Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review

Abstract

Purpose: To describe the characteristics and effectiveness of pediatric telerehabilitation interventions offered to children 0–12 years old or to their families.

Methods: A systematic review was conducted on randomized control trials published between 2007 and 2018 involving at least one rehabilitation professional who provided services remotely. Information was extracted about key study, participants and intervention characteristics. The percentage of outcomes that improved were computed per study, and per intervention characteristic.

Results: Out of 4472 screened articles, 23 were included. Most studies were published after 2016 and evaluated outcomes related to the child’s behavior (n = 12, 52.2%) or to the parent (n = 10, 43.5%), such as parental skills or stress. Overall, 56.1% (SD: 38.5%) of evaluated outcomes improved following telerehabilitation. A great diversity of population and teleintervention characteristics was observed. Effective interventions tended to target parents, centered around an exercise program, used a coaching approach, focused on improving children’s behavioral functioning, lasted >8 weeks and were offered at least once a week.

Conclusions: Intervention characteristics that appear to yield better outcomes should inform the development of future telerehabilitation studies, especially in populations for whom telerehabilitation is currently understudied (e.g., children’s with physical functioning difficulties). Future trials should compare telerehabilitation interventions to well-described evidence-based face-to-face interventions, and document their cost-effectiveness.

Implications for Rehabilitation

• Despite a great variety in practices, telerehabilitation might be as effective as face-to-face interventions, across disciplines, for a variety of clinical outcomes.

• Telerehabilitation might be more effective when coaching approaches are used, especially to achieve outcomes related to children’s behavior or parental skills.

• Further research is required to better understand the characteristics of effective telerehabilitation interventions, and to determine how these characteristics may differ for specific populations and outcomes.

Keywords:

• Telehealth
• children
• rehabilitation
• online intervention

Declaration of interests

The authors report no declaration of interest.

Acknowledgements

The authors want to thank the research team who contributed to the feasibility randomized control trial, as well as the REPAR (provincial rehabilitation network in Québec, Canada), the University of Sherbrooke and the Telerehabilitation Chair of Sherbrooke University (no grant numbers are available).