Veille documentaire sur la téléréadaptation
Résultats du mois de décembre 2012
1.
Challenges and questions upon a new practice: The interest of telepsychiatry for care
Intérêt de la télé-psychiatrie pour la prise en charge des patients : enjeux et questions d'une pratique nouvelle
Astruc B., Henry C., Masson M.
[Article in Press] Ann. Med.-Psychol. 2012 :
Objectives: Telemedicine grows differently among the different specialties. Tele-psychiatry, one of the earliest
applications of telemedicine, is struggling to find its full place in patient care, and is often seen only as a geographical
distances stopgap. The main objective of this paper is to summarize the stakes of this new practice and to put some
answers to the question of its place in our current practices. Materials and methods: Literature review focused on
patient satisfaction and comparison with the practice of face-to-face. Review of international recommendations on the
practice of tele-psychiatry. Reminder of its ethical, professional and legal framework in France. Results: The use of videoconsultation appears to improve access to care, may serve to promote patient education, to avoid unnecessary travel to
the patient or therapist. Patient satisfaction appears identical to the face-to-face practice. Conclusions: Tele-psychiatry,
used and disclosed appropriately, can greatly contribute to improve care in numerous fields: consultation-liaison
psychiatry, accessibility to overspecialised consultations, continuing education of physicians. © 2012 Elsevier Masson
SAS. All rights reserved.
2.
Telemedicine practice will improve the quality of care in nursing homes
Les établissements d'hébergement pour personnes âgées dépendantes: un modèle de choix pour l'amélioration du soin
par les pratiques de télémédecine
Rumeau P., Leclercq C., Savoldelli M., Lareng L.
[Article in Press] Cah. l'Annee Gerontol. 2012 : (1-7)
Telemedicine is a remote medical practice. French law is framing telemedicine. It is most fitting hardly movable or
assessed out of their ecosystem elderly patients. Nursing homes are a telemedicine national priority. A project is based
on optimizing local processes to better answer needs; technical and organizational choices are made accordingly.
Regulation is providing the financial setup for development. © 2012 Springer-Verlag France.
3.
Telemedicine is cost effective in acute ischemic stroke
Conners J.J., Ouyang B., Prabhakaran S.
Stroke 2012 43:2
Introduction: Rapid availability to stroke specialists remains a critical hurdle in thrombolysis for acute ischemic stroke in
many regions of the United States. Remote consultation is often utilized with varying success. Telemedicine use has
been increasing but it is unclear if this is cost effective when compared to simple telephone consultation. Hypothesis:
We assessed the hypothesis that telemedicine is cost effective for acute ischemic stroke patients. Methods: We created
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a decision tree model to compare telemedicine (with videoconferencing and image sharing) to telephone consultation.
We estimated probabilities and utilities from the available literature and calculated incremental cost-effectiveness ratios
(ICER). We used actual costs of telemedicine equipment, installation, and physician fees based on our own experience
($50,900 per hospital per year). We assumed equal access to standard medical treatments between the two
approaches; an 8-hospital spoke system; and 60 patients assessed for acute stroke per year at each spoke hospital.
However, we estimated higher tissue plasminogen activator (tPA) utilization among telemedicine-treated patients (28%
vs 23%) based on the STRokE-DOC trial. We performed sensitivity analyses to assess all assumptions in our model. An
ICER < $50,000/QALY was considered cost-effective. Results: In the first year after stroke, telemedicine resulted in a gain
of 0.00459 QALY, but with an additional cost of $799 compared to telephone only (ICER = $174,074/QALY). In the long
term (over 30 years), telemedicine resulted in a gain of 0.0282 QALY at an additional cost of $497 (ICER =
$17,624/QALY). Using a long term sensitivity analysis, ICER remained < $50,000/QALY when the absolute difference in
tPA utilization (telemedicine vs. telephone) was > 2.5%. When the absolute difference in tPA use is > 12%, telemedicine
had cost-saving effects (ICER < 0). Cost-effectiveness was also sensitive to number of patients: 30 or more patients must
be evaluated with telemedicine per hospital annually to remain cost-effective. Telemedicine remained cost-effective
when varying its program costs from $500 to $1,500 per patient. Conclusions: Assuming that telemedicine consultations
increase the use of tPA for acute ischemic stroke patients by at least 2.5%, we found that it is cost-effective compared to
telephone only consultations. However, 30 patients must be assessed annually per spoke hospital to remain costeffective. Telemedicine stroke networks need to consider these aspects when assessing their societal impact and when
justifying their considerable costs.
4.
Financial impact of a pediatric telemedicine program: A health system perspective
Dharmar M., . Sadorra C.K., Leigh P., . Yang N.H., . Nesbitt T.S., . Marcin J.P.
Pediatr. Crit. Care Med. 2012 13:6 (714)
Introduction: Telemedicine is increasingly used by critical care physicians to provide specialty consultations to rural
hospitals and emergency departments. The goal of this study was to evaluate the financial impact of telemedicine
services on the number of transfers, hospital revenue, and professional billing revenue from a Children's Hospital's
perspective in a competitive healthcare market. Methodology: We compared the number of transfers, average hospital
revenue, and average professional billing revenue per year before and after the deployment of telemedicine at 16
remote hospitals. Data were abstracted from transfer center data and billing records. Results: 2,029 children were
transferred to the Children's Hospital during the study period. Overall, the average number of transfers per year
increased from 143 to 285. The average hospital revenue per year increased from $2.4 million pre-telemedicine to $4
million post-telemedicine. The average professional billing revenue per year increased from $320,000 pre-telemedicine
to $680,000 post-telemedicine. On average, after the deployment of telemedicine to a rural hospital, hospital revenue
increased by $101,744 and physician revenue increased by $23,404 per site, per year. Conclusion: From the perspective
of the Children's Hospital, the deployment of telemedicine to rural hospitals in a competitive healthcare market resulted
in an increased market share, and as a result, an increase in hospital revenue and professional billing revenue.
5.
J Med Internet Res. 2012 Jul 18;14(4):e105. doi: 10.2196/jmir.1953.
Effects of functional interactivity on patients' knowledge, empowerment, and health outcomes: an experimental modeldriven evaluation of a web-based intervention.
Camerini L, Schulz PJ.
Institute of Communication and Health, Faculty of Communication Sciences, Università della Svizzera italiana, Lugano,
Switzerland. lukame@gmail.com
BACKGROUND:
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The effectiveness of eHealth interventions in terms of reach and outcomes is now well documented. However, there is a
need to understand not only whether eHealth interventions work, but also what kind of functions and mechanisms
enhance their effectiveness. The present investigation contributes to tackling these challenges by investigating the role
played by functional interactivity on patients' knowledge, empowerment, and health outcomes.
OBJECTIVES:
To test whether health knowledge and empowerment mediate a possible relationship between the availability of
interactive features on an eHealth application and individuals' health outcomes. We present an empirical, model-driven
evaluation of the effects of functional interactivity implemented in an eHealth application, based on a brief theoretical
review of the constructs of interactivity, health knowledge, empowerment, and health outcomes. We merged these
constructs into a theoretical model of interactivity effects that we tested on an eHealth application for patients with
fibromyalgia syndrome (FMS).
METHODS:
This study used a pretest-posttest experimental design. We recruited 165 patients and randomly assigned them to three
study groups, corresponding to different levels of functional interactivity. Eligibility to participate in the study required
that patients (1) be fluent in Italian, (2) have access to the Internet, (3) report confidence in how to use a computer, and
(4) have received a diagnosis of FMS from a doctor. We used structural equation modeling techniques to analyze
changes between the pretest and the posttest results.
RESULTS:
The main finding was that functional interactivity had no impact on empowerment dimensions, nor direct observable
effects on knowledge. However, knowledge positively affected health outcomes (b = -.12, P = .02), as did the
empowerment dimensions of meaning (b = -.49, P < .001) and impact (b = -.25, P < .001).
CONCLUSION:
The theoretical model was partially confirmed, but only as far as the effects of knowledge and empowerment were
concerned. The differential effect of interactive functions was by far weaker than expected. The strong impact of
knowledge and empowerment on health outcomes suggests that these constructs should be targeted and enhanced by
eHealth applications.
PMCID: PMC3409610 Free PMC Article
PMID: 22810046
7.
Heart. 2012 Oct;98(20):1523-8. Epub 2012 Aug 11.
A randomised trial of a remote home support programme for infants with major congenital heart disease.
McCrossan B, Morgan G, Grant B, Sands AJ, Craig BG, Doherty NN, Agus AM, Crealey GE, Casey FA.
Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK.
brianmccrossan@doctors.org.uk
Abstract
OBJECTIVES: To assess the sustainability, clinical utility and acceptability to clinicians and parents of a tele-homecare
programme for infants with major congenital heart disease (CHD), and to evaluate the impact on healthcare resource
use.
DESIGN: Randomised control trial.
SETTING: UK tertiary congenital cardiac centre.
PARTICIPANTS: 83 infants with major CHD.
INTERVENTION: Participants were randomised to one of three groups: video-conferencing support (n=35), telephone
support (n=24) and a control group (n=24). Patients in the two intervention groups received regular, standardised
remote consultations. Video-conferences (VCs) were facilitated by Integrated Systems Digital Network lines and replaced
by home broadband connections later in the study.
MAIN OUTCOME MEASURES: Healthcare resource use, utilisation including hospitalisation, clinicians' opinions on utility
and quality of interventions, parental opinions on quality of interventions.
RESULTS:
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Clinicians were more confident making medical decisions following VCs compared with telephone consultations
(p=0.01). Both VC and telephone support were very well received, but parents expressed significantly higher levels of
satisfaction with VC support (p=0.001). Healthcare resource use was 37% lower in the video-conferencing group
compared with both telephone support and control groups (p<0.001), as was the risk of hospitalisation (p=0.006). Direct
health service costs were significantly lower in the video-conferencing group (p<0.05).
CONCLUSIONS:
A tele-medicine home support programme for families of infants with major CHD is feasible, sustainable and effective.
Home support with video-conferencing is superior to telephone consultations. Parents are highly satisfied with telehomecare. Tele-homecare significantly reduces health service utilisation and may reduce health service costs.
PMID: 22888158
8.
J Med Internet Res. 2012 Aug 2;14(4):e110. doi: 10.2196/jmir.2084.
The therapeutic relationship in e-therapy for mental health: a systematic review.
Sucala M, Schnur JB, Constantino MJ, Miller SJ, Brackman EH, Montgomery GH.
Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA. madalina.sucala@mssm.edu
BACKGROUND:
E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video
conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been
rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services
over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about etherapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the
absence of nonverbal cues.
OBJECTIVE: Our objective in this study was to systematically review the therapeutic relationship in e-therapy.
METHODS: We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and
results was abstracted independently by the authors using a standardized form.
RESULTS:
From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed
studies were focused on the therapeutic alliance-a central element of the therapeutic relationship. Although the results
do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in
terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome.
CONCLUSIONS:
Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is
needed to understand the therapeutic relationship in online environments.
PMCID: PMC3411180
PMID: 22858538
9.
J Med Internet Res. 2012 Jul 18;14(4):e105. doi: 10.2196/jmir.1953.
Effects of functional interactivity on patients' knowledge, empowerment, and health outcomes: an experimental modeldriven evaluation of a web-based intervention.
Camerini L, Schulz PJ.
Institute of Communication and Health, Faculty of Communication Sciences, Università della Svizzera italiana, Lugano,
Switzerland. lukame@gmail.com
BACKGROUND:
The effectiveness of eHealth interventions in terms of reach and outcomes is now well documented. However, there is a
need to understand not only whether eHealth interventions work, but also what kind of functions and mechanisms
4
enhance their effectiveness. The present investigation contributes to tackling these challenges by investigating the role
played by functional interactivity on patients' knowledge, empowerment, and health outcomes.
OBJECTIVES:
To test whether health knowledge and empowerment mediate a possible relationship between the availability of
interactive features on an eHealth application and individuals' health outcomes. We present an empirical, model-driven
evaluation of the effects of functional interactivity implemented in an eHealth application, based on a brief theoretical
review of the constructs of interactivity, health knowledge, empowerment, and health outcomes. We merged these
constructs into a theoretical model of interactivity effects that we tested on an eHealth application for patients with
fibromyalgia syndrome (FMS).
METHODS:
This study used a pretest-posttest experimental design. We recruited 165 patients and randomly assigned them to three
study groups, corresponding to different levels of functional interactivity. Eligibility to participate in the study required
that patients (1) be fluent in Italian, (2) have access to the Internet, (3) report confidence in how to use a computer, and
(4) have received a diagnosis of FMS from a doctor. We used structural equation modeling techniques to analyze
changes between the pretest and the posttest results.
RESULTS:
The main finding was that functional interactivity had no impact on empowerment dimensions, nor direct observable
effects on knowledge. However, knowledge positively affected health outcomes (b = -.12, P = .02), as did the
empowerment dimensions of meaning (b = -.49, P < .001) and impact (b = -.25, P < .001).
CONCLUSION:
The theoretical model was partially confirmed, but only as far as the effects of knowledge and empowerment were
concerned. The differential effect of interactive functions was by far weaker than expected. The strong impact of
knowledge and empowerment on health outcomes suggests that these constructs should be targeted and enhanced by
eHealth applications.
PMCID: PMC3409610
PMID: 22810046
10.
Assessment and diagnosis of musculoskeletal shoulder disorders over the internet
Steele L., Lade H., McKenzie S., Russell T.G.
Int. J. Telemed. Appl. 2012 :
Abstract
Shoulder disorders are common, debilitating, and represent a considerable burden on society. As primary contact
practitioners, physiotherapists play a large role in the management and rehabilitation of people with these conditions.
For those living outside of urban areas, however, access to physiotherapy can be limited. The aim of this study was to
evaluate the validity and reliability of using a telerehabilitation system to collect physical examination findings and
correctly identify disorders of the shoulder. Twenty-two participants with 28 shoulder disorders were recruited and
underwent a face-to-face physical examination and a remote telerehabilitation examination. Examination findings and
diagnoses from the two modes of assessment were used to determine validity and reliability of the new method.
Diagnostic agreement and agreement on individual findings between the two methods were found to be consistent with
the reliability of conventional assessment methods. This study provides important preliminary findings on the validity
and reliability of musculoskeletal examinations conducted via telerehabilitation. © 2012 Leah Steele et al.
11.
A regulatory framework for pervasive e-health: A case study
Troshani I., Goldberg S., Wickramasinghe N.
Health Policy Technol. 2012 1:4 (199-206)
Abstract
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To facilitate superior healthcare delivery and address current challenges faced by healthcare today, a plethora of
pervasive e-health solutions are emerging. However, existing regulatory regimes are ill-equipped for dealing with them.
This not only causes frustration to various stakeholders including patients, providers, healthcare organizations and
payers, not to mention vendors but also means that the most appropriate solution cannot be accessed and used. Hence
this exploratory study serves to investigate institutional regulatory factors that can impact the adoption of such
pervasive e-health solutions. These factors are important as they can shape both the nature of these solutions and their
diffusion trajectory. We argue that co-regulation, a mixture of direct monitoring and intervention of regulators through
legislation and complete industry self-regulation, can be an effective approach especially in view of the complex and
dynamic nature of this industry, co-regulation can minimize monitoring costs and enhance compliance. We illustrate
with a case vignette. © 2012 Fellowship of Postgraduate Medicine.
Am J Speech Lang Pathol. 2012 Aug;21(3):222-38. doi: 10.1044/1058-0360(2012/11-0056). Epub 2012 Mar 21.
Script training and generalization for people with aphasia.
Goldberg S, Haley KL, Jacks A.
The University of North Carolina at Chapel Hill, USA.
PURPOSE:
To examine the effects and generalization of a modified script training intervention, delivered partly via
videoconferencing, on dialogue scripts that were produced by 2 individuals with aphasia.
METHOD:
Each participant was trained on 2 personally relevant scripts. Intervention sessions occurred 3 times per week, with a
combination of in-person meetings and videoconferencing, and lasted for 3 weeks per script. This study followed a
multiple baseline design across scripts. Measures of accuracy, grammatical productivity, speaking rate, and articulatory
fluency were obtained during baseline, intervention, and maintenance phases. Generalization probes were administered
by challenging participants to engage in a conversation about their script topic with conversation partners who did not
follow the script.
RESULTS:
Both participants showed improvement on all dependent variables for both scripts during and after the intervention
phase. Generalization samples showed improved grammatical morpheme use and increased rate of speech over
prebaseline samples.
CONCLUSION:
There is evidence that script training intervention can improve accuracy, grammatical productivity, speaking rate, and
articulatory fluency in script production tasks as well as in more functional conversational tasks. Videoconferencing is a
viable method of conducting script training intervention when it is supported by face-to-face intervention sessions,
slight modifications to the procedure, and an emphasis on self-cuing skills.
PMID: 22442283
12.
Tablet telerounding
Kaczmarek B.F., Trinh Q.-D., Menon M., Rogers C.G.
Urology 2012 80:6 (1383-1388)
Abstract
Objective: To evaluate the feasibility of remote rounding using commercially available standard tablets with
videoconferencing system and assess patient satisfaction. Methods: Thirty-two patients with at least 2 postoperative
days of hospital stay after robotic urologic procedures were included in the study. On the first postoperative day, the
physician-patient encounter was performed as telerounding with videoconferencing due to the physician's duties
scheduled in another affiliated hospital. On the second day, the personal bedside encounter took place. The tablet we
used was an iPad2 (Apple, iOS 5.1; Apple, Cupertino, CA) with a videoconferencing application. A telerounding
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satisfaction survey was fulfilled by all patients on the touchscreen of the tablet. Results: Average time of telerounding
encounter was 4.5 minutes (range, 1.0-13.5 minutes), average age of the patient was 57.7 years (range, 19-80 years),
and 19 were men (59%). Patients expressed a high level of satisfaction with 91% of patients stating that their care was
better using telerounding and 97% of patients stating that telerounding should be a regular part of patient care in the
hospital. Additionally, 94% of patients stated that they could easily communicate with their doctor over the telerounding
system, 84% of patients agreed that they would feel comfortable with telerounding daily if they were hospitalized again
and 81% of patients would prefer telerounding communication with their doctor than be directly seen by another
doctor. Conclusion: Tablet telerounding using videoconferencing can be a strong supplementing tool in doctor-patient
communication. It is convenient for the physician and increases the patient's hospital stay satisfaction. © 2012 Elsevier
Inc. All Rights Reserved.
La Veille en téléréadaptation est une initiative du Comité de développement des pratiques cliniques en
téléréadaptation, coordonné par Johanne Lambert, chargée de projet (IRDPQ)
Recherche documentaire effectuée par Ann Murchison, bibliothécaire, CIGI, IRDPQ
Sélection réalisée par Geneviève Bastien, physiothérapeute et coordonnatrice clinique au Programme des grands
brûlés de la Direction des services à la clientèle adultes-aînés, Louis Deschênes, spécialiste en réadaptation
visuelle au Programme de déficience visuelle de la Direction des services à la clientèle et Ann Murchison,
bibliothécaire
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