Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services
Keywords:Healthcare, Patient-centered care, Pediatric rehabilitation, Telerehabilitation
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.
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§ion=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
How to Cite
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.