Facilitator of the month: Dr. Taslina Kader (Occupational therapist), India.
The following article is an open access systematic review (Level I evidence) published in the Hongkong Journal of occupational therapy . The link to the article is provided at the end of the post.
Why this title was selected?
Telerehabilitation is the current trend and the need of the time. In current COVID 19 situation we all found ways to provide our services to our clients through telerehabilitation and we all found innovative ways to tackle with all the problems we faced through this mode.This study will provide us the evidence and overview as to how effective it is and will help us to provide the best to our client.
Aims and Issues addresses by the article:
This article aims to review the current evidence on the application of telerehabilitation in occupational therapy practice and its clinical outcomes over the last 10 years.
A systematic research was performed using seven databases: MEDLINE, Cochrane library, CINAHL, Web of science, SAGE, Science direct and EMBASE. Also manual searches of articles identified as relevant and search was limited to articles published between January 2008 and October 2017. Full text studies published in English were selected and all clinical trials relevant to topic without restrictions on pathology, Impairment, age or nature of intervention. Amongst the 15 selected studies three RCTs were further rated using the PEDro scale to measure the quality of the study and also elaborated level of evidence of studies. There were eight level III quasi experimental studies , three class IV single case studies, one trial of class III and three RCT studies that were level II.
The result is based on analysis of these articles which included 198 patients overall showed significant improvement in functional performance. They have highlighted studies showing increased carryover of home programme, increased motivation, enhanced home safety, enhanced hand functions and improvement in cognitive function.The results also categorized studies measuring satisfaction of participants, parents and/or caregivers stating that all participants and caregivers expressed satisfaction with the quality of their program and had a positive perception of telerehabilitation and two participants and one caregiver preferred face-to-face intervention if given the choice.
This Systematic Review concluded that using telerehabilitaion in occupational therapy practice has positive therapeutic effects and it offers an alternative service delivery model. The review also indicated the necessity to provide initial preparation or training prior to OT intervention through TR, and to upgrade staff equipment and technical support in-order to provide a successful service which we should keep in mind and implement to avoid the issues we generally face during telerahabilitation. This review also shows limited studies involving cost effective smartphones and this leaves a basis for future study.
My perspective of this Systematic Review:
Authors of the study have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Authors researched studies using seven databases and using keywords ‘Telerehabilitation’ , ‘telemedicine’ , ‘telehealth’ , ‘ehealth’, ‘mobile health’ or ‘mhealth’ and ‘occupational therapy’, but the lack of standardization in the terminology used made it difficult to identify relevant studies thereby making the sample size small and Four of the fifteen articles were then retrieved through manual search.
The review has taken into account the methodological quality of only three RCTs using PEDro score. They have mentioned in detail the characteristics of studies selected according to the level of evidence and this helps in better understanding of the various studies included in the review.
Authors have clearly stated their basis for inclusion or exclusion of the studies.
Although the review mentioned in detail all the characteristics variations in the studies selected, participants involved, telerehabilitation modes, intervention regime, length of study, and types of outcome measures, but because of the wide variations most of the differences noted in standardized assessments did not exceed the minimum level for clinically important difference thereby making it difficult to generalize the result.
This review states that there were different types of outcome measures both standardized and non standardized assessments and were assessed by investigators, occupational therapists, caregivers and some by participants themselves and made a note that there is a need of further research to determine which OT assessments are appropriate for telerehabilitation.
The review has elaborated the results very well and have highlighted various studies supporting the results obtained.
Review highlights that little research has been conducted on the effectiveness of telerehabilitation in OT practice and the need of further trials with larger samples.
Myself Dr. Taslina Kader (M.O.Th) a Mumbai based Occupational therapist who is currently working with Adult clients with neurological and musculoskeletal disorders in Jupiter Hospital, Thane. It is an advanced rehabilitation setup, includes Robotic as well as sensor based devices.
I would like to thank the authors of the study to give us the access to the review. The article is open for your views and discussions. Do let us know your views on it in the comment section.
The link for the full article can be found at: