Impact of Telehealth Services on Adherence to Exercise Programs in Individuals with Neurological Conditions: A Literature Review
Alan Kroll, SPT; Nathan McCall, SPT; Shelby McNealy, SPT; Logan Taylor, SPT; Elizabeth Wagnon, SPT
Faculty Mentor: Ann Marie Decker, PT, MSA, GCS, CEEAA
Alan Kroll, SPT; Nathan McCall, SPT; Shelby McNealy, SPT; Logan Taylor, SPT; Elizabeth Wagnon, SPT
Faculty Mentor: Ann Marie Decker, PT, MSA, GCS, CEEAA
Institution(s): Rockhurst University Department of Physical Therapy, Kansas City, MO
Purpose/Hypothesis: The study seeks to determine how physical therapy treatment via tele-health impacts exercise adherence in clients with neurological conditions. There are many barriers to adherence to traditional exercise programs in all patient populations. How using tele-health services in the treatment of individuals with neurologic conditions effects exercise program adherence, has not been determined. Additionally, little research has examined how tele-health services impacts adherence especially in clients with neurological conditions.
Subjects: While an individual’s ability to adhere to medical recommendations is a key element determining long-term positive outcomes in health care, the World Health Organization (WHO) reports that, as few as 35% of patients fully adhere to traditional exercise programs. According to the WHO, numerous barriers affecting adherence to traditional exercise programs, have been identified in previous research including, but not limited to, low self-efficacy regarding exercise, lack of self-motivation, low sense of personal control, and poor social/family support. The purpose of this study is to review recent studies investigating how the use of tele-health services effects adherence to exercise programs in individuals with neurologic conditions.
Methods/ Materials: Literature search conducted from January 2018 to December 2018 using various electronic databases including: PubMed, Medline, Google Scholar, CINHAL, SAGEjournals, ResearchGate, EbscoHost, and NIH. Keywords used were “tele-health,” “tele-rehab,” “tele-rehabilitation,” “tele-medicine,” “tele-practice,” “tele-health services,” “adherence,” “compliance,” “concordance,” “patient compliance,” “non-compliance,” “compliance to treatment,” “exercise,” “physical therapy,” “Multiple Sclerosis,” “MS,” “stroke,” “neuro-disorder,” “neurologic conditions,” “Parkinson’s,” and “spinal cord injury.” Dates searched: 2000-2018. Inclusion criteria for the search included free, full-text, scholarly, peer reviewed articles including tele-health services as a treatment method, and evaluated exercise adherence in individuals with neurologic conditions. All article abstracts screened for inclusion criteria compatibility. Well-suited journals were reviewed, by reading their entirety, and then graded by their level of evidence using the criteria of Oxford Centre for Evidence-based Medicine for Levels of Evidence.
Results: Eleven articles were reviewed to assess the effect of using tele-health services on exercise adherence; four addressing patients with stroke, one addressing patient’s with Parkinson’s, two addressing patients with Multiple Sclerosis (MS), and four addressing patients with spinal cord injuries (SCI). All four studies addressing patients with stroke reported high or increased exercise adherence with the use of tele-medicine. Tele-medicine services for studies were delivered in a variety of ways such as: wearable devices, electronic video games, 3-D cameras, laptop programs, and force plates. The single article focused on patients with Parkinson’s disease reported high short-term improved adherence, though the adherence not maintained long-term. Tele-medicine delivered via video, audio, and motion capture devices. Both articles addressing patients with MS reported high or increased adherence with the use of tele-medicine, both articles addressing patients with MS reported high or increased adherence, though only one reported statistically significant improvements. Tele-medicine services for these studies were delivered in a variety of ways such as: text, audio, video, and computer games. Three of the four articles addressing patients with SCI reported high or increased adherence; the results of the fourth SCI journal were inconclusive. Tele-medicine services for these studies were delivered in a variety of ways such as: live and recorded video, audio, text, and phone calls.
Conclusions: The studies reviewed included 257 subjects and showed tele-health services improved exercise program adherence in patients with neurologic conditions when compared to non-tele-health intervention groups, or when compared to the 35% adherence rate found with traditional exercise programs.
Funding Source: No additional sources of funding
Purpose/Hypothesis: The study seeks to determine how physical therapy treatment via tele-health impacts exercise adherence in clients with neurological conditions. There are many barriers to adherence to traditional exercise programs in all patient populations. How using tele-health services in the treatment of individuals with neurologic conditions effects exercise program adherence, has not been determined. Additionally, little research has examined how tele-health services impacts adherence especially in clients with neurological conditions.
Subjects: While an individual’s ability to adhere to medical recommendations is a key element determining long-term positive outcomes in health care, the World Health Organization (WHO) reports that, as few as 35% of patients fully adhere to traditional exercise programs. According to the WHO, numerous barriers affecting adherence to traditional exercise programs, have been identified in previous research including, but not limited to, low self-efficacy regarding exercise, lack of self-motivation, low sense of personal control, and poor social/family support. The purpose of this study is to review recent studies investigating how the use of tele-health services effects adherence to exercise programs in individuals with neurologic conditions.
Methods/ Materials: Literature search conducted from January 2018 to December 2018 using various electronic databases including: PubMed, Medline, Google Scholar, CINHAL, SAGEjournals, ResearchGate, EbscoHost, and NIH. Keywords used were “tele-health,” “tele-rehab,” “tele-rehabilitation,” “tele-medicine,” “tele-practice,” “tele-health services,” “adherence,” “compliance,” “concordance,” “patient compliance,” “non-compliance,” “compliance to treatment,” “exercise,” “physical therapy,” “Multiple Sclerosis,” “MS,” “stroke,” “neuro-disorder,” “neurologic conditions,” “Parkinson’s,” and “spinal cord injury.” Dates searched: 2000-2018. Inclusion criteria for the search included free, full-text, scholarly, peer reviewed articles including tele-health services as a treatment method, and evaluated exercise adherence in individuals with neurologic conditions. All article abstracts screened for inclusion criteria compatibility. Well-suited journals were reviewed, by reading their entirety, and then graded by their level of evidence using the criteria of Oxford Centre for Evidence-based Medicine for Levels of Evidence.
Results: Eleven articles were reviewed to assess the effect of using tele-health services on exercise adherence; four addressing patients with stroke, one addressing patient’s with Parkinson’s, two addressing patients with Multiple Sclerosis (MS), and four addressing patients with spinal cord injuries (SCI). All four studies addressing patients with stroke reported high or increased exercise adherence with the use of tele-medicine. Tele-medicine services for studies were delivered in a variety of ways such as: wearable devices, electronic video games, 3-D cameras, laptop programs, and force plates. The single article focused on patients with Parkinson’s disease reported high short-term improved adherence, though the adherence not maintained long-term. Tele-medicine delivered via video, audio, and motion capture devices. Both articles addressing patients with MS reported high or increased adherence with the use of tele-medicine, both articles addressing patients with MS reported high or increased adherence, though only one reported statistically significant improvements. Tele-medicine services for these studies were delivered in a variety of ways such as: text, audio, video, and computer games. Three of the four articles addressing patients with SCI reported high or increased adherence; the results of the fourth SCI journal were inconclusive. Tele-medicine services for these studies were delivered in a variety of ways such as: live and recorded video, audio, text, and phone calls.
Conclusions: The studies reviewed included 257 subjects and showed tele-health services improved exercise program adherence in patients with neurologic conditions when compared to non-tele-health intervention groups, or when compared to the 35% adherence rate found with traditional exercise programs.
Funding Source: No additional sources of funding