Toward successful future use of telehealth in occupational therapy practice: What the COVID-19 rapid shift revealed

Abstract

BACKGROUND: Prior to the onset of the COVID-19 pandemic, occupational therapy (OT) services delivered through telehealth demonstrated comparative effectiveness to in-person services. At the onset of the pandemic, occupational therapy practitioners (OTPs) needed to continue delivering care to clients without being in-person. Many OT practitioners pivoted rapidly to telehealth, in many instances, with very little training. OBJECTIVE: The objective of this study was to describe the use of telehealth in occupational therapy during the early stages of the pandemic, and to explore how participants traversed the barriers. The perceived benefits and barriers to success with rapid telehealth adoption as experienced by OTPs, along with the specific strategies used to promote favorable outcomes may inform ongoing successful telehealth use in occupational therapy. METHOD: This study used a mixed-methods sequential explanatory design. Data was collected from September to December 2020 with an electronic survey. RESULTS: A total of 193 OTPs completed the survey, representing the delivery of OT services in 13 countries. Three main barriers to the use of telehealth were availability of materials, mastery of technology, and collaboration with caregivers/e-helpers. These barriers were negatively and significantly correlated with the participants’ confidence level in the use of telehealth. Participants overcame barriers by independently obtaining telehealth training, including training within one’s organization, support from social media, self-directed learning, and paid online telehealth webinars. CONCLUSION: Employers and educators can remove barriers to telehealth use by OTPs by providing a variety of learning opportunities and supports to enhance practitioners’ confidence, thus increasing the likelihood of continued use of telehealth as a powerful and gap-bridging delivery model in occupational therapy.

Remote Delivery of Service: A Survey of Occupational Therapists’ Perceptions

“…These findings are consistent with previous studies which had found that technological difficulties cause frustration among patients and providers, and constitute a disadvantage of remote rehabilitation. 5 , 11 , 45 Remote delivery service should take the technology into account and make efforts to make it accessible to all. Moreover, training on how to use videoconferencing and other technology to deliver effective rehabilitation interventions should integrate curriculum for all health providers.…”

“… 4 OT delivered remotely has proven to be highly acceptable and effective for individuals with a variety of health conditions across their life-span. 5 Efficacy had also been established in multiple studies analyzing interventions for varying populations such as children with autism, 6 adolescents with myelomeningocele, 7 adults cancer-survivors, 8 , 9 and people with acquired brain injury. 10 , 11 …”

“… 18 These studies found overall positive perceptions toward telehealth, whereas most respondents were satisfied and perceived telehealth to be an effective delivery model for OT services. 5 , 28 - 30 The overarching aim of this study is to examine the perceptions of Israeli occupational therapists regarding remote delivery of service following the COVID-19 outbreak and to explore the perceived benefits and barriers.…”

“…4 OT delivered remotely has proven to be highly acceptable and effective for individuals with a variety of health conditions across their life-span. 5 Efficacy had also been established in multiple studies analyzing interventions for varying populations such as children with autism, 6 adolescents with myelomeningocele, 7 adults cancer-survivors, 8,9 and people with acquired brain injury. 10,11 The World Federation of Occupational Therapists affirmed the efficacy of telehealth for the delivery of rehabilitation and OT services, stating its use "leads to similar or better clinical outcomes when compared to conventional inperson interventions."…”

Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems

“…Challenges unique to OT include the need for adequate visualization of the client and the environment for assessment and to ensure client safety, especially when clinical care requires moving throughout the home, and the need to compensate for the lack of hands-on care. Gaps in available training about how to adapt OT clinical services to telehealth was a primary reported barrier of OT practitioners who utilized telehealth in response to COVID restrictions 56 . Further research is also needed identify the best match between specific client capacities, the goals of therapeutic intervention, and technology.…”