Models of Telehealth Service Delivery in Adults With Spinal Cord Injuries: Scoping Review

Abstract

Background In Canada, approximately 86,000 people live with spinal cord injury (SCI), and there are an estimated 3675 new cases of traumatic or nontraumatic etiology per year. Most people with SCI will experience secondary health complications, such as urinary and bowel issues, pain syndrome, pressure ulcers, and psychological disorders, resulting in severe chronic multimorbidity. Moreover, people with SCI may face barriers in accessing health care services, such as primary care physicians’ expert knowledge regarding secondary complications related to SCI. Telehealth, defined as the delivery of information and health-related services through telecommunication technologies, may help address some of the barriers, and indeed, the present global COVID-19 pandemic has emphasized the importance of integration of telehealth in health care systems. As a result of this crisis, health care providers have increased the usage of telehealth services, providing health services to individuals in need of community-based supportive care. However, the evidence on models of telehealth service delivery for adults with SCI has not been previously synthesized. Objective The purpose of this scoping review was to identify, describe, and compare models of telehealth services for community-dwelling adults with SCI. Methods This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies published between 1990 and December 31, 2022, were identified by searching the Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Web of Science, and CINAHL databases. Papers with specified inclusion criteria were screened by 2 investigators. Included articles focused on identifying, implementing, or evaluating telehealth interventions, including primary health care services and self-management services delivered in the community and home-based settings. One investigator performed a full-text review of each article, and data extraction included (1) study characteristics; (2) participant characteristics; (3) key characteristics of the interventions, programs, and services; and (4) outcome measures and results. Results A total of 61 articles reported telehealth services used for preventing, managing, or treating the most common secondary complications and consequences of SCI, including chronic pain, low physical activity, pressure ulcers, and psychosocial dysfunction. Where evidence exists, improvements in community participation, physical activity, and reduction in chronic pain, pressure ulcers, etc, following SCI were demonstrated. Conclusions Telehealth may offer an efficient and effective option for health service delivery for community-dwelling individuals with SCI, ensuring continuity of rehabilitation, follow-up after hospital discharge, and early detection, management, or treatment of potential secondary complications following SCI. We recommend that the stakeholders involved with patients with SCI consider the uptake of hybridized (blend of web-based and in-person) health care delivery models to optimize the care continuum and self-management of SCI-related care. The findings of this scoping review may be used to inform policy makers, health care professionals, and stakeholders engaged in establishing web-based clinics for individuals with SCI.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

“… 62 A recent scoping review concluded that telehealth/telerehabilitation may ensure efficient follow-up, rehabilitative care continuity, early detection of secondary complications, and their management in community-dwelling patients with SCI. 63 An RCT demonstrated that videoconferencing may be used efficiently for the management of pressure injuries in terms of HRQoL, healing, interaction, and satisfaction compared to conventional care for people with SCI. 64 Another RCT pointed to the feasibility, effectiveness, and safety of TeleSCI in terms of improvement in self-care, mobility, and anxiety in individuals with SCI.…”

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities

“…Historically, home-based rehabilitation programs have been limited to using detailed written instructions and illustrations, before evolving into video-based instructions delivered through videotape or digital video disk [57][58][59]61,64,69,72,84]. More recently, the advent of high-speed internet, massive data storage capacity, and affordable digital videography have revolutionized in-home rehabilitation programming, through the emergence of web-based tele-rehabilitation [86][87][88][89]. Specifically, these advancements in telecommunications technology offer a more versatile approach to tele-exercise, which allows clinicians to efficiently create and upload large libraries of custom video content that can be ac-cessed by users from any device with internet connectivity (i.e., tablet, smart phone, etc.).…”