Telehealth Interventions for Patients Diagnosed with Neurodegenerative Diseases

Talia Bartolotta, OTS & Michelle Wilson, OTS

Touro University Nevada: School of Occupational Therapy

Research Question
Does telehealth improve quality of life through adherence to interventions
for individuals diagnosed with neurodegenerative diseases?

Background & Clinical Scenario

Neurodegenerative Diseases
Neurodegeneration: umbrella term encompassing a wide variety of diseases
where progressive deterioration of neuron structures occur, further decreasing an
individuals independence and quality of life (QOL)
Display similar symptoms including fatigue, weakness, decreased independence,
memory loss
As disease progresses, number of needed medications and medical team
increases
Medical team may include occupational therapist (OT), physical therapist, nurse,
doctor, psychologist, etc.
Health care visits become more frequent, increasing health care costs
By providing services in the natural environment, QOL is expected to increase
as a result of decreased mortality rate and increased independence (Jelcic et al.,
2014)
Telehealth is individualized to each patient seen, comparable to routine care
Feasibility
Telehealth shown to be low-cost alternative compared to routine care for those
homebound or living in rural areas requiring long travel time to access care
(Dorsey et al., 2013)
Computer and information technologies have become increasingly accessible
over past decade (Telehealth, 2005)
Telehealth used to monitor disease symptoms, educate on disease progression,
implement appropriate interventions, monitor medication management, and
provide additional services as needed
Occupational Therapy
OT practitioner may use telehealth to deliver encompassing services for
evaluation, intervention, consultation, education, and supervision of other
students or needed personnel (Telehealth, 2005)
OT practitioners have the skill and education needed to treat individuals
diagnosed with a wide variety of neurodegenerative impairments
Telehealth model of service delivery may be used to provide interventions that
are preventative, habilitative, or rehabilitative in nature (Telehealth, 2005)

References (Partial List)

Asano, M., Preissner, K., Duffy, R., Meixell, M., & Finlayson, M. (2015). Goals set after
completing a teleconference-delivered program for managing multiple sclerosis
fatigue. The American Journal of Occupational Therapy,69(3), 6903290010p1
6903290010p8. doi:10.5014/ajot.2015.015370
Dobkin, R.D., Menza, M., Allen, L.A., PsyM, J.T., Friedman, J., Bienfait, K.L., Gara, M.A.,
Mark, M.H. (2011). Telephone-based cognitive-behavioral therapy for depression in
Parkinsons disease. Journal of Geriatric Psychiatry and Neurology, 4, 206-214.
doi:10.1177/0891988711422529
Zissman, K., Lejbkowicz, I., Miller, A. (2012). Telemedicine for multiple sclerosis patients
assessment using Health Value Compass. Multiple Sclerosis Journal, 18, (4). 472-480.
doi:10.1177/1352458511421918

Implications for Occupational

Therapy
The clinical and community-based practice of OT:

Search Methods & Level of Evidence

Inclusion Criteria:
Published after 2008
13 years old or older
Intervention of telehealth
Diagnosis of neurodegenerative disease

Levels of Evidence

Level I
Level II
Level III

Exclusion Criteria:
Languages other than English
Studies Reviewed:
Randomized controlled trials: 7
Cohort study: 1
Before and after: 2

Level of evidence utilized for systematic review

Results
Level I
Greater adherence to treatment sessions in telemedicine versus standard, routine care (Dorsey et al., 2013)
Telemedicine found to be feasible and effective due to decreased travel time (Dorsey et al., 2013)
Web-based physiotherapy is effective for improving physical functioning with those diagnosed with multiple sclerosis (MS)
(Paul et al., 2014)
Memory aids implemented through telehealth shown to increase adherence to medication for those diagnosed with MS (Settle et
al., 2015)
Teleconference fatigue management program for individuals diagnosed with MS is effective in reducing fatigue, e (Finlayson,
Preissner, Cho, & Plow, 2011)
As fatigue decreases, physical and social components correlated to QOL increase
Studies show individuals prefer video method teleconference over telephone-based (Fincher, Ward, Dawkins, Magee, & Willson,
2009)
Education and counselling via telehealth regarding medication management increases mood, emotions, physical functioning,
sleep, and overall QOL in those diagnosed with Parkinsons disease (PD) (Fincher, Ward, Dawkins, Magee, & Willson, 2009)
Telehealth found to be effective and easily used by individuals diagnosed with PD (Fincher, Ward, Dawkins, Magee, & Willson,
2009)
Telecare with those diagnosed with MS display improvements in QOL as evidence by self-reported decrease in MS related
symptoms (Zissman, Lejbkowicz, Miller, 2010)
Level II
Short term goals established via teleconference are more likely to be achieved than intermediate or long term goals for those
diagnosed with MS (Asano, Preissner, Duffy, Meixell, & Finlayson, 2015)
Goals established through teleconference structured around IADLs and leisure activities had the highest achievement rates
(Asano, Preissner, Duffy, Meixell, & Finlayson, 2015)
Teleconference delivered intervention can be used to educate individuals with MS on the importance of establishing achievable
and measurable goals (Asano, Preissner, Duffy, Meixell, & Finlayson, 2015)
Level III
Use of in-home, remotely monitored, virtual reality videogame-based telerehabilitation displayed improvements in finger flexion
and extension, overall finger dexterity, and thumb movement (Golomb et al., 2010)
Engagements in virtual reality videogame via telerehabilitation displayed improvements in spatial firing for adolescents with
hemiplegic cerebral palsy (CP) (Golomb et al., 2010)
Studies found that telephone-based cognitive behavioral therapy does not increase QOL for those with depression associated
with PD (Dobkins, 2011)

Telehealth is an effective healthcare service delivery for individuals diagnosed

with neurodegenerative diseases
Telehealth leads to increased perceived health and well-being, leading to more
occupational engagement and increased QOL (Paul et al., 2014)
Implementing memory aids into a telehealth programs lead to increased
independence in IADLs
Program development:
Telehealth is just as effective and produces similar results as routine care
Telehealth is found to have greater attendance to therapy interventions as
compared to routine care for all health care disciplines
Societal needs:
Allows those who are homebound or living in rural areas to receive treatment
Individuals diagnosed with neurodegenerative diseases benefit from receiving
therapy in their homes
Telehealth can improve fatigue-related deficits, cognitive impairments, and
reduce the disease-related symptoms
Healthcare delivery and policy:
Telehealth can significantly decrease healthcare costs and reduce current
health related economic burden
Additional research needs to be done to determine future funding
Treatment can be monitored more frequently and closely
Education and training of OT students:
More education and training needs to be incorporated into OT curriculum
OT practitioners need to be educated on telehealth service delivery when
working with individuals diagnosed with progressive diseases
Students need to receive additional training on the various types of technology
Refinement, revision, and advancement of factual knowledge or theory:
Research on the impact of telehealth for neurodegenerative diseases beyond
MS and PD is scarce
Little research is available on interventions with OT practitioners within the
realm of telehealth based service delivery
A greater number of objective measurements needed to increase validity and
reliability of the research findings

Limitations
Small sample size limiting generalization of results (Asano, Preissner, Duffy,
Meixell, & Finlayson, 2015; Dobkin et al., 2011; Dorsey et al., 2013; Golomb
et al., 2010; Paul et al., 2014; Settle et al., 2015)
Results not statistically significant, therefore cannot be considered clinically
valid or reliable (Dorsey et al., 2013)
Short intervention period (Paul et al., 2014)
Poor randomization, limiting level of evidence (Asano, Preissner, Duffy,
Meixell, & Finlayson, 2015)
Malfunctioning technology; poorly calibrated (Golomb et al., 2010)
Majority of outcome measures relied on self-report (Finlayson, Pressner, Cho,
& Plow, 2009)
Motor changes unable to be assessed via telehealth (Dobkin et al., 2011)
Results may not be generalizable due to advanced stages of neurodegenerative
diseases (Dobkin et al., 2011)

Contact Information
Talia Bartolotta: ot16.talia.bartolotta@nv.touro.edu
Michelle Wilson: ot16.michelle.wilson@nv.touro.edu