Journal of Telemedicine and Telecare

There is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services.

We searched Medline, Embase and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson's disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated.

Nine randomized controlled trials were included; eight evaluated video and one evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI −0.4 to 0.6, p = 0.70). For people with Parkinson's disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI −1.2 to 2.5, p = 0.49). Four trials investigated interventions for speech sound disorder, voice disorder and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery.

Evidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson's disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction, and economic outcomes.

Obesity and its associated health challenges represent a pressing global concern. Telemedicine interventions offer a promising solution for effective weight loss support. This study examines the impact of telemedicine interventions on weight loss support.

We conducted a search of PubMed, Scopus, and Web of Science, starting from their inception. Both researchers systematically selected articles and extracted data using a designated data collection form. To assess the risk of bias in the included studies, we employed the Mixed Methods Appraisal Tool. Publication bias was evaluated through funnel plots and Egger's and Begg's tests. Utilizing the gathered data, we computed the standardized mean differences (Hedges's g) between the treatment and control groups. We estimated heterogeneity variance using the Q test and I² statistic. The analysis was carried out using Stata 17.0.

Out of a total of 2626 retrieved articles, 30 studies were included in the analysis. Telemedicine interventions can cause weight loss in people (Hedges's g = 0.09, 95% CI: −0.13, 0.39; p-value < 0.001). The type of telemedicine intervention and target population were a significant moderator of the heterogeneity between studies (p < 0.05).

This study highlights the potential of telemedicine interventions as valuable tools in weight loss programs. Embracing these technologies can enhance the effectiveness of weight management strategies for diverse populations.

Mobile applications for mental health have the potential to aid people with mental health disorders, especially depression, by providing them with tools and coping mechanisms. Adolescents and young adults, being at risk of depressive symptoms and leading mobile users, are among the main targets of using mobile applications to alleviate symptoms.

This study aimed to evaluate the impact of mobile application–based psychological interventions in reducing depression symptoms in adolescents and young adults compared to those not exposed to the intervention.

We conducted a meta-analysis focusing on mobile applications for reducing depressive symptoms. We searched two databases: MEDLINE and EMBASE and included randomized controlled trials conducted in English among participants aged 18–35 years old who were assessed for depressive symptoms using a validated screening measure and used mobile applications–based psychological interventions. Two of six independent reviewers conducted study selection, data extraction, and bias assessment. A pooled mean standardized difference (Cohen's d) and 95% CI were calculated using random-effects meta-analysis. Risk of bias was assessed using I2 statistics and forest plot. Egger's test was used for assessing publication bias.

After screening 740 references, we identified 12 trials with 1869 participants, with a mean age of participants ranging from 14.70 to 25.1 years. The interventions ranged from cognitive behavioral therapy (CBT)-based mobile apps to interactive story-telling apps and apps delivering a mix of CBT, interpersonal psychotherapy for adolescents, and dialectical behavior therapy elements. Control groups included information-only, waitlist, no intervention, and treatment as usual. Seven studies used Patient Health Questionnaire-9 (PHQ-9) to assess the severity of depressive symptoms, while the other five used different scales. There was no evidence of publication bias (p = 0.325). The mobile applications reduced depression score by 0.08 units of standardized difference more than the control, with a 95% CI of −0.19 to 0.03 (p = 0.294, I²= 15.4%) using standardized mean difference (SMD) as the effect estimate. In a sensitivity analysis including only studies that used PHQ-9, we found a similar trend, SMD −0.72 (95%CI −1.48 to 0.03). However, both findings were not significant.

Current evidence is insufficient to support mobile applications to relieve depression symptoms in adolescents and young adults. Further trials with larger sample size are needed to confirm our findings of a positive trend. With emerging technologies and the high exposure of apps in this population, mobile applications for depression hold promise for the future of treatment and awareness of mental health disorders in this population.

Language sampling is a widely used means of language assessment; it is based on the collection and transcription of a child's language production in various communicative contexts. The need for social distancing due to the COVID-19 pandemic impacted language sampling and speech and language therapy services in general. The in-person assessment became extremely challenging leading to the immediate increased use of telepractice in speech and language therapy. This scoping review aimed to identify the use of telepractice for language sampling in speech and language therapy during the COVID-19 pandemic.

A scoping review of existing literature was performed to collect evidence on using language sample collection via telepractice. A database search was conducted in PubMed, PsycINFO, Cochrane Library, Mendeley, Electronic, and grey bibliography in 2022. Articles were included if they met the inclusion criteria. The quality of each selected study was assessed using the modified critical appraisal skills program (CASP) checklist.

Systematic searches identified 51 studies with six studies in total meeting the inclusion criteria. The results showed that telepractice was a necessary tool during the pandemic of COVID-19 to conduct language sampling in speech and language assessment.

Speech and language therapists (SLTs) effectively collected language samples through telepractice during the COVID-19 pandemic. Although, to date, the literature on language sampling via telepractice is limited. The need for SLTs to rely on telepractice for language sampling warrants further investigation.

Telehealth increases care accessibility to patients with type-2 diabetes mellitus but the duration of its implementation to sustain optimal glycaemic control remains unclear. This study aimed to assess the health outcomes of these patients using the Optimizing care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus (OPTIMUM) home tele-monitoring (HTM) system 6 months post-intervention, compared to standard care.

An open-labelled randomized controlled trial involving 330 participants with type-2 diabetes mellitus, aged 26–65 years, and suboptimal glycaemic control (HbA1c = 7.5%–10%) was conducted. Intervention group received OPTIMUM HTM for 6 months followed by usual care for another 6 months, while control group received usual care for 12 months. OPTIMUM HTM includes in-app video-based tele-education, tele-monitoring of the blood pressure, capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based tele-management by the OPTIMUM HTM team. Assessments using self-care inventory scale and medication adherence were administered for both groups at baseline, 6-month, and 12-month timepoints.

Complete data from 156 (intervention) and 159 (control) participants, with comparable demographic profiles, were analysed. Both groups showed a significant reduction in HbA1c from baseline (p < 0.001). From 6-month to 12-month time-points, the intervention group was twice as likely to maintain their HbA1c ≤ 8% (adjusted odds ratio = 2.02, 95%CI = 1.18–3.49; p < 0.011). The intervention group demonstrated higher scores for self-care behaviours (adjusted odds ratio = 3.83 [95%CI = 1.68–5.97], p = 0.001) and not skipping medications (adjusted odds ratio = 2.32 [95%CI = 1.09–4.97], p = 0.030) at 12 months.

The OPTIMUM HTM system enabled patients to maintain their glycaemic control beyond the intervention period. The favourable outcomes could be the effect of telehealth in sustaining self-care behaviour and medication adherence.

Despite its reach, very limited evidence exists on the effectiveness of real-time video counselling for smoking cessation (e.g. via Skype). This study compared the effectiveness of real-time video counselling for smoking cessation to (a) telephone counselling; and (b) a control among rural and remote residents.

Between 25 May 2017 and 3 March 2020, a three-arm, parallel group, randomised trial, randomised 1244 rural and remote residents from New South Wales, Australia who smoked tobacco to: video counselling (4–6 video sessions); telephone counselling (4–6 telephone calls); or a control (printed materials). The primary outcome was 7-day point prevalence abstinence at 13 months post-baseline. Secondary outcomes were point prevalence abstinence at 4 months and 7-months post-baseline, prolonged abstinence, quit attempts, anxiety and depression.

For the primary outcome of 7-day point prevalence abstinence at 13 months post-baseline, there was no significant difference between video counselling and telephone counselling (14.6% vs 13.3%; (OR = 1.11, 95% CI (0.75–1.64), P = 0.61) or video counselling and control (14.6% vs 13.9%; (OR = 1.06, 95% CI (0.71–1.57), P = 0.77). For secondary outcomes at 4 months post-baseline, the video counselling group had significantly higher odds than the control of 7-day point prevalence abstinence (14.3% vs 8.2%; OR = 1.88, 95% CI (1.20–2.95), P = 0.006) and 3-month prolonged abstinence (4.9% vs 2.2%; OR = 2.28, 95% CI (1.03–5.07), P = 0.04). There were no significant differences for other secondary outcomes.

Video counselling increased smoking cessation in the short-term compared to a control although strategies to improve its long-term effectiveness are needed.

Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au ACTRN12617000514303.

Electronic consults (e-consults) are asynchronous, formalized requests by a provider to involve a specialist to assist with decision making. E-consults are an alternative to face-to-face consultation and are a promising strategy to efficiently address certain requests for advice. The objective of this project was to examine the utility and characteristics of electronic consults utilized in a safety-net hospital outpatient neurology clinic.

We retrospectively reviewed e-consults to the neurology clinic from1 January 2021 to 31 September 2021. The reasons for requests and any diagnostic or treatment recommendations were collected. The time to completion of the e-consults and the percentage of e-consult referred for an in-person clinic evaluation were determined as outcome measures. Following each e-consult, the consulting provider completed a survey to gather their assessment on the appropriateness of the consult, time spent answering the consult, and if unnecessary testing or clinic visits were avoided.

A total of 528 e-consults were completed during the study period. The most frequent e-consult referrals were for headache (22%), stroke/neurovascular (21%), neuropathy/neuritis/disturbance of skin sensation (11%), and seizures/spells (11%). The majority of e-consults (94%) were answered in one business day (defined as occurring within 24 h) with 67% of consults answered the same day (defined as occurring within the same calendar day). The consulting providers reported that more than 90% of e-consults took <15 min to answer, and 84% of e-consult requests were felt to be appropriate. A total 156 (41.4%) patients initially seen as an e-consult were referred for a face-to-face visit within 90 days of the e-consult.

E-consults provided expedited input from neurologists, which is vital in health systems that provide care to vulnerable populations. The majority of e-consults were answered within 1 day of referral, offering rapid access to neurological expertise in comparison to wait times currently encountered for face-to-face visits. Accordingly, e-consults have the potential to expedite treatment for patients, empower primary care providers, and reduce demand for in-person consultations, particularly in large health systems caring for vulnerable populations.

Telestroke enables timely and remote evaluation of patients with acute stroke syndromes. However, stroke mimics represent more than 30% of this population. Given the resources required for the management of suspected acute ischemic stroke, several scales have been developed to help identify stroke mimics. Our objective was to externally validate four mimic scales (Khan Score (KS), TeleStroke Mimic Score (TS), simplified FABS (sFABS), and FABS) in a large, academic telestroke network.

This is a retrospective, Institutional Review Board-exempt study of all patients who presented with suspected acute stroke syndromes and underwent video evaluation between 2019 and 2020 at a large academic telestroke network. Detailed chart review was conducted to extract both the variables needed to apply the mimic scales, the final diagnosis confirmed by final imaging, and discharge diagnosis (cerebral ischemic vs stroke mimic). Overall score performance was assessed by calculating the area under curve (AUC). Youden cutpoint was established for each scale and used to calculate sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy.

A total of 1043 patients were included in the final analysis. Final diagnosis of cerebral ischemia was made in 63.5% of all patients, and stroke mimic was diagnosed in 381 patients (36.5%). To predict stroke mimic, TS had the highest AUC (68.3), sensitivity (99.2%), and NPV (77.3%); KS had the highest accuracy (67.5%); FABS had the highest specificity (55.1%), and PPV (72.5%).

While each scale offers unique strengths, none was able to identify stroke mimics effectively enough to confidently apply in clinical practice. There remains a need for significant clinical judgment to determine the likelihood of stroke mimic at presentation.

Several barriers can preclude people with type 2 diabetes (T2D) from in-person exercise session participation. Telehealth may be an alternative mode of service delivery to increase uptake. We evaluated the feasibility, safety and preliminary efficacy of delivering group exercise via telehealth for people with T2D.

Sixteen people with T2D (age 59.9 ± 12.7 years, 63% male, duration of T2D 11.5 ± 11.1 years) underwent an 8-week telehealth-delivered group exercise intervention. Weekly supervised sessions incorporated whole-body aerobic and resistance exercises, followed by education. Feasibility was evaluated by recruitment, enrolment, attendance and attrition rates, the practicality of telehealth delivery, and participant feedback. Adverse events were monitored throughout (safety). Preliminary efficacy was determined from changes in glycaemic control, body composition, blood pressure, exercise capacity, neuromuscular strength/fitness, quality of life and physical activity levels. The agreement/reliability of in-person clinician-measured versus telehealth-supervised participant-self-measured assessments was also evaluated.

Feasibility was supported by high attendance (97.1%) and low attrition (81%). All (100%) participants reported they would participate in telehealth-delivered exercise interventions in the future and would recommend them to other people with T2D. No serious adverse events were reported. There were improvements in hip circumference (Cohen's d −0.50), diastolic blood pressure (–0.75), exercise capacity (1.72), upper body strength (1.14), grip strength (0.58), health-related quality of life (0.76–0.81) and self-reported physical activity (1.14). Participant-self-measured assessment of body weight, 2-min step test and 30-sec sit-to-stand test were deemed acceptable.

Telehealth-delivered group exercise appears feasible, safe and efficacious for people with T2D. These findings warrant further exploration in a powered trial.

Australian New Zealand Clinical Trials Registry (ACTRN12622000379718).

The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions.

Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated.

Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty.

Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0–0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

Providing telehealth care requires unique professionalism skills (i.e. telehealth etiquette) to ensure patients have a positive experience. Given the effect of patient–provider relationships on healthcare outcomes and the limited evidence for healthcare professionals to learn and practice these skills, developing a telehealth etiquette competency tool is necessary.

This multiround Delphi study utilized subject matter experts’ opinions to validate a telehealth etiquette competency checklist, using Lawshe's content validity measurements. Panelists were diverse in professional backgrounds, years of experience, telehealth teaching, clinical experience, and involvement in telehealth professional society and governmental policy making.

Consensus and validation were achieved on the checklist by the 17 panelists in Round 1 for 19 of 20 competencies. Following revisions based on their expert opinions, consensus was achieved by all 16 panelists in Round 2 for 20 competencies.

The Telehealth Etiquette Competency Checklist (TECC) provides a validated telehealth etiquette tool that can be used by health professionals to improve their telehealth videoconsultations, thus enhancing patient satisfaction.

Telehealth is a growing part of the healthcare field, and healthcare professionals and trainees require training not only on the clinical skills relevant to telehealth but also on professionalism skills or telehealth etiquette. As healthcare outcomes are influenced by the patient-provider relationship, training healthcare professionals on telehealth etiquette skills is imperative.

Forty-eight healthcare professionals across different disciplines, work settings, and experience levels participated in a telehealth etiquette skills educational intervention workshop wherein their knowledge and readiness to use the skills (specific to technology, environment, confidentiality, and communication) were assessed before and after the workshop.

Paired sample t-tests revealed that participating in the educational intervention resulted in statistically significant improvements in knowledge and perceived readiness to use telehealth etiquette skills pertinent to technology, environment, and communication. There were no associations between participants’ personal factors and post-educational intervention changes.

Study findings are significant and suggest that training healthcare professionals in telehealth etiquette have a positive impact. Since there is a known positive association between provider communication and patient satisfaction and a known association between patient satisfaction and healthcare outcomes, gaining telehealth etiquette skills is critical for promoting a positive patient-provider relationship via telehealth.

While telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations.

We included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities.

Our cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5–14.9; p < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4–1.0; p < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6–1.3; p < 0.001) per 100 index encounters compared to in-person visits.

Contrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.

Virtual care and remote monitoring were widely used during the COVID-19 pandemic. However, early evaluations of effectiveness were often inconclusive due to low rates of enrolment and limited data. The aim of this study was to evaluate the effectiveness of virtual care in managing individuals in community-based self-isolation and quarantine in Australia during this pandemic.

A retrospective cross-sectional study was conducted of individuals admitted to a virtual hospital in Sydney who either tested positive for COVID-19 and required self-isolation, or tested negative but still needed to self-isolate, amidst the Delta wave of the COVID-19 pandemic. Outcome measures included health service utilisation, in-hospital mortality, patient-reported experience measures (PREM), and cost savings resulting from avoided emergency department (ED) presentations.

Out of 9571 individuals admitted, 8544 (89.3%) had COVID-19. Clinical deterioration or acute illness occurred in 2477 (25.9%) individuals, of whom 890 (9.3%) were referred to ED for further assessment or investigation, and 614 (6.4%) were admitted for inpatient treatment. Overall mortality was 0.2%. Out of 1020 individuals who completed the PREM survey, 846 (82.9%) rated the overall virtual care experience as ‘good’ or ‘very good’. Avoided ED presentations possibly resulted in cost savings estimated between AU$691,214 and AU$2,994,540.

Virtual care was successfully used to manage a large number of individuals in community-based self-isolation and quarantine during the COVID-19 pandemic. Scalable pathways for triage, monitoring and clinical escalation via telehealth ensured patient safety and acceptability, and alleviated strain on the broader health system.

Ukraine's health and trauma system has been detrimentally impacted since the start of the Russian invasion in February 2022. Use of telemedicine became critical to providing timely medical care. As such, the aim of this study was to describe telemedicine's use in the health and trauma system of Ukraine following the full-scale invasion.

We conducted qualitative key informant interviews with military and civilian health care workers using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on telemedicine use. Thematic content analysis was used to derive key telemedicine themes from interviews.

We conducted 36 key informant interviews. Most respondents described using telemedicine through informal means of communication such as messaging apps to meet patient care needs. Concerns and challenges with use of telemedicine included weapons targeting, internet connections and safety of communications from Russian hackers. A unified system for telemedicine would greatly improve use in country both during and post conflict.

Telemedicine use has rapidly increased in Ukraine during the current conflict particularly in the scope of providing trauma care when numerous specialties are needed. Development of a unified, secure telemedicine system with mechanisms for integrating multinational medical support would aid in providing swift medical care to persons injured in the conflict or unable to access a specialty provider in their proximity.