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Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review
Marina Pagaki-Skaliora1, Eileen Morrow1,2, Tim Theologis1,2
1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Insights
Telehealth shows promise for children with cerebral palsy (CP), offering comparable or improved outcomes and reduced caregiver burden. Further research is needed for lower limb function, postural management, and pain control.
Area of Science:
- Pediatric Rehabilitation
- Digital Health
- Cerebral Palsy Management
Background:
- The COVID-19 pandemic accelerated the adoption of telehealth for children with cerebral palsy (CP) due to limited access to in-person care.
- Despite increased use, a comprehensive synthesis of existing telehealth evidence for pediatric CP is lacking.
Purpose of the Study:
- To systematically review and summarize the current evidence on telehealth interventions for treating children with CP.
- To identify gaps in the research for future investigation.
Main Methods:
- A scoping review was conducted using MEDLINE and PubMed, searching for literature published between 2010 and 2021.
- Inclusion criteria focused on primary research and systematic reviews of telehealth for children with CP, with specific exclusion criteria applied.
Main Results:
- The review identified 5 papers encompassing 11 studies, predominantly of low methodological quality (case series).
- Telehealth interventions showed positive results for children with CP, comparable or superior to traditional care, and reduced caregiver burden.
- Evidence suggests telehealth needs vary by developmental stage and functional level, with mixed findings on patient compliance.
Conclusions:
- The current evidence base for telehealth in pediatric CP lacks breadth and methodological rigor for definitive clinical recommendations.
- Existing research primarily focuses on hand function, highlighting a need for studies on lower limb function, postural management, and pain control.
- Telehealth demonstrates potential for improving function and accessibility in pediatric CP care, with implementation barriers also meriting further study.
Background:
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.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
