Perceived Barriers and Facilitators of Using Synchronous Telerehabilitation of Physical and Occupational Therapy in Musculoskeletal Disorders: A Scoping Review (preprint)

ABSTRACT Purpose Physical and occupational therapy interventions are increasingly delivered through videoconferencing to overcome barriers related to face-to-face delivery. The objective of this scoping review was to identify barriers and facilitators of using synchronous telerehabilitation to deliver these interventions for musculoskeletal disorders. Materials and Methods MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Library, and ProQuest Dissertations and Theses databases were searched in May 2020. Qualitative and quantitative studies in any language that described barriers and facilitators of using synchronous videoconferencing for physical or occupational interventions or assessments for individuals with musculoskeletal diseases were eligible. Results Twenty-three publications were included that reported 59 facilitators and 41 barriers to using telerehabilitation. All included studies (100%) reported on facilitators, and 20 (87%) studies also reported on barriers. Most commonly reported facilitators included convenience and accessibility of services, audio and visual quality, and financial and time savings. Most commonly reported barriers included technological issues, privacy concerns, impersonal connection, and difficulty establishing rapport between patients and healthcare professionals. Conclusions Factors including quality and user-friendliness may facilitate the delivery of physical or occupational therapy interventions or assessments for musculoskeletal diseases using telerehabilitation. Strategies to address key barriers should be considered when developing and implementing such interventions or assessments. Implications for rehabilitation Videoconferencing with a healthcare professional can be an effective way to deliver patient-centered physical or occupational therapy telerehabilitation interventions. Strategies to combat barriers to using telerehabilitation may include using a stable, high-quality videoconferencing platform, enhancing self-efficacy to using videoconferencing amongst patients and health care providers, and addressing concerns related to privacy. During the current COVID-19 pandemic, the present study provides insight into the successful development and delivery of physical or occupational telerehabilitation interventions for at-risk populations.

Comparison of Mental Health Symptoms Prior to and During COVID-19 among Patients with Systemic Sclerosis from Four Countries: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort Study (preprint)

BackgroundNo studies have reported comparisons of mental health symptoms prior to and during COVID-19 in vulnerable populations. Objectives were to compare anxiety and depression symptoms among people with a pre-existing medical condition, the autoimmune disease systemic sclerosis (SSc; scleroderma), including continuous change scores, proportion with change [≥] 1 minimal clinically important difference (MCID), and factors associated with changes, including country. MethodsPre-COVID-19 Scleroderma Patient-centered Intervention Network Cohort data were linked to COVID-19 data collected April 9 to April 27, 2020. Anxiety symptoms were assessed with the PROMIS Anxiety 4a v1.0 scale (MCID = 4 points) and depression symptoms with the Patient Health Questionnaire-8 (MCID = 3 points). Multiple linear and logistic regression were used to assess factors associated with continuous change and change[≥] 1 MCID. FindingsAmong 435 participants (Canada = 98; France = 159; United Kingdom = 50; United States = 128), mean anxiety symptoms increased 4.9 points (95% confidence interval [CI] 4.0 to 5.7). Depression symptom change was negligible (0.3 points; 95% CI -0.7 to 0.2). Compared to France, adjusted scores from the United States and United Kingdom were 3.8 points (95% CI 1.7 to 5.9) and 2.9 points higher (95% CI 0.0 to 5.7); scores for Canada were not significantly different. Odds of increasing by [≥] 1 MCID were twice as high for the United Kingdom (2.0, 95% CI 1.0 to 4.2) and United States (1.9, 95% CI 1.1 to 3.2). Participants who used mental health services pre-COVID had adjusted increases 3.7 points (95% CI 1.7 to 5.7) less than other participants. InterpretationAnxiety symptoms, but not depression symptoms, increased dramatically during COVID-19 among people with a pre-existing medical condition. Increase was larger in the United Kingdom and United States than in Canada and France but substantially less for people with pre-COVID-19 mental health treatment. RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSWe referred to a living systematic review that is evaluating mental health changes from pre-COVID-19 to COVID-19 by searching 7 databases, including 2 Chinese language databases, plus preprint servers, with daily updates (https://www.depressd.ca/covid-19-mental-health). As of June 13, 2020, only 5 studies had compared mental health symptoms prior to and during COVID-19. In 4 studies of university students, there were small increases in depression or general mental health symptoms but minimal or no increases in anxiety symptoms. A general population study from the United Kingdom reported a small increase in general mental health symptoms but did not differentiate between types of symptoms. No studies have reported changes from pre-COVID-19 among people vulnerable due to pre-existing medical conditions. No studies have compared mental health changes between countries, despite major differences in pandemic responses. Added value of this studyWe evaluated changes in anxiety and depression symptoms among 435 participants with the autoimmune condition systemic sclerosis and compared results from Canada, France, the United Kingdom, and the United States. To our knowledge, this is the first study to compare mental health symptoms prior to and during COVID-19 in any vulnerable population. These are the first data to document the substantial degree to which anxiety symptoms have increased and the minimal changes in depression symptoms among vulnerable individuals. It is also the first study to examine the association of symptom changes with country of residence and to identify that people receiving pre-COVID-19 mental health services may be more resilient and experience less substantial symptom increases than others. Implications of all the available evidenceAlthough this was an observational study, it provided evidence that vulnerable people with a pre-existing medical condition have experienced substantially increased anxiety symptoms and that these increases appear to be associated with where people live and, possibly, different experiences of the COVID-19 pandemic across countries. By comparing with evidence from university samples, which found that depression symptoms were more prominent, these data underline the need for accessible interventions tailored to specific needs of different populations. They also suggest that mental health treatments may help people to develop skills or create resilience, which may reduce vulnerability to major stressors such as COVID-19.