1
|
Gurgel-Juarez N, Torres-Pereira C, Haddad AE, Sheehy L, Finestone H, Mallet K, Wiseman M, Hour K, Flowers HL. Accuracy and effectiveness of teledentistry: a systematic review of systematic reviews. Evid Based Dent 2022:10.1038/s41432-022-0257-8. [PMID: 35804195 PMCID: PMC9264296 DOI: 10.1038/s41432-022-0257-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023]
Abstract
Introduction The COVID-19 pandemic has urged healthcare systems to develop new ways to safely provide care. Telehealth has become a compelling alternative. Our purpose was to evaluate the accuracy and effectiveness of teledentistry for screening, diagnosis and therapeutic management of dental care in children and adults.Methods We conducted a systematic review (SR) of systematic reviews. Multiple databases, the grey literature and conference archives were searched. Eligible SRs included those reporting virtual screening, diagnostic investigations and therapeutic interventions. Two investigators independently reviewed abstracts, articles, critically appraised SRs and extracted the data.Results We identified 817 citations and included six SRs. The accepted SRs involved >7,000 participants, used primarily asynchronous communication for diagnostic/screening outcomes and used synchronous communication for treatment outcomes. SRs were of low quality and included 30 primary studies of our interest. Sensitivity and specificity for dental referrals and diagnostic treatment planning were higher than other index/reference tests, ranging from 80-88% and 73-95%, respectively. Treatment outcome measured patient compliance and professional supervision.Conclusion This SR provides the best existing evidence for clinical decision-making involving teledentistry. Current evidence supports teledentistry as an effective means for dental referrals, treatment planning and compliance and treatment viability. Asynchronous communication and the adoption of smartphones for image capturing are feasible and convenient for the implementation of teledentistry.
Collapse
Affiliation(s)
| | | | - Ana E Haddad
- Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Lisa Sheehy
- Bruyère Research Institute, Ottawa, Canada; University of Ottawa Heart Institute Research Corporation, Ottawa, Canada
| | - Hillel Finestone
- Department of Physical Medicine and Rehabilitation, Élisabeth Bruyère Hospital, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Karen Mallet
- The Ottawa Hospital Research Institute, Ottawa, Canada; Champlain Regional Stroke Network, Ottawa, Canada
| | | | - Kannika Hour
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Heather L Flowers
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada
| |
Collapse
|
2
|
Pugliese M, Ramsay T, Shamloul R, Mallet K, Zakutney L, Corbett D, Dukelow S, Stotts G, Shamy M, Wilson K, Guerinet J, Dowlatshahi D. RecoverNow: A mobile tablet-based therapy platform for early stroke rehabilitation. PLoS One 2019; 14:e0210725. [PMID: 30682076 PMCID: PMC6347149 DOI: 10.1371/journal.pone.0210725] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Stroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might not be able to otherwise. The study objective was to demonstrate the feasibility of RecoverNow, a tablet-based stroke recovery platform aimed at delivering speech and cognitive therapy. Methods We recruited a convenience sample of 30 acute stroke patients to use RecoverNow for up to 3 months. Allied health professionals assigned specific applications based on standard of care assessments. Participants were encouraged to take home the RecoverNow tablets upon discharge from acute care. The study team contacted participants to return for a follow-up interview 3 months after enrollment. The primary outcome of interest was feasibility, defined using 5 facets: recruitment rate, adherence rate, retention rate, the proportion of successful follow-up interventions, and protocol deviations. We tracked barriers to tablet-based care as a secondary outcome. Results We successfully recruited 30 of 62 eligible patients in 15 weeks (48% recruitment rate). Participants were non-adherent to tablet-based therapy inside and outside of acute care, using RecoverNow for a median of 12 minutes a day. Retention was high with 23 of 30 patients participating in follow-up interviews (77% retention rate) and all but 3 of the 23 interviews (87%) were successfully completed. Only 2 major protocol deviations occurred: one enrollment failure and one therapy protocol violation. Barriers to tablet-based care were frequently encountered by study participants with many expressing the assigned applications were either too easy or too difficult. Conclusions Acute stroke patients are interested in attempting tablet-based stroke rehabilitation and are easily recruited early post-stroke. However, tablet-based therapy may be challenging due to patient, device and system-related barriers. Reducing the frequency of common barriers will be essential to keeping patients engaged in tablet-based therapy.
Collapse
Affiliation(s)
- Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- * E-mail:
| | - Tim Ramsay
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rany Shamloul
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen Mallet
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Lise Zakutney
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dale Corbett
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean Dukelow
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Grant Stotts
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Shamy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Dar Dowlatshahi
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Mallet K, Shamloul R, Pugliese M, Power E, Corbett D, Hatcher S, Shamy M, Stotts G, Zakutney L, Dukelow S, Dowlatshahi D. RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting. Int J Stroke 2018; 14:174-179. [PMID: 30019633 DOI: 10.1177/1747493018790031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIM We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets. METHODS Speech-language pathologists or occupational therapists identified patients with stroke and communication, fine motor, or cognitive/perceptual deficits. Patients were provided with iPads individually programmed with applications based on assessment results, and instructed to use it at least 1 h/day. At discharge, patients completed a 19-question quantitative and open-ended engagement survey addressing intervention timing, mobile device/apps, recovery goals, and therapy duration. RESULTS Over a six-month period, we enrolled 33 participants (three did not complete the survey). Median time from stroke to initiation of tablet-based therapy was six days. Patients engaged in therapy on average 59.6 min/day and preferred communication and hand function therapies. Most patients (63.3%) agreed that therapy was commenced at a reasonable time, although half expressed an interest in starting sooner, 66.7% reported that using the device 1 h/day was enough, 64.3% would use it after discharge, and 60.7% would use it for eight weeks. Sixty-seven percent of patients expressed a need for family/friend/caregiver to help them use it. CONCLUSION Our results suggest that stroke patients are interested in mobile tablet-based therapy in acute care. Patients in the acute setting prefer to focus on communication and hand therapies, are willing to begin within days of their stroke and may require assistance with the tablets.
Collapse
Affiliation(s)
- Karen Mallet
- 1 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,2 The Ottawa Hospital, Ottawa, Ontario, Canada.,3 Champlain Regional Stroke Network, Ottawa, Ontario, Canada.,4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Rany Shamloul
- 1 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | | | - Emma Power
- 6 University of Sydney, Lidcome, NSW, Australia
| | - Dale Corbett
- 4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada.,5 University of Ottawa, Ottawa, Ontario, Canada.,7 Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Hatcher
- 5 University of Ottawa, Ottawa, Ontario, Canada.,7 Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Shamy
- 1 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,2 The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada.,5 University of Ottawa, Ottawa, Ontario, Canada
| | - Grant Stotts
- 1 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,2 The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada.,5 University of Ottawa, Ottawa, Ontario, Canada
| | | | - Sean Dukelow
- 4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada.,8 Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dar Dowlatshahi
- 1 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,2 The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada.,5 University of Ottawa, Ottawa, Ontario, Canada.,7 Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|