Telehealth services for children with neuro-developmental disabilities in the Asia-Pacific region: A systematic review

BACKGROUND

In recent years telehealth became a popular and a rational health service delivery approach, especially amidst multiple challenges posed while providing health care interventions during the COVID-19 pandemic.

AIM

We synthesized available evidence on telehealth for managing children with NDDs in the Asia-Pacific region with the aim of identifying successful methods.

METHODOLOGY

We systematically reviewed six electronic databases: MEDLINE, AMED, EMBASE, PsychInfo, Web of Science, and (CINAHL plus) using the keywords and database-specific subject headings from their inception to 25th August 2021. Review findings were synthesized narratively, and harvest plots were used to demonstrate the effect of interventions. The protocol and reporting the findings of this review adhered to PRISMA 2020 guidelines. PROSPERO registration: CRD 340690.

RESULTS

We harvested 30,823 records; 17,563 duplicates were removed, and 196 full-text articles were assessed for eligibility. 16 studies with multiple research designs were included in the review. Eight were from the Pacific region and eight represented Asia. The interventions targeted families and children with a variety of NDDs (autism spectrum disorder, Down syndrome, cleft lip and palate, hearing impairment, cerebral palsy etc.) via telehealth. Telehealth packages consisted of direct and indirect methods of synchronous, asynchronous, and hybrid approaches. All studies used parent-led intervention strategies. Telehealth reported a positive effect in 7/16 studies while five showed a neutral effect.

CONCLUSIONS

According to published evidence telehealth for children with NDDs is an evolving, evidence-based service facilitation modality in the Asia-Pacific region, with only a few published randomized controlled trials. The systematic review shows promising telehealth practices emerging across the region despite the diversity in NDDs studied.

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status

Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

Remote PEERS® for preschoolers: A pilot parent-mediated social skills intervention for young children with social challenges over telehealth

INTRODUCTION

Social differences characteristic of autism spectrum disorder (ASD) and other developmental disabilities are evident in early childhood and are associated with later difficulties. Unfortunately, there is a paucity of evidence-based interventions explicitly targeting social skills development for young children, few actively integrate parents and caregivers, and even fewer have remote models. The importance of providing accessible, tailored services for families in the wake of the COVID-19 pandemic, prompted the creation of a parent-mediated telehealth version of Program for the Education and Enrichment of Relational Skills (PEERS^®) for Preschoolers (P4P), a pre-existing, evidence-based social skills intervention for children 4-6 years focused on making and keeping friends.

METHOD

This methodological paper documents the implementation, feasibility, and satisfaction of a novel telehealth group-based delivery of P4P.

RESULTS

Qualitative results indicate acceptable feasibility and satisfaction. Additionally, following completion there was an increase in parental confidence in social coaching and increased use of child social skills.

DISCUSSION

Future work will evaluate quantitative outcomes and comparisons between delivery methods (e.g., telehealth vs. in-person).

Psychological interventions during COVID pandemic: Telehealth for individuals with cystic fibrosis and caregivers

INTRODUCTION

Coronavirus disease 2019 (COVID-19) emerged in China, leading to worldwide morbidity and mortality, including depression and anxiety. As the pandemic spread throughout Italy, mental health concerns increased for people with cystic fibrosis (pwCF), who are at greater risk. The aim was to pilot a Telehealth Psychological Support Intervention for pwCF and caregivers to reduce stress, depression, and anxiety during the lockdown in Italy in March 2020.

METHODS

This intervention utilized cognitive behavioral skills (e.g., cognitive reframing). Participants included 16 pwCF and 14 parents, who completed four individual telehealth sessions with a psychologist. Stress ratings, Patient Health Questionnaire and General Anxiety Disorder, PHQ-8 and GAD-7, were completed, in addition to Feasibility and Satisfaction ratings.

RESULTS

Ratings of stress significantly decreased from pre- to post-testing for pwCF (paired t(14) = -4.06, p < .01) and parents (paired t = -5.2, p < .001). A large percentage of both groups scored in the clinical range for depression and anxiety at baseline (pwCF: depression/anxiety = 71%; parents: depression = 57%; anxiety = 79%); a large proportion (20%-40%) reported moderate to severe symptomatology. Significant reductions in depression for pwCF were found (pre: M = 8.0 to post: M = 4.7; paired t(14) = 2.8, p < .05) but not anxiety (pre: M = 6.9 to post: M = 5.6, t(14) = 1.2, p = NS-non-significant). Parental depression decreased for parents (pre: M = 6.4 to post: M = 5.1, t(14) = -2.5, p < .05), but not anxiety (pre: M = 8.1 to post: M = 7.9, t(14) = -0.2, p = NS). Feasibility and Satisfaction were positive.

CONCLUSION

This telehealth intervention yielded reductions in stress and depression for participants. Anxiety did not significantly decrease, possibly because COVID was ongoing. This feasible, satisfactory intervention was effective for improving mental health.

Anthropometric Outcomes of Children and Adolescents Using Telehealth with Weight Management Interventions Compared to Usual Care: A Systematic Review and Meta-analysis

Objective:This systematic review and meta-analysis evaluated the effect of telehealth (TH) weight management interventions compared to usual care on anthropometric outcomes in children and adolescents with overweight and obesity.Methods: Comprehensive searches were conducted identifying randomized controlled trials (RCTs) published between January 1, 2005 and June 1, 2019. Studies using a web-based, smartphone or email TH intervention in children between 2-18 years of age were included. Outcome measures of interest included body mass index (BMI) z-score, BMI percentile, waist circumference (WC) and waist-to-hip-ratio (WHR). The Grade Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to rate strength of evidence (SOE) and a random-effects meta-analysis was performed when five or more RCTs reported the same outcome.Results: Thirteen RCTs met the inclusion criteria for the systematic review. Random effects meta-analysis of 10 RCTs detected a small effect for TH interventions compared to usual care in reducing BMI z-score (pooled net change in BMI z-score = -0.04; 95% CI -0.07, 0.00: I2 = 12%). No significant differences were found between groups for other outcomes. Strength of evidence ratings were low or very low in part due to concerns with heterogeneity in study designs, intervention durations, ages of participants, the type of TH used and risk of bias (ROB) of included studies.Conclusions: There is a low strength of evidence that TH had a small effect on anthropometric outcomes compared to usual care. Future RCTs should be well designed to minimize clinical heterogeneity and ROB. Studies of longer intervention duration with adequate, statistically powered analyses should be conducted. Key teaching pointsStudies using TH with pediatric weight management interventions may be effective to improve health of children with overweight and obesity.Future RCTs should consider clinical heterogeneity of study design for setting, age-group of children, preferences for type of TH and ROB.Studies that include children with severe obesity (<95th%) may need more sensitive outcome measures.Studies of longer duration are needed to better understand long-term weight management success.

Application of telehealth intervention in Parkinson's disease: A systematic review and meta-analysis

INTRODUCTION

Telehealth intervention has been proposed as a sustainable and innovative intervention approach to Parkinson's disease (PD) patients, but there are still conflicting results in the literature about its effect. This study aimed to evaluate the efficacy of telehealth intervention for PD patients.

METHODS

PubMed, EMBASE, CENTRAL and China National Knowledge Infrastructure (CNKI) were searched from the inception to June 2018 for randomized controlled trials (RCTs) and cohort studies, without language restrictions. When feasible, data were statistically pooled for meta-analysis using Review Manager 5.3. Otherwise, narrative summaries were used.

RESULTS

Twenty-one studies were included. With respect to PD severity, compared with usual care, telehealth intervention was beneficial in lowering motor impairment of PD patients significantly (mean difference (MD) = -2.27, 95% confidence interval (95% CI) -4.25 to -0.29, p = 0.02), rather than mental status (MD = -0.98, 95% CI -2.61 to 0.65, p = 0.24), activities of daily living (MD = -1.51, 95% CI -4.91 to 1.89, p = 0.38) and motor complications (MD = -0.36, 95% CI -1.31 to 0.59, p = 0.46). Telehealth intervention did not lead to significant reduction in quality of life (standardized mean difference (SMD) = 0.04, 95% CI -0.20 to 0.28, p = 0.76), depression (SMD = -0.12, 95% CI -0.37 to 0.13, p = 0.34), cognition (MD = 0.37, 95% CI -0.34 to 1.09, p = 0.31) and balance (MD = 0.09, 95% CI -2.49 to 2.66, p = 0.95).

DISCUSSION

Telehealth intervention is an effective option for individuals with PD to improve their motor impairment. Further well-designed studies are warranted to confirm our findings.

A randomized trial using telehealth technology to link caregivers with dementia care experts for in-home caregiving support: FamTechCare protocol

The number of persons with dementia (PWD) in the United States is expected to reach 16 million by 2050. Due to the behavioral and psychological symptoms of dementia, caregivers face challenging in-home care situations that lead to a range of negative health outcomes such as anxiety and depression for the caregivers and nursing home placement for PWD. Supporting Family Caregivers with Technology for Dementia Home Care (FamTechCare) is a multisite randomized controlled trial evaluating the effects of a telehealth intervention on caregiver well-being and PWD behavioral symptoms. The FamTechCare intervention provides individualized dementia-care strategies to in-home caregivers based on video recordings that the caregiver creates of challenging care situations. A team of dementia care experts review videos submitted by caregivers and provide interventions to improve care weekly for the experimental group. Caregivers in the control group receive feedback for improving care based on a weekly phone call with the interventionist and receive feedback on their videos at the end of the 3-month study. Using linear mixed modeling, we will compare experimental and control group outcomes (PWD behavioral symptoms and caregiver burden) after 1 and 3 months. An exploratory descriptive design will identify a typology of interventions for telehealth support for in-home dementia caregivers. Finally, the cost for FamTechCare will be determined and examined in relation to hypothesized effects on PWD behavioral symptoms, placement rates, and caregiver burden. This research will provide the foundation for future research for telehealth interventions with this population, especially for families in rural or remote locations.

Effect of telehealth intervention on breast cancer patients' quality of life and psychological outcomes: A meta-analysis

Introduction Telehealth intervention has been proposed as an innovative intervention approach to breast cancer patients, but there are still conflicting results in the literature about its effect. Methods PubMed, EMBASE, CENTRAL and China National Knowledge Infrastructure (CNKI) were searched from inception to 3 October 2016 for randomized controlled trials (RCTs) which assessed the effect of telehealth intervention versus usual care in breast cancer patients. No language restrictions were used. Standardized mean difference (SMD) with corresponding 95% confidence interval (95% CI) was pooled when needed. Subgroup and sensitivity analyses were conducted if necessary and feasible. Results Twenty RCTs with a total of 2190 participants were included into this meta-analysis. Compared with usual care, telehealth intervention was associated with higher quality of life (SMD = 0.60, 95% CI 0.18-1.01, p = 0.005) and self-efficacy (SMD = 0.59, 95% CI 0.19-0.98, p = 0.003), with less depression (SMD = -1.29, 95% CI -2.28 to -0.30, p = 0.01), distress (SMD = -0.25, 95% CI -0.40 to -0.10, p = 0.001) and perceived stress (SMD = -0.30, 95% CI, -0.59 to -0.02, p = 0.04). However, anxiety score did not differ significantly between the two groups (SMD = -0.09, 95% CI -0.22 to 0.04, p = 0.17). Discussion Telehealth intervention is superior to usual care in breast cancer patients for improved quality of life, higher self-efficacy and less depression, distress, and perceived stress. However, these results should be recognized cautiously due to between-study heterogeneity, indicating that further well-designed RCTs are warranted.