Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation

Abstract

Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.

Lessons Learned during a Naturalistic Study of Online Treatment for Pediatric Rehabilitation

“…Similar to global trends, Israel also changed its use of telehealth services. A study carried out by a pediatric rehabilitation hospital in Israel [ 23 ] demonstrated how the number of tele-rehabilitation sessions increased to 110 over a five-week period in late March to the end of April 2020. They reported that although both children (mean age = 11 years) and therapists were able to maintain a therapeutic “connection” during this period, other rehabilitation goals were perceived to be less achievable, specifically in physical and occupational therapy.…”

“…Pre-COVID, a lot of key information was shared between therapists during those breaks, information that was not necessarily documented in the electronic medical record. Similar to other global and local tele-rehabilitation settings [ 22 , 23 ] particular attention is now focused on how information is documented and shared between therapists and with families to better meet their needs for both remote and in-person therapy.…”

“…Other tele-rehabilitation settings also reported the patient-therapist rapport challenge. In some cases [ 23 ], therapists noted a positive effect between prior acquaintanceship and online treatment effectiveness. In other cases [ 17 ] satisfaction with the tele-rehabilitation services was reported even when the child-clinician relationship developed only during tele-rehabilitation sessions.…”

“…In summary, the potential of online technologies for pediatric rehabilitation has been demonstrated in a range of clinical interventions with children and their families. They appear to encourage greater physical activity, promote a healthier lifestyle, help manage chronic conditions and, indeed, to be viable alternatives to traditional one-on-one interventions [ 3 , 23 , 24 ]. Nevertheless, despite initial promising research results, the adoption of these technologies has been limited, and even waned after the first wave of excitement [ 25 ].…”

Self-Feeding Kinematics in an Ecological Setting: Typically Developing Children and Children With Cerebral Palsy

“…Furthermore, kinematic measurement recorded via objects such as instrumented spoons may provide assessment of movement remotely. Existing telehealth applications are often limited in their ability to accurately assess movement quality, specifically in children [29]. Thus, kinematic analysis of self-feeding may be a valuable addition to existing measures of movement quality.…”