19 and return to in-person practice for UK children with neurodisability.
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Affiliation(s)
- Sally Morgan
- Department of Language & Communication Science, City, University of London, London, UK
| | - Kelly A Weir
- Menzies Health Institute Queensland, Griffith University; Gold Coast Health, The University of Melbourne, Melbourne, Australia
| | - Kathleen Mulligan
- City, University of London, East London NHS Foundation Trust, London, UK
| | | | - Katerina Hilari
- Department of Language & Communication Science, City, University of London, London, UK
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Su WC, Cleffi C, Srinivasan S, Bhat A. Telehealth Versus Face-to-Face Fine Motor and Social Communication Interventions for Children With Autism Spectrum Disorder: Efficacy, Fidelity, Acceptability, and Feasibility. Am J Occup Ther 2023; 77:7706205130. [PMID: 38048263 PMCID: PMC10846418 DOI: 10.5014/ajot.2023.050282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
IMPORTANCE The efficacy of telehealth (TH) interventions needs to be studied. OBJECTIVE To compare the efficacy, fidelity, acceptability, and feasibility of face-to-face (F2F) versus TH seated play (SP) interventions among children with autism spectrum disorder (ASD). DESIGN As part of a larger randomized controlled trial, children were assigned to the SP group and received TH and F2F interventions over 8 wk using a pretest-posttest study design. SETTING A research lab or through videoconferencing. PARTICIPANTS Fifteen children with ASD (ages 5-14 yr) were randomly assigned to the SP group and received the intervention F2F or through TH. INTERVENTION Children received 16 SP intervention sessions (2 sessions per week for 8 wk). OUTCOMES AND MEASURES Pretests and posttests included standardized fine motor assessments. Video coding compared socially directed verbalization during training sessions. Parents and trainers provided feedback on their experiences. RESULTS Seven children received the intervention F2F, whereas 8 received TH intervention. Children in both subgroups showed similar training improvements in fine motor skills and socially directed verbalizations (ps > .01). Parents rated both interventions as acceptable and feasible; however, they reported longer preparation time and effort during TH interventions (ps < .01). Trainers reported greater parental involvement but more communication and technological issues during TH interventions. Fidelity checks indicated fewer reinforcements during TH versus F2F sessions. CONCLUSIONS AND RELEVANCE TH intervention is feasible and effective in improving fine motor and social communication performance. Clinicians should reduce parental burden and overcome technological issues. What This Article Adds: This study confirmed the efficacy, fidelity, acceptability, and feasibility of delivering seated play, standard of care interventions for children with autism spectrum disorder via telehealth. However, clinicians should work on reducing parental burden and overcoming communication and technological issues related to telehealth.
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Affiliation(s)
- Wan-Chun Su
- Wan-Chun Su, PhD, MS, PT, is Postdoctoral Fellow, National Institutes of Health, Bethesda, Maryland
| | - Corina Cleffi
- Corina Cleffi, BS, is Graduate Student, Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark
| | - Sudha Srinivasan
- Sudha Srinivasan, PhD, MS, PT, is Assistant Professor, Physical Therapy Program, Department of Kinesiology; Institute for Health, Intervention, and Policy; and Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Anjana Bhat
- Anjana Bhat, MS, PhD, PT, is Professor, Department of Physical Therapy, Biomechanics and Movement Science Program, and Department of Psychological and Brain Sciences, University of Delaware, Newark;
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Aultman J, Bassi M, Richner G, Delahanty S, Rush S, Spalding S, Grossoehme D. Fulfilling 6 Domains of Health Care Quality: A Qualitative Parental Caregiver Study of Pediatric Telehealth During a Pandemic. Clin Pediatr (Phila) 2023; 62:991-1007. [PMID: 36691227 DOI: 10.1177/00099228221150115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Using qualitative methods, we examine telehealth care quality from the perspective of parents of pediatric patients during a pandemic. We fill a gap in the literature essential for measuring effectiveness of pediatric telehealth. A total of 22 participants (n = 21 female; n = 1 male) enrolled in 1 of 9 interviews and focus groups conducted in 2021. Transcribed data were thematically analyzed and organized based on the 6 domains of quality health care by the Institute of Medicine (IOM). Analyzed data revealed 7 themes and 52 codes. Pediatric telehealth visits were perceived as efficient, timely, safe, and generally effective by parents for their child's health care. Participants experienced equal or greater time with their child's care provider via telehealth than through in-person visits. Qualitative results directly align with IOM domains of quality health care and contribute to the growing literature and evidence that may lead to improved telehealth outcomes and better preparedness for emergent public health events.
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Affiliation(s)
- Julie Aultman
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Mandip Bassi
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | | | - Sarah Rush
- Akron Children's Hospital, Akron, OH, USA
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Vanderhout S, Goldbloom EB, Li A, Newhook D, Garcia M, Dulude C. Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study. J Med Internet Res 2023; 25:e45287. [PMID: 37647120 PMCID: PMC10500354 DOI: 10.2196/45287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/04/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Virtual care was rapidly integrated into pediatric health services during the COVID-19 pandemic. While virtual care offers many benefits, it is necessary to better understand the experiences of those who receive, deliver, and coordinate virtual care in order to support sustainable, high-quality, and patient-centered health care. To date, methods implemented to evaluate users' experiences of virtual care have been highly variable, making comparison and data synthesis difficult. OBJECTIVE This study aims to describe evaluation strategies currently used to understand personal experiences with pediatric virtual care in Canada. METHODS In this mixed methods environmental scan, we first distributed a web-based questionnaire to clinical, research, and operational leaders delivering and evaluating pediatric virtual care in Canada. The questionnaire collected information about how experiences with virtual care have been or are currently being evaluated and whether these evaluations included the perspectives of children or youth, families, providers, or support staff. Second, respondents were asked to share the questions they used in their evaluations, and a content analysis was performed to identify common question categories. Third, we conducted semistructured interviews to further explore our respondents' evaluation experiences across 4 domains-evaluation approaches, distribution methods, response rates, and lessons learned-and interest in a core set of questions for future evaluations. RESULTS There were 72 respondents to the web-based questionnaire; among those who had conducted an evaluation, we identified 15 unique evaluations, and 14 of those provided a copy of the tools used to evaluate virtual care. These evaluations measured the virtual care experiences of parents or caregivers (n=15, 100%), children or youth (n=11, 73%), health care providers (n=11, 73%), and support staff (n=4, 27%). The most common data collection method used was electronic questionnaires distributed by email. Two respondents used validated tools; the remainder modified existing tools or developed new tools. Content analysis of the 14 submitted questionnaires revealed that the most common questions were about overall participant satisfaction, the comparison of virtual care to in-person care, and whether participants would choose virtual care options in the future. Interview findings indicate respondents frequently relied on methods used by peers and that a standardized, core set of questions to evaluate experiences with virtual care would be helpful to improve evaluation practices and support pediatric health care delivery. CONCLUSIONS At our institution and elsewhere in Canada, experiences with pediatric virtual care have been evaluated using a variety of methods. A more consistent evaluation approach using standardized tools may enable more regular comparisons of experiences with virtual care and the synthesis of findings across health care settings. In turn, this may better inform our approach to virtual care, improve its integration into health systems, and facilitate sustainable, high-quality, patient-centered care.
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Affiliation(s)
- Shelley Vanderhout
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Amy Li
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dennis Newhook
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Meghan Garcia
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Catherine Dulude
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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