Telehealth delivery of paediatric rehabilitation for children with neurodisability: A mixed methods realist evaluation of contexts, mechanisms and outcomes.
Fiona Graham, Jonathan Williman, Lena Sutherland and 1 others
PMID 35778916WHAT IT FOUND
Telehealth improved access and scheduling for families of children with neurodisability, but only worked when offered as a choice alongside in-person care.
Practitioners lacked training and organizational support, leading to inconsistent delivery and poor documentation of goals.
Key findings
01Telehealth was valued for enabling greater access to therapy, particularly through easier scheduling, but was rejected when presented as the only option rather than a choice.
02Casenote audits revealed substantial missing data regarding the delivery of family-centred telehealth, with goal progress not documented for any goal and therapeutic alliance scores recorded in only 27% of cases.
03Insufficient data were gathered for Māori families to determine if culturally specific needs influenced telehealth uptake, though practitioners perceived that trust was harder to build remotely.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The casenote audit relied on retrospective documentation, which resulted in substantial missing data and may not accurately reflect what was actually delivered. The sample size for qualitative interviews was small (5 practitioners, 8 parents), limiting the generalizability of the themes. There was insufficient data on Māori families to evaluate cultural responsiveness or specific barriers to telehealth uptake for this population. The study took place during the early months of the COVID-19 pandemic, a period of unusual pressure and rapid adaptation that may not reflect routine practice conditions.
Declared interests
The authors declared no competing interests. The study was supported by non-U.S. government funding.
The easy way to misread this
Do not assume that telehealth delivery was consistent or high-quality across all services. The audit showed that goal progress was never documented and therapeutic alliance was rarely recorded, meaning the 'family-centred' aspect of the intervention was largely unverified in the clinical records.