Tele-treatments

Mixed diagnoses

Evidence reviewed as of before 20-05-2021

Author(s): Ogourtsova, T. (PhD OT), Osman, G. (MSc OT student), & Dunn, T. (MSc student)

Introduction

For mixed diagnoses, we found 3 studies on tele-treatments. Out of these studies, 2 are high quality RCTs and 1 is a non-RCT.

These tele-treatments were provided by psychologists. Most tele-treatments (66.6% of studies) targeted to improve both, parent- and child-related outcomes. For instance, interventions focused on child’s behavior, anxiety, social participation, loneliness, self-perceptions, coping, and parenting skills, knowledge, and self-efficacy. Interventions were mainly provided through phone calls (66.6% of studies) and clinicians were mainly actively involved in sessions (66.6% of studies).

Eleven (n=11) different outcomes were studied, and 45% of them emerged from RCTs. Telerehabilitation was found to be more effective (vs. another intervention) in improving 80% of outcomes.

Proceed to the Clinician information section to find out more.

Clinician Information

In this section, you will find a list of outcomes that were examined in the selected studies; whether telerehabilitation was more or as effective (for RCTs) or effective/not effective (for non-RCTs); the comparison intervention (e.g., usual care, if present); and the level of evidence. Find out more about the levels of evidence here.
Psychology / Paraprofessional coaching
Results Table
For mixed diagnoses, we found 3 studies on tele-treatments provided by psychologists. Out of these studies, 2 are high quality RCTs and 1 is a non-RCT.

The focus of the tele-interventions provided by psychologists was to improve child’s behavior, anxiety disorders, social participation, loneliness, sense of community, self-perceptions, coping, and parental skills, knowledge, confidence and self-efficacy.

Eleven (n=11) different outcomes were studied, and 45% of them emerge from RCTs.

Expand on the outcomes below to find out more.
Severity of diagnosisMore effective vs. Usual care1b
One high quality RCT (McGrath et al., 2011) investigated the effect of telerehabilitation on severity of diagnosis among children with different disorders (Opposition-Defiant Disorder, ADHD, Anxiety). This high quality RCT study randomized participants (child/youth and parent) to receive telerehabilitation (Strongest Families intervention targeting disruptive behavior and anxiety disorders in 40-minute weekly calls, with 11 sessions for the anxiety program and 12 sessions for the behavioural program) vs. usual care. Severity of diagnosis was measured by the Schedule for Affective Disorders and Schizophrenia School Age Children—Present and Lifetime Versions using parental interview (K-SADS-PL: ADHD, Anxiety, Opposition-defiant disorder [ODD]) at follow-up (120 days, 240 days, and 1 year). A significant between-group difference was found at 120 days (K-SADS-PL: ODD); at 240 days (K-SADS-PL: ODD; ADHD; Anxiety); and at 1 year (K-SADS-PL: ADHD; Anxiety), favouring telerehabilitation vs. usual care.

Conclusion: There is moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (Strongest Families intervention targeting disruptive behavior and anxiety) is more effective as the comparison intervention (usual care) in improving severity of diagnosis among children with different disorders.
Parental self-efficacyMore effective vs. Usual care1b
One high quality RCT (Hinton et al., 2017) investigated the effect of telerehabilitation on parental self-efficacy among caregivers of children with developmental, intellectual, or physical disabilities. This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Triple P Online – Disability [TPOL-D] targeting parenting skills, knowledge, confidence, and parent self-efficacy in a 9 week-intervention; parents complete 7 modules and participate in an average of six weekly telephone calls or email consultations) vs. usual care. Parental self-efficacy was measured by the primary caregiver version of the Child Adjustment and Parent Efficacy Scale—Developmental Disability (CAPES-DD) at post-treatment (9 weeks). A significant between-group difference was found, favouring TPOL-D vs. usual care.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (TPOL-D targeting parenting skills, knowledge, confidence, and parent self-efficacy) is more effective than the comparison intervention (usual care) in improving parental self-efficacy among caregivers of children with developmental, intellectual, or physical disabilities.
Parenting skills and family relationships More effective vs. Usual care1b
One high quality RCT (Hinton et al., 2017) investigated the effect of telerehabilitation on parenting skills and family relationships among caregivers of children with developmental, intellectual, or physical disabilities. This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Triple P Online – Disability [TPOL-D] targeting parenting skills, knowledge, confidence, and parent self-efficacy in a 9 week-intervention, parents completed 7 modules and participate in an average of six weekly telephone calls or emails consultations) vs. usual care. Parenting skills and family relationships were measured by the primary caregiver version of the Parenting and Family Adjustment Scales (PAFAS) at post-treatment (9 weeks). A significant between-group difference was found, favouring TPOL-D vs. usual care.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (TPOL-D targeting parenting skills, knowledge, confidence, and parent self-efficacy) is more effective than the comparison intervention (usual care) in improving parenting skills and family relationships among caregivers of children with developmental, intellectual, or physical disabilities.
Severity of diagnosisMore effective vs. Usual care1b
One high quality RCT (McGrath et al., 2011) investigated the effect of telerehabilitation on severity of diagnosis among children with different disorders (opposition-defiant disorder, ADHD, anxiety). This high quality RCT study randomized participants (child/youth and parent) to receive telerehabilitation (Strongest Families intervention targeting disruptive behaviour and anxiety disorders in 40-minute weekly calls, with 11 sessions for the anxiety program and 12 sessions for the behavioural program) vs. usual care. Severity of diagnosis was measured by the Schedule for Affective Disorders and Schizophrenia School Age Children—Present and Lifetime Versions using parental interview (K-SADS-PL: ADHD, Anxiety, Opposition-defiant disorder [ODD]) at follow-up (120 days, 240 days, and 1 year). A significant between-group difference was found at 120 days (K-SADS-PL: ODD); at 240 days (K-SADS-PL: ODD; ADHD; Anxiety); and at 1 year (K-SADS-PL: ADHD; Anxiety), favouring telerehabilitation vs. usual care.

Conclusion: There is moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (Strongest Families intervention targeting disruptive behaviour and anxiety) is more effective than the comparison intervention (usual care) in improving severity of diagnosis among children with different disorders.
Severity of diagnosis for disruptive behavior or anxiety disorderMore effective vs. Usual care1b
One high quality RCT (Hinton et al., 2017) investigated the effect of telerehabilitation on the severity of diagnosis for disruptive behavior or anxiety disorder among children with developmental, intellectual, or physical disabilities. This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Triple P Online – Disability [TPOL-D] targeting parenting skills, knowledge, confidence, and parent self-efficacy in a 9 week-intervention; parents completed 7 modules and participate in an average of six weekly telephone calls or email consultations) vs. usual care. Severity of diagnosis for disruptive behavior or anxiety disorder was measured by the primary caregiver version of the Parenting and Family Adjustment Scales (PAFAS) at post-treatment (9 weeks). A significant between-group difference was found, favouring TPOL-D vs. usual care.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (TPOL-D targeting parenting skills, knowledge, confidence, and parent self-efficacy) is more effective than the comparison intervention (usual care) in improving of the severity of diagnosis for disruptive behaviour or anxiety disorder in children with developmental, intellectual, or physical disabilities.
Behavioural and emotional problemsAs effective vs. Usual care 1b
One high quality RCT (Hinton et al., 2017) investigated the effect of telerehabilitation on behavioral and emotional problems among children with developmental, intellectual, or physical disabilities. This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Triple P Online – Disability [TPOL-D] targeting parenting skills, knowledge, confidence, and parent self-efficacy in a 9 week-intervention; parents completed 7 modules and participate in an average of six weekly telephone calls or email consultations) vs. usual care. Behavioural and emotional problems were measured by the primary caregiver version of the Developmental Behaviour Checklist (DBC-P) at post-treatment (9 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (TPOL-D targeting parenting skills, knowledge, confidence, and parent self-efficacy) is as effective as the comparison intervention (usual care) in improving behavioural and emotional problems among children with developmental, intellectual, or physical disabilities.
Self-acceptanceEffective5
One non-RCT study (Stewart et al., 2011) investigated the effect of telerehabilitation on self-acceptance in adolescents with cerebral palsy (CP) or Spina Bifida (SB). This non-RCT study assigned participants (child/youth alone) to receive telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping in 60–90-minute sessions, once a week for 25 sessions over 6 months). Self-acceptance was measured by What I am Like: Self Perception Profile for Adolescents at post-treatment (6 months) and follow-up (9 months). A significant improvement was found at follow-up.

Conclusion: There is insufficient evidence (Level 5) from one non-RCT study regarding the effect of telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping) on self-acceptance in adolescents with CP or SB. However, one non-RCT study found improvements following telerehabilitation.
Self-worthEffective5
One non-RCT study (Stewart et al., 2011) investigated the effect of telerehabilitation on self-worth in adolescents with cerebral palsy (CP) or Spina Bifida (SB). This non-RCT study assigned participants (child/youth alone) to receive telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping in 60–90-minute sessions, once a week for 25 sessions over 6 months). Self-worth was measured by What I am Like: Self Perception Profile for Adolescents at post-treatment (6 months) and follow-up (9 months). A significant improvement was found at follow-up.

Conclusion: There is insufficient evidence (Level 5) from non-RCT study regarding the effect of telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping) on self-worth in adolescents with CP or SB. However, one non-RCT study found improvements following telerehabilitation.
Sense of communityEffective5
One non-RCT study (Stewart et al., 2011) investigated the effect of telerehabilitation on sense of community in adolescents with cerebral palsy (CP) or Spina Bifida (SB). This non-RCT study assigned participants (child/youth alone) to receive telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping in 60–90-minute sessions, once a week for 25 sessions over 6 months). Sense of community was measured by the Sense of Community Scale at post-treatment (6 months) and follow-up (9 months). A significant improvement was found at 9-months follow up only.

Conclusion: There is insufficient evidence (Level 5) from non-RCT study regarding the effect of telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping) on sense of community in adolescents with CP or SB. However, one non-RCT study found improvements following telerehabilitation.
CopingNot effective 5
One non-RCT study (Stewart et al., 2011) investigated the effect of telerehabilitation on coping in adolescents with cerebral palsy (CP) or Spina Bifida (SB). This non-RCT study assigned participants (child/youth alone) to receive telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping in 60–90-minute sessions, once a week for 25 sessions over 6 months). Coping was measured by the Self-Report Coping Scale—Seeking Social Support Subscale at post-treatment (6 months) and follow-up (9 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) from one non-RCT study regarding the effect of telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping) on coping in adolescents with CP or SB.
Peer RelationshipsNot effective 5
One non-RCT study (Stewart et al., 2011) investigated the effect of telerehabilitation on peer relationships in adolescents with cerebral palsy (CP) or Spina Bifida (SB). This non-RCT study assigned participants (child/youth alone) to receive telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping in 60–90-minute sessions, once a week for 25 sessions over 6 months). Peer relationships were measured by the Loneliness and Social Dissatisfaction scale at post-treatment (6 months) and follow-up (9 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) from one non-RCT study regarding the effect of telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping) on peer relationships in adolescents with CP or SB.
Social supportNot effective 5
One non-RCT study (Stewart et al., 2011) investigated the effect of telerehabilitation on social support in adolescents with cerebral palsy (CP) or Spina Bifida (SB). This non-RCT study assigned participants (child/youth alone) to receive telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping in 60–90-minute sessions, once a week for 25 sessions over 6 months). Social support was measured by the Children’s Inventory of Social Support at post-treatment (6 months) and follow-up (9 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) from non-RCT study regarding the effect of telerehabilitation (Online support intervention targeting social participation, loneliness, sense of community, self-perceptions, and coping) on social support in adolescents with CP or SB.
References
Hinton, S., et al., A randomized controlled trial of a telehealth parenting intervention: A mixed-disability trial. Res Dev Disabil, 2017. 65: p. 74-85.

McGrath, P.J., et al., Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: Randomized trials and overall analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 2011. 50(11): p. 1162-1172.

Stewart, M., et al., Brief report: an online support intervention: perceptions of adolescents with physical disabilities. Journal of Adolescence, 2011. 34(4): p. 795-800.

Patient and family information

Summary for Patients/Families

This is the title

What research is available?
There are 3 studies on different available telerehab-treatments for children with different developmental disabilities.
How strong is the research behind these treatments?
There are 2 studies of high research quality and 1 study is of low research quality. Telerehabilitation is an emerging and a rapidly growing field. More high-quality research is on its way.

We are dedicated to update the available information with the most recent findings.
Who provides these treatments?
These telerehab-treatments are provided by psychologists.
What is the involvement of the clinician in these treatments?
Clinicians are mainly actively involved in these telerehab-treatments. In other words, they are present and engaged with you and/or the child in every therapy session.
How are these treatments provided?
In most cases, telerehab-treatments are provided through phone calls.
Who receives these treatments?
Telerehab-treatments are provided either directly to parents of children with a mixed diagnosis, to the children themselves, or to both the parent and the child together.
What are the goals of these treatments?
Most of these telerehab-treatments focus on improving both child and parent-related outcomes including:

Parent’s… • Parenting skills
• Confidence
• Self-efficacy


Child’s…
• Disruptive behaviors
• Anxiety disorders
• Social participation
• Sense of community
• Self-perceptions
• Coping
Does it work?
Yes! Telerehab-treatments are shown to work for children and youth with mixed diagnoses and their families.

For instance, telerehab was shown to be more effective in improving numerous skills and abilities among parents and children than when the family receives usual care.

It is important to note that no studies showed that the telerehab-treatments were less effective (than other interventions) or detrimental.
Are there any side effects/risks?
If your medical and rehabilitation team have cleared you and/or your child to engage in telerehabilitation, there are no specific associated risks or side effects. Your rehabilitation professional will help you and your child to perform the therapy safely and effectively.

However, it is important to relay any concerns and/or questions to your rehabilitation professional because telerehabilitation is a relatively new approach and it is different from the traditional face-to-face method. For instance, sometimes, technical issues (e.g., access to suitable technology such as a computer or a smart phone, internet connection, the platform that is used) might come up.

We encourage you to discuss these and other issues with your rehabilitation specialist to promote best results and optimize your therapy sessions.
How many treatments are necessary to make progress?
On average, improvements were noted following telerehab-treatments that were provided for 40-90 minutes, up to 6 weekly sessions, for about 3-6 months.

However, every child’s needs and progress journeys, as well as parents’ resources, preferences, and availabilities are different.

In collaboration with your rehabilitation professional, you can determine the duration and frequency of tele-treatments that are most optimal and suitable for you and your child.
Is this appropriate for me and my child?
Telerehab could be a great option for certain interventions that are feasible to be delivered and received virtually.

Children with mixed diagnoses aged anywhere from about 2 to 18 years old, and their families, can benefit from telerehab. However, every child’s needs, family’s resources, and progress journeys are different.

We encourage that you discuss the appropriateness of telerehabilitation with your health professional.
Where can I access more detailed information (e.g., that I can share with my child’s health provider)?
More detailed information is available here. We are encouraging you to share this resource with your rehabilitation professional.

The scientific publication that synthesizes the aforementioned research findings can be found here.