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

Abstract

The COVID-19 pandemic forced many health care providers to modify their service model by adopting telehealth and tele-rehabilitation with minimal time to plan for its execution. ALYN—Pediatric Rehabilitation Hospital in Jerusalem, Israel, responded with alacrity by providing a broad range of rehabilitation services to young people via online therapy during the first 5 months of the pandemic. The objectives of this naturalistic study were: (1) to monitor usage and user experience of online rehabilitation provided to young people receiving out-patient sessions of physical therapy, occupational therapy, speech and language therapy and psychology and (2) to consider the advantages and disadvantages of retaining this model of online treatment in full or in part post-COVID-19. The online rehabilitation treatment program was provided to 147 young people, aged 3 months to 20 years (mean 8.5 y; SD 5.3), and monitored and evaluated via data from the medical records as well as interviews, questionnaires and focus groups. The results use descriptive and inferential statistics to analyze data on the types and frequencies of therapy provided to 147 young people. Over a five month-period, 2392 therapy sessions were provided, 61 therapists from four disciplines were involved and 56.4% of the young people received two or more types of therapies via online rehabilitation. A repeated measures ANOVA showed significant differences over time per therapy. Feedback and recommendations about the process from therapists, parents and young people were collected during two focus groups of the professional staff (n = 12), parents and young people (parents n = 5, young people n = 3). Tele-rehabilitation services were perceived to be beneficial and effective by the great majority of young people, their parents and the healthcare professionals. The results are discussed within the context of conventional therapy as well as in comparison to reports of other online services for similar populations. We conclude that a hybrid approach in which in-person therapy sessions are coordinated with synchronous, online sessions, will provide a best-case fit for young people with chronic disabilities.

Commentary on “Using Telehealth to Conduct Family-Centered, Movement Intervention Research in Children With Autism Spectrum Disorder During the COVID-19 Pandemic”

“…In the telehealth environment, caregiver engagement increased as did generalization of activities in the home. This finding is like that of other recent studies1–4 and highlights the use of telehealth in a family-centered approach.…”

“…In the telehealth environment, caregiver engagement increased as did generalization of activities in the home. This finding is like that of other recent studies [1][2][3][4] and highlights the use of telehealth in a family-centered approach.This telehealth approach facilitated collaboration between the caregiver and the therapist, increasing caregivers' empowerment to perform movement interventions with their children, individualizing activities, and incorporating them into family routines. The child likely benefits from generalization of interventions beyond the structured session, practice in the natural environment, and ultimately the incorporation of physical activity into family life.…”

“…Telehealth has the potential to increase access to services in a variety of circumstances and facilitate participation for children who have anxiety related to attending therapy sessions. [1][2][3][4] However, the authors highlighted challenges in telehealth delivery in general and specific to this population. Choices about whether to provide services in-person, via telehealth, or via a hybrid approach should be made on an individual basis.…”

“…Telehealth has the potential to increase access to services in a variety of circumstances and facilitate participation for children who have anxiety related to attending therapy sessions 1–4. However, the authors highlighted challenges in telehealth delivery in general and specific to this population.…”

“…"Telehealth has the potential to increase access to services in a variety of circumstances and facilitate participation for children who have anxiety related to attending therapy sessions. [1][2][3][4] However, the authors highlighted challenges in telehealth delivery in general and specific to this population. Choices about whether to provide services in-person, via telehealth, or via a hybrid approach should be made on an individual basis.The authors included several family-friendly elements in their intervention including sending materials for sessions in the mail, using common household items, and providing explicit instructional documents and videos.…”