An Appraisal of Evidence on Telehealth and Quality of Life of Adults With Multiple Sclerosis Open Access

RESEARCH QUESTION: What is the evidence for the effectiveness of telehealth interventions on the quality of life of adults with multiple sclerosis (MS)?

RATIONALE: MS is a neurodegenerative disease that affects one’s ability to effectively utilize body systems and engage in daily occupations, ultimately affecting one’s quality of life (QOL; Dirette, 2012). Symptoms such as fatigue, cognitive decline, spasticity, or ataxia can be addressed with an occupational therapist (OT) and potentially result in a targeted outcome of improved life satisfaction (Dirette, 2012). OTs who utilize telehealth can provide effective, accessible interventions to people with MS in order to improve dysfunction in their daily lives (Finlayson & Holberg, 2007). By critically appraising the most recent evidence, this research considers the effectiveness of telehealth as an OT treatment method to improve one’s health and QOL.

DESIGN: A systematic review of the literature was performed.

PARTICIPANTS: Studies were considered if published in 2006–2015; recruited adults >18 yr with a diagnosis of MS, including all subtypes and severity levels, and telehealth interventions were applicable to OT practice and utilized a QOL outcome measure.

METHOD: Database search included Cochrane, OT Search, CINAHL Complete, OTseeker, PubMed, ERIC, PsycINFO, and Google Scholar. Medical subject headings (MeSH) included multiple sclerosis, transverse myelitis, telemedicine, quality of life, and value of life. Reference lists from identified studies were also reviewed, and clinical trials were searched.

ANALYSIS: Studies meeting the above criteria were assessed by two authors and a peer reviewer for eligibility. Relevant data were populated in a critical appraisal chart analyzing key findings, limitations, and OT implications.

RESULTS: Three randomized controlled trials, 1 systematic review, and 2 nonrandomized single-group studies with 968 total participants were analyzed for this review. Telehealth interventions of weekly telephone counseling or self-management software resulted in no significant differences between intervention and control groups related to functional QoL for strength, participation, cognition, or social and community integration. Significant improvements in QoL resulting from telephone-delivered interventions, online modules, or self-management software were primarily linked to fatigue impact, depression, and anxiety. Minimal evidence supported the long-term effectiveness of telehealth for adults with MS.

DISCUSSION: The strength of evidence for telehealth interventions in occupational therapy is inconsistent and shows limitations across all studies. Home-based interventions managed online could enable clients to become more self-sufficient and result in fewer visits to the clinic. Telehealth media can provide video, text, and social forums to help clients achieve therapy goals, improve QoL, and gain social support while saving clinicians time. However, further research is recommended to support more evidence-based practice.

IMPACT STATEMENT: Telehealth for clients with MS can be used as a self-management tool but should be supplemented with telephone or web-based video consultations with an occupational therapist. Further research is indicated to measure the impact of telehealth interventions on QoL.

References

Dirette, D. K. (2012). Progressive neurological disorders. In B. J. Atchison & D. K. Dirette (Eds.), Conditions in occupational therapy: Effect on occupational performance (4th ed., pp. 209–223). Baltimore: Lippincott Williams & Wilkins.

Finlayson, M., & Holberg, C. (2007). Evaluation of a teleconference-delivered energy conservation education program for people with multiple sclerosis. Canadian Journal of Occupational Therapy, 74, 337–347. http://dx.doi.org/10.2182/cjot.06.0018