Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services

Authors

  • Kelly Tanner Nationwide Children's Hospital https://orcid.org/0000-0003-1808-5738
  • Rachel Bican Nationwide Children's Hospital
  • Jamie Boster Nationwide Children's Hospital
  • Catie Christensen Nationwide Children's Hospital
  • Candace Coffman Nationwide Children's Hospital
  • Kristin Fallieras Nationwide Children's Hospital
  • Rene Long Nationwide Children's Hospital
  • Christine Mansfield Nationwide Children's Hospital
  • Sara O'Rourke Nationwide Children's Hospital
  • Lindsey Pauline Nationwide Children's Hospital
  • Grace Sagester Nationwide Children's Hospital
  • James Marrie Nationwide Children's Hospital

DOI:

https://doi.org/10.5195/ijt.2020.6336

Keywords:

Healthcare, Patient-centered care, Pediatric rehabilitation, Telerehabilitation

Abstract

Objective: Telerehabilitation has long been recognized as a promising means of providing pediatric services; however, significant barriers such as cost, payor reimbursement, and access prevented widespread use. The advent of the COVID-19 pandemic necessitated rapid adoption of telerehabilitation into clinical practice to provide access to care while maintaining social distancing. The purpose of this study is to present clinical data on the feasibility and acceptability of speech-language pathology, developmental occupational and physical therapies, and sports and orthopedic therapies telerehabilitation delivered in a pediatric hospital setting. Methods: Telerehabilitation services were rapidly implemented in three stages: building the foundation, implementing, and refining this service delivery model. Paper patient satisfaction surveys were administered as part of ongoing quality improvement efforts throughout 2019 and were adapted for online administration in 2020 for telerehabilitation patients. Outpatient visit counts by type (in-person, phone, and video) were extracted from the electronic medical record using data warehousing techniques. Results: Historical patient satisfaction rates from 2019 indicated high patient satisfaction (98.97% positive responses); these results were maintained for telerehabilitation visits (97.73%), indicating that families found telerehabilitation services acceptable. Patient volume returned to 73.5% of pre-pandemic volume after the implementation of telerehabilitation services. Conclusions: Pediatric telerehabilitation is feasible to provide in clinical settings, and the services are acceptable to patient families. Future work is needed to evaluate the impact of telerehabilitation services on patient care and applications for ongoing use of this delivery model.

 

  

References

American Occupational Therapy Association. (2018). Telehealth in occupational therapy. American Journal of Occupational Therapy, 72(Supplement_2), 7212410059p1-7212410059p18. https://doi.org/10.5014/ajot.2018.72S219

American Physical Therapy Association. (2019). Position on telehealth. American Physical Therapy Association. https://www.apta.org/apta-and-you/leadership-and-governance/policies/telehealth

American Speech-Language-Hearing Association. (2020). Telepractice. https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934956&section=Overview

Badawy, S. M., & Radovic, A. (2020). Digital approaches to remote pediatric health care delivery during the COVID-19 pandemic: Existing evidence and a call for further research. JMIR Pediatrics and Parenting, 3(1), e20049. https://doi.org/10.2196/20049

Ben-Pazi, H., Beni-Adani, L., & Lamdan, R. (2020). Accelerating telemedicine for cerebral palsy during the COVID-19 pandemic and beyond. Frontiers in Neurology, 11, 746. https://doi.org/10.3389/fneur.2020.00746

Brennan, D. M., Georgeadis, A. C., Baron, C. R., & Barker, L. M. (2004). The effect of videoconference-based telerehabilitation on story retelling performance by brain-injured subjects and its implications for remote speech-language therapy. Telemedicine Journal and E-Health, 10(2), 147–154. https://doi.org/10.1089/tmj.2004.10.147

Brophy, P. D. (2017). Overview on the challenges and benefits of using telehealth tools in a pediatric population. Advances in Chronic Kidney Disease, 24(1), 17–21. https://doi.org/10.1053/j.ackd.2016.12.003

Burke, B. L., Hall, R. W., & The Section on Telehealth Care (2015). Telemedicine: Pediatric applications. Pediatrics, 136(1), e293–e308. https://doi.org/10.1542/peds.2015-1517

Cason, J. (2014). Telehealth: A rapidly developing service delivery model for occupational therapy. International Journal of Telerehabilitation, 6(1), 29–35. https://doi.org/10.5195/ijt.2014.6148

Coyle, J. (2012). Tele-dysphagia management: An opportunity for prevention, cost-savings and advanced training. International Journal of Telerehabilitation, 4(1), 37–40. https://doi.org/10.5195/IJT.2012.6093

Crutchley, S., & Campbell, M. (2010). Telespeech therapy pilot project: Stakeholder satisfaction. International Journal of Telerehabilitation, 2(1), 23–30. https://doi.org/10.5195/ijt.2010.6049

Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. The New England Journal of Medicine, 375(2), 154–161. https://doi.org/10.1056/NEJMra1601705

Douglas, N. F., Hinckley, J. J., Haley, W. E., Andel, R., Chisolm, T. H., & Eddins, A. C. (2014). Perceptions of speech-language pathologists linked to evidence-based practice use in skilled nursing facilities. American Journal of Speech-Language Pathology, 23(4), 612–624. https://doi.org/10.1044/2014_AJSLP-13-0139

Eckberg Zylstra, S. (2013). Evidence for the use of telehealth in pediatric occupational therapy. Journal of Occupational Therapy, Schools, & Early Intervention, 6(4), 326–355. https://doi.org/10.1080/19411243.2013.860765

Gloff, N. E., LeNoue, S. R., Novins, D. K., & Myers, K. (2015). Telemental health for children and adolescents. International Review of Psychiatry, 27(6), 513–524. https://doi.org/10.3109/09540261.2015.1086322

Hall, N., Boisvert, M., & Steele, R. (2013). Telepractice in the assessment and treatment of individuals with aphasia: A systematic review. International Journal of Telerehabilitation, 5(1), 27–38. https://doi.org/10.5195/ijt.2013.6119

Hill, A. J., Theodoros, D. G., Russell, T. G., Cahill, L. M., Ward, E. C., & Clark, K. M. (2006). An internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study. American Journal of Speech-Language Pathology, 15(1), 45–56. https://doi.org/10.1044/1058-0360(2006/006)

Lee, A. C., Davenport, T. E., & Randall, K. (2018). Telehealth physical therapy in musculoskeletal practice. The Journal of Orthopaedic and Sports Physical Therapy, 48(10), 736–739. https://doi.org/10.2519/jospt.2018.0613

Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-based coaching by means of telehealth for families of young children with autism spectrum disorder. American Journal of Occupational Therapy, 72(2), 7202205020p1-7202205020p7. https://doi.org/10.5014/ajot.2018.024786

Lovo Grona, S., Bath, B., Bustamante, L., & Mendez, I. (2016). Case report: Using a remote presence robot to improve access to physical therapy for people with chronic back disorders in an underserved community. Physiotherapy Canada, 69(1), 14–19. https://doi.org/10.3138/ptc.2015-77

McGill, M., Noureal, N., & Siegel, J. (2018). Telepractice treatment of stuttering: A systematic review. Telemedicine and E-Health, 25(5), 359–368. https://doi.org/10.1089/tmj.2017.0319

Nelson, E.-L., & Sharp, S. (2016). A review of pediatric telemental health. Pediatric Clinics of North America, 63(5), 913–931. https://doi.org/10.1016/j.pcl.2016.06.011

Ohannessian, R., Duong, T. A., & Odone, A. (2020). Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: A call to action. JMIR Public Health and Surveillance, 6(2), e18810. https://doi.org/10.2196/18810

Olayiwola, J. N., Magaña, C., Harmon, A., Nair, S., Esposito, E., Harsh, C., Forrest, L. A., & Wexler, R. (2020). Telehealth as a bright spot of the COVID-19 pandemic: Recommendations from the virtual frontlines (“frontweb”). JMIR Public Health and Surveillance, 6(2), e19045. https://doi.org/10.2196/19045

Olson, C. A., McSwain, S. D., Curfman, A. L., & Chuo, J. (2018). The current pediatric telehealth landscape. Pediatrics, 141(3). https://doi.org/10.1542/peds.2017-2334

Rangarathnam, B., Gilroy, H., & McCullough, G. H. (2016). Do patients treated for voice therapy with telepractice show similar changes in voice outcome measures as patients treated face-to-face? EBP Briefs, 11(5), 1–6.

Reifenberg, G., Gabrosek, G., Tanner, K., Harpster, K., Proffitt, R., & Persch, A. (2017). Feasibility of pediatric game-based neurorehabilitation using telehealth technologies: A case report. American Journal of Occupational Therapy, 71(3), 7103190040p1-7103190040p8. https://doi.org/10.5014/ajot.2017.024976

Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ (Clinical Research Ed.), 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71

Sauers-Ford, H. S., Hamline, M. Y., Gosdin, M. M., Kair, L. R., Weinberg, G. M., Marcin, J. P., & Rosenthal, J. L. (2019). Acceptability, usability, and effectiveness: A qualitative study evaluating a pediatric telemedicine program. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 26(9), 1022–1033. https://doi.org/10.1111/acem.13763

Schmidt, R. A., & Lee, T. D. (2005). Motor control and learning: A behavioral emphasis, 4th ed (pp. vi, 535). Human Kinetics.

Shigekawa, E., Fix, M., Corbett, G., Roby, D. H., & Coffman, J. (2018). The current state of telehealth evidence: A rapid review. Health Affairs, 37(12), 1975–1982. https://doi.org/10.1377/hlthaff.2018.05132

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20(3), 324–336. https://doi.org/10.1080/17549507.2018.1465123

Tenforde, A. S., Hefner, J. E., Kodish-Wachs, J. E., Iaccarino, M. A., & Paganoni, S. (2017). Telehealth in physical medicine and rehabilitation: A narrative review. PM & R: The Journal of Injury, Function, and Rehabilitation, 9(5S), S51–S58. https://doi.org/10.1016/j.pmrj.2017.02.013

Tomines, A. (2019). Pediatric telehealth: Approaches by specialty and implications for general pediatric care. Advances in Pediatrics, 66, 55–85. https://doi.org/10.1016/j.yapd.2019.04.005

Utidjian, L., & Abramson, E. (2016). Pediatric telehealth: Opportunities and challenges. Pediatric Clinics of North America, 63(2), 367–378. https://doi.org/10.1016/j.pcl.2015.11.006

Weidner, K. & Lowman, J.. (2020). Telepractice for adult speech-language pathology services: A systematic review. Perspectives of the ASHA Special Interest Groups, 5(1), 326–338. https://doi.org/10.1044/2019_PERSP-19-00146

Zoom. (2020). Zoom Video Communications Inc. https://zoom.us/docs/doc/Zoom-Security-White-Paper.pdf

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Published

2020-12-08

How to Cite

Tanner, K., Bican, R., Boster, J., Christensen, C., Coffman, C., Fallieras, K., Long, R., Mansfield, C., O’Rourke, S., Pauline, L., Sagester, G., & Marrie, J. (2020). Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services. International Journal of Telerehabilitation, 12(2), 43–52. https://doi.org/10.5195/ijt.2020.6336

Issue

Vol. 12 No. 2 (2020)

Section

Clinical Research

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