Pagaki-Skaliora Marina, Morrow Eileen, Theologis Tim
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom.
JMIR Rehabil Assist Technol. 2022 Oct 17;9(4):e36842. doi: 10.2196/36842.
Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP.
This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research.
A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children's results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate.
In all, 5 papers were identified, which included the results of 11 studies-2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children's developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children's compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care.
The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth.
远程治疗，即远程医疗，在2020年之前就已显示出对脑瘫（CP）儿童的治疗前景；然而，全球新冠疫情的爆发限制了患儿前往医院进行面对面治疗的机会，这推动了对远程医疗的需求，并促使其迅速发展。由于近期的这些发展，关于远程医疗应用于CP儿童的现有证据的综合研究有限。
本研究旨在分析和总结远程医疗干预治疗CP儿童的现有证据，并确定任何需要进一步研究的领域。
进行了一项范围综述。2021年7月对MEDLINE和PubMed中的可用文献进行了系统检索。纳入文章的标准为：研究远程医疗的原始研究和系统评价；纳入CP儿童；发表于2010年至2021年之间；以英文撰写。排除标准为：除系统评价之外的二次研究；不符合世界卫生组织远程医疗定义的干预措施；或所有参与者年龄均大于18岁、未单独报告儿童结果或未报告CP儿童结果的研究。由于预期参与者的异质性、预期的小样本量以及测量结果的不一致性，选择了范围综述；因此，认为对结果进行叙述性报告是合适的。
总共确定了5篇论文，其中包括11项研究的结果——纳入的文章中有2篇是系统评价，各包括3项研究的结果。这6项研究以及5篇原始研究文章被纳入本范围综述。现有证据的方法学质量较低，主要由病例系列组成。有一些证据表明，远程医疗的要求因儿童的发育阶段和功能水平而异。据报道，远程医疗可减轻照顾者的负担。关于儿童对远程医疗的依从性，证据不一。总体而言，远程医疗干预治疗CP儿童的结果是积极的，表明与接受常规面对面护理的儿童相比，结果相当或有所改善。
证据基础在广度和方法学质量上均不足以提供有力的临床建议。大多数研究仅调查了手部功能，表明现有研究的范围有限。然而，本综述表明，远程医疗已显示出改善CP儿童功能的潜力，同时使医疗服务更易获得并减轻照顾者负担。需要进一步研究的领域包括针对下肢的远程医疗干预、姿势管理、疼痛控制以及实施远程医疗的障碍。
