Telehealth Interventions Within the Scope of OT Therapy Practice: A Systematic Review

IMPORTANCE: With changing healthcare environments and policies, there are increasing demands for healthcare services, including occupational therapy, to adopt a telehealth service delivery mechanism. Telehealth is prompted by advancing technologies and other social determinants which add increasing complexity to an individual’s ability to access needed health care, such as transportation, finances, health professional shortages in rural and underserved areas, and cultural barriers.

PURPOSE: With increasing evidence regarding the efficacy and feasibility of telehealth services, it is imperative to synthesize the existing telehealth evidence to examine the effectiveness of interventions and inform practitioners and reimbursement entities. This systematic review sought to examine the effectiveness of telehealth occupational therapy interventions across the lifespan, delivered independently or as part of an interdisciplinary team.

DATA SOURCES: This systematic review was conducted using the Cochrane methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Search terms were established by four of the researchers in conjunction with a health science librarian. These terms were derived from the Occupational Therapy Practice Framework to reflect the occupational therapy scope of practice. Searches were conducted in CINAHL, SAGE, Cochrane, Medline, PsychInfo, OTSeeker, and OT Search. Researchers also hand searched systematic reviews, relevant journals, and known occupational therapy telehealth researchers.

STUDY SELECTION AND DATA COLLECTION: Articles were included in this review if they were peer-reviewed, written in English, published between 2009 and 2019, and included the population of recipients of telehealth services, occupational therapy intervention, and occupational outcomes within the scope of occupational therapy practice. The Oxford Center for Evidence Based Medicine was used to classify levels of evidence. Articles which utilized an intervention (Levels of evidence 1B, 2B, and 3B) were included. Researchers identified 799 articles meeting inclusion criteria, of which 747 were screened and 147 included in full-text review. Researchers extracted information from the articles into evidence tables which were analyzed based upon the population, intervention, setting, and outcomes and was synthesized into themes which were agreed upon by the entire research team.

RESULTS/FINDINGS: Twenty full-text articles (8 Level 1B, 9 Level 2B, and 3 Level 3B) met inclusion criteria and were evaluated for level of evidence, study design, risk of bias, participants, study setting, intervention and control, outcome measures, and results, including significance of findings. All studies found statistically significant improvements in areas of occupational performance and associated client factors with use of telehealth interventions. Several studies found no statistically significant differences between groups when comparing telehealth with face-to-face therapy interventions but did demonstrate statistically significant within group improvements. Strong strength of evidence supports use of telehealth approaches for occupational therapy interventions for individuals with neurologic and pain conditions. Moderate strength of evidence supported use of telehealth intervention to support education outcomes. Low strength of evidence was found for other outcomes for children with developmental disorders and additional conditions.

CONCLUSIONS AND RELEVANCE: There is evidence of occupational therapy interventions delivered via telehealth to support effectiveness similar to face-to-face delivery methods, especially for neurologic and pain conditions.

References

Cason, J. (2015). Health Policy Perspectives—Telehealth and occupational therapy: Integral to the Triple Aim of health care reform. American Journal of Occupational Therapy, 69, 6902090010. https://doi.org/10.5014/ajot.2015.692003

Harkey, L. C., Jung, S., Newton, E. R., & Patterson, A. (2020). Patient satisfaction with telehealth in rural settings: A systematic review. International Journal of Telerehabilitation, 12(2), 53–64. https//doi.org/10.5195/ijt.2020.6303

Hung, K. G., & Fong, K. N. (2019). Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong Journal of Occupational Therapy, 32(1), 3–21. https://doi.org/10.1177/1569186119849119