Journal of Telemedicine and Telecare最新文献

AimPatients' trust and confidence in telehealth are core components of its adoption, effectiveness and sustained use. This study aimed to develop and validate scales to measure trust and confidence in using telephone and video consultations in people with chronic kidney disease (CKD).MethodsAfter developing potential items, two-phases were conducted to investigate construct validity. Phase 1 examined face and content validity via: think-aloud patients focus group (n = 5), specialists email feedback (n = 3) and telehealth investigators group discussion (n = 4). Phase 2 used factor analytical methods to evaluate structural validity and internal consistency reliability after surveying a sample of people with CKD at an Australian metropolitan hospital. Four exploratory factor analyses (EFA) with oblique rotation Promax were conducted. Parallel analysis was used for factor retention and items with factor loadings ≥0.60 on the primary factor and without substantive cross-loadings were maintained. Cronbach's alpha (α) measured the internal consistency reliability.ResultsPhase 1 resulted in 17 items to measure trust in telephone consultations, 17 items to measure trust in video consultations, 8 items to measure confidence in using telephone consultations and 8 items to measure confidence in using video consultations (total 50 items). Phase 2: EFA results (N = 156) for the trust scales were both unidimensional: (1) 12-item trust in telephone consultations (α = 0.92); (2) 12-item trust in video consultations (α = 0.93). EFA resulted in two factors for each of the confidence scales: (3) Confidence in using telephone consultations (α = 0.82), comprising 4-item 'competence & capability' factor (α = 0.84) and 3-item 'social & technical support' factor (α = 0.82); (4) Confidence in using video consultations (α = 0.84) comprising 4-item experience 'competence & capability' factor (α = 0.84) and 3-item 'social & technical support' factor (α = 0.82). Internal consistency reliability of all scales and subscales were adequate (α > 0.80).ConclusionOur study demonstrated excellent psychometric properties of the TCTVC scales, which can be reliably used across broader cohorts.

BackgroundTelehealth has been widely accepted and investigated however little is known about virtual physical examination (VPE) in primary care settings. In order to understand and improve patient and clinician experience during VPE, we need to analyse the physical examination during in-person general practitioner (GP) consultations.ObjectiveWe aim to analyse the characteristics of physical examination (PE) during in-person GP consultations including topics of consultations, types of physical examinations, equipment used and body area examined. We then evaluate how translatable these PE are over telehealth.MethodsEligible consultations were extracted from a dataset archive named HaRI, which contains 281 in-person GP consultations in de-identified transcript and video format. Eligible consultations were processed with data extracted. Finally, an evidence-based scoring system was used on each PE, determining its likelihood of being translated to telehealth.ResultsWe analysed 169 in-person GP consultations, in which 79% (133 out of 169) required physical examination (PE). A total of 307 physical examinations, 224 counts of equipment and 331 counts of body parts were observed. Out of 52 physical examination components we have observed, 79% were translatable but only 8% of these were deemed easily translatable over telehealth. 21% of the physical examinations were considered 'untranslatable over telehealth'.ConclusionOver half (54%) of the physical examinations were at least moderately translatable, especially for vital signs, musculoskeletal, neurological and cardiovascular exams. However, more research is warranted to increase the accuracy, reliability and translatability of virtual physical examinations and when VPE is not feasible, safety netting should be applied.

IntroductionTelemedicine use has undergone rapid transformation in recent years. We designed this study to evaluate factors associated with telemedicine use and modality and the association with telemedicine use and healthcare utilization in a post-pandemic period.MethodsThis observational study included four regions of the Alaska Tribal Health System. We used electronic health record data to evaluate a cohort of adults who had chronic disease specialty care visits, with or without telemedicine, between July 1, 2021 to December 31, 2021 for factors associated with telemedicine use and modality. We then evaluated the association between telemedicine use and healthcare utilization in 2022. We used propensity score matching to improve covariate balance between adults who had used telemedicine or not, and then estimated the effect of telemedicine on outcomes (inpatient hospitalizations, outpatient visits, and emergency department visits) using multivariable models.ResultsAdults who used telemedicine were slightly older, had more chronic conditions and clinic visits, and resided in different regions compared to those who did not, with differences also observed between telemedicine modalities. The incident rate ratio for inpatient visits (1.16, p = 0.28), outpatient visits (1.15, p = 0.13), and emergency department visits (1.12, p = 0.36) were higher but not statistically significant for adults using telemedicine when compared to individuals not using telemedicine.DiscussionWe found a non-significant association of higher rates of inpatient, outpatient, and emergency department visits in people who used telemedicine compared to propensity-matched "controls." These findings should be considered in context of potential benefits of telemedicine and patient preference.

The COVID-19 pandemic resulted in a dramatic increase in the use of telemedicine, with heightened rates of use persisting postpandemic. This change in use created a need for a valid and reliable scale to assess telemedicine use and facilitators impacting its uptake. The current study developed and validated the Telemedicine Facilitators Scale (TFS), a novel measure for assessing facilitators of telemedicine uptake. A sample of 228 physicians completed 13 items for the TFS along with an index of telemedicine use for convergent validity. We conducted two confirmatory factor analysis (CFA) models testing a four-factor structure (Positive Attitudes, Facilitating Infrastructure, Organizational Support, and External Policies) and a bifactor model in which all items loaded onto to a single telemedicine facilitators factor and the previous four factors. Both the four-factor CFA and bifactor models demonstrated acceptable fit for χ²/degrees of freedom, comparative fit index, and incremental fit index. The correlations among subscales showed that each subscale, while related, measured independent constructs. Both the general telemedicine facilitators factor and all four subfactors were positively correlated with telemedicine use, evidencing good convergent validity. Results suggest that the TFS may be used as a four-factor scale, a unidimensional scale, or a scale composed of both an overarching construct and four subconstructs. The TFS represents a useful tool for researchers, clinicians, and healthcare administrators who wish to study, use, or facilitate the use and evolution of telemedicine.

BackgroundStroke is a leading cause of mortality and disability worldwide. In Brazil, ischemic strokes account for 85% of cases, but many hospitals lack resources for acute stroke care. Telestroke programs connect underserved hospitals to specialized centers, improving access to treatment. However, stroke mimics (SMs) pose a diagnostic challenge, potentially delaying appropriate management. The Telestroke Mimic Score (TM-Score) is a clinical tool designed to differentiate ischemic cerebrovascular disease (ICVD) from SM, but it has not been validated in South America. The objective of this study is to assess the validity of the TM-Score in distinguishing ICVD from SM in a Brazilian cohort.MethodsWe conducted a retrospective study using data from the Neurological Telemedicine Database of Hospital Pró-Cardíaco, Rio de Janeiro. Patients evaluated for suspected stroke via telemedicine (January 2019-December 2022) were classified as ICVD or SM by a telestroke neurologist. The TM-Score's performance was analyzed using receiver-operating characteristic (ROC) curves, sensitivity, specificity, and predictive values.ResultsAmong 777 patients (ICVD: 561, SM: 216), the mean TM-Score was significantly higher in ICVD (20.72 ± 6.86 vs 14.36 ± 5.73, p < 0.001). A score ≥25 had high specificity (96%) and PPV (95%) for ICVD, while <10 had an NPV of 0.71. The AUC was 0.755 (95% CI: 0.718-0.791).ConclusionThe TM-Score is a valuable tool for differentiating ICVD from SM in Brazil, supporting more accurate decision-making, particularly in telemedicine settings without stroke specialists.

ObjectiveThis study aimed to determine the effectiveness of telerehabilitation in managing ongoing dyspnea and associated issues following coronavirus disease 2019 (COVID-19), and observe changes over time.DesignThe study included 36 participants who previously had COVID-19 but continued to experience dyspnea (mean age, 42.44 ± 15.51 years). The participants were randomly allocated into three groups: telerehabilitation (TRG), home exercise (HEG), and control (CG). Dyspnea level, exercise capacity, muscle oxygenation, respiratory function, and fatigue were evaluated at baseline, at 6th, and at 12th weeks. Telerehabilitation was performed supervised and synchronously via video-calls.ResultsAt the 6-week assessment, TRG showed significant improvements in dyspnea, fatigue (p < 0.001), exercise capacity (p = 0.001), and respiratory muscle strength (p < 0.001). By the 12th week, these gains were maintained, with no further changes from week 6. In HEG, dyspnea and fatigue improved at weeks 6 and 12 (p < 0.001), with no additional changes between these time points. In CG, only dyspnea improved at both assessments (p < 0.001); other parameters remained unchanged. TRG achieved greater benefits compared to CG in reducing dyspnea and fatigue at week 6 (p = 0.001 and p = 0.003, respectively), but no group differences were found at week 12 (p > 0.05). No changes in muscle oxygenation were observed in any groups or evaluation points (p > 0.05).ConclusionsTelerehabilitation effectively improved and sustained dyspnea, fatigue, respiratory muscle strength, and exercise capacity in patients with post-COVID, while home-based exercises only reduced dyspnea and fatigue. Supervised and structured telerehabilitation may be a viable approach to managing post-COVID-19 symptoms.

BackgroundThe prevalence of chronic diseases in children and adolescents has significantly increased. The COVID-19 pandemic accelerated telemedicine adoption, leading to improved healthcare access and outcomes. Despite its benefits, telemedicine is still not fully integrated into standard care. Previous reviews have been limited in scope. This systematic review aims to provide a comprehensive overview of recent trials on web or app-based telemedicine for chronically ill children and adolescents, identifying interventions and outcomes for future healthcare strategies.MethodsA comprehensive search was conducted on PubMed on November 21, 2023, and updated on January 9, 2025. Results were filtered to include prospective intervention studies involving children and adolescents with chronic conditions and limited to publications from 2017 onwards. A total of 8699 results were retrieved, and 1506 titles were screened for eligibility, resulting in 116 studies included in the review.ResultsThese studies covered 45 different conditions, with the highest numbers for diabetes, asthma, and obesity. Telemedicine interventions varied, including gamification, video meetings, integrated devices, psychological components, symptom tracking, and educational content. Most studies reported high feasibility and patient satisfaction. Clinical outcomes improved in some cases, and none were worse than standard care. The heterogeneity limited direct comparisons and meta-analysis, and small sample sizes in many studies affected the generalizability and statistical significance of the findings.ConclusionsOur study highlights the potential of telemedicine in managing chronic illnesses among children, emphasizing the need for standardized methodologies, larger sample sizes, and continued investment in infrastructure and equitable policies to fully realize its benefits in improving accessibility, convenience, cost savings, and overall health outcomes.

IntroductionThe aim of the study was to evaluate the intra- and inter-rater reliability, and validity of the Trunk Control Measurement Scale (TCMS) for tele-assessment in children with cerebral palsy (CP).MethodA cross-sectional study was conducted with 36 children aged 4-18 years, diagnosed with hemiplegic CP. Participants underwent four TCMS assessments: in-person assessment, tele-assessment via videoconferencing, and two video-based tele-assessments scored by same rater and by a second rater. Reliability was analyzed using intraclass correlation coefficients (ICC). Discriminant validity was assessed by comparing TCMS tele-assessment scores between children with Gross Motor Function Classification System (GMFCS) levels I and II, while criterion validity was evaluated by examining the correlation between face-to-face and tele-assessment TCMS scores.ResultsExcellent reliability was observed between face-to-face and tele-assessment (ICC: 0.91; 95%CI: 0.83-0.95). TCMS tele-assessment also demonstrated excellent intra-rater reliability (ICC: 0.90, 95%CI: 0.80-0.94) and high inter-rater reliability (ICC: 0.82, 95%CI: 0.66-0.90). Criterion validity was confirmed by strong correlations between face-to-face and tele-assessment scores (r = 0.925, and r = 0.892, p < 0.001 for rater-1 and rater-2, respectively). The TCMS successfully discriminated children by functional levels, demonstrating discriminative validity (p = 0.002). Bland-Altman analysis revealed minimal systematic error, with internal consistency remaining high across all assessments (>0.88).DiscussionTCMS is a valid and reliable tool for teleassessing trunk control in children with hemiplegic CP. These results may pave the way for developing child-specific, targeted telerehabilitation programs, bringing telerehabilitation closer to its primary aim of ensuring equal opportunities.This study was registered as a clinical trial (NCT06707831). https://clinicaltrials.gov/study/NCT06707831.

BackgroundSince Coronavirus disease 2019, telepractice delivery has become increasingly integrated in the standard practice of speech-language pathologists and audiologists. It is therefore important to synthesize existing knowledge on this intervention modality. However, limited evidence exists regarding its use in children. This meta-analysis evaluated evidence on the effectiveness of telepractice compared to in-person intervention for children aged ≤ 12 years.MethodA systematic search was conducted for systematic reviews, meta-analyses and randomized controlled trials comparing telepractice and in-person intervention for children ≤12 years. Eight databases were searched: PsychINFO, Linguistics and Language Behaviour Abstracts, Education Resources Information Centre, Web of Sciences, PubMed, Embase, the Joanna Briggs Institute database, and Cumulative Index to Nursing and Allied Health Literature.ResultsSeven studies on speech-language pathology intervention met the inclusion criteria; no audiology studies could be included. Effect sizes were calculated for 31 outcomes reported across both conditions (telepractice and in-person intervention). Eight effect sizes were inverted, allowing all positive values to indicate favourable intervention outcomes. Overall, interventions resulted in moderate to high effects, with telepractice intervention resulting in equal or larger effect sizes compared to in-person intervention.ConclusionTelepractice intervention demonstrated outcomes comparable or better than in-person intervention across speech-language pathology subdomains. This applies to both child-related and caregiver-related outcomes, as well as for child-directed (typically for children ≥ 4 years) and caregiver-mediated approaches, where caregivers are trained to implement the strategies at home with their child. These findings suggest that telepractice intervention is an effective alternative to in-person intervention.