Family-Centred Telehealth Training for Telerehabilitation

(TIPS Trial)

Recruiting at 2 trial locations

Overseen By Jade Berbari

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Université de Sherbrooke

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

2360 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Family-Centred Telehealth Training for Telerehabilitation?

Research shows that telerehabilitation can help maintain the connection between therapists and families, provide coping strategies, and prevent functional decline in children. Additionally, family-centered approaches in rehabilitation empower families to actively participate in care, which can improve outcomes. ^{1 2 3 4 5}

Is Family-Centred Telehealth Training for Telerehabilitation safe for humans?

The available research does not specifically address the safety of Family-Centred Telehealth Training for Telerehabilitation, but telerehabilitation in general is considered acceptable and can be as effective as face-to-face interventions for various clinical outcomes. ^{1 6 7 8 9}

How is the Family-Centred Telehealth Training (TIPS for FCT) treatment different from other treatments for pediatric rehabilitation?

The Family-Centred Telehealth Training (TIPS for FCT) is unique because it focuses on training pediatric therapists to adopt family-centered telerehabilitation, which is a relatively new approach that became more prominent due to the COVID-19 pandemic. This treatment emphasizes providing evidence-based training and support to therapists, which is not commonly addressed in other rehabilitation treatments. ^{1 4 9 10 11}

What is the purpose of this trial?

Timely access to family-centred services for children with disability and their families is important to support their development and well-being. Currently, many children face long wait times and barriers to services. Lack of access can lead to negative impacts for children and stress for their families. With the COVID-19 pandemic, these issues have been made more challenging with the loss of rehabilitation support for children, increasing stress on families. During this time, therapists moved to telehealth service delivery to support children and families. We know that telehealth can improve access to services, children's outcomes, and family satisfaction, and that telehealth a key element of Family Centred Services (FCS) in pediatric rehabilitation. FCC include practices that promote flexibility, respect and dignity for families' views, knowledge and strengths, effective information sharing, partnership and collaboration in decision making, and coordinated and comprehensive care. FCC focuses on developing collaborative family-provider relationships, where parents are active participants in collaborative goal-setting, therapy planning, implementation, and evaluation, and where activities are integrated within daily routines and contexts (e.g., home and community). Compared to traditional service delivery methods, telehealth offers opportunities to enhance FCC practices. FCC provides alternate, convenient, and flexible ways to partner with families, respecting their characteristics and barriers, allows knowledge and information sharing about the child within their contexts, supports family decision making and parents' well-being, and has been recognized as an important addition to comprehensive care coordination and service delivery. Telehealth is an important and effective alternative for families living in both urban and remote or underserved areas and can be more convenient than in-person visits (e.g., less travel time, schedule flexibility). However, the use of telehealth prior to the pandemic was low in pediatric rehabilitation. In addition, many therapists report delivering telehealth without prior experience, and lack confidence, knowledge, and training in effective intervention strategies. Although therapists' knowledge, skills and attitudes toward telehealth can improve with time and experience, training and support are required for behavioural changes to occur. Following the pandemic, there has been continued support for the use of FCT and for its ongoing use to support families of children with disability. Pediatric rehabilitation therapists, service managers, professional associations, policy makers, and families are all making the case for not "returning to normal", and are asking for help to keep telehealth as part of FCS care. The goal of the current study is to evaluate the use and effectiveness of a Training Intervention and Program of Support (TIPS) to increase the uptake of FCT in pediatric rehabilitation centres across Canada. The main research question is: Can TIPS be adapted to increase the use of FCT interventions by therapists working in different contexts? The primary objectives are to: 1. Evaluate the use of FCT regarding: 1. Therapists' desire to use vs actual use of FCT practices 2. Use of FCT practices as they were intended to be used Secondary objectives are to: 2. Describe the variations required to adapt the TIPS to meet each site's needs 3. Identify factors that influence FCT use and adherence 4. Evaluate the effectiveness with regards to: 1. Service wait-times 2. Family-centredness of services 3. Changes in service delivery 5. Evaluate the costs (and possible cost savings) related to increased use of FCT The primary hypotheses are that therapists' desire to adopt FCT and deliver FCT practices as intended will (i) improve slightly in the short term (i.e., one-month post-TIPS), yet (ii) will improve significantly post-TIPS, (iii) while actual use will vary over time, across sites and therapists, and will depend on therapist-, client-, organizational- and system-factors. For the secondary hypotheses, the investigators expect that, for sites with the largest changes in desire to use and use of FCT practices as intended, (iv) wait times will significantly decrease and (v) families' perceptions of service quality will significantly improve post-TIPS.

Research Team

Chantal Camden, PhD

Principal Investigator

École de réadaptation, CRCHUS, Université de Sherbrooke

Eligibility Criteria

This trial is for pediatric rehabilitation therapists, managers, and parents involved in telehealth services. It includes therapist champions recognized by peers, managers overseeing rehab services, parents who've used these services recently, and parent/patient-partners from advisory committees or engagement programs. Participants must be able to speak French or English.

Inclusion Criteria

Managers: Person responsible for rehabilitation services at the site, or their delegate

I can speak French or English.

Parent/patient-partners: Recruited from family, parent or patient advisory committees at the participating sites or, in the absence of such initiatives, from regional, provincial, or national patient engagement programs

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training Intervention

A 10-hour intensive training program offered to participating therapists, including 4 hours of self-paced learning modules and a 6-hour mandatory interactive webinar

4 weeks

1 visit (virtual)

Program of Support

An 11-month program of support composed of monthly mentoring meetings and a national virtual community of practice

11 months

Monthly virtual meetings

Follow-up

Participants are monitored for the effectiveness of the TIPS implementation and its impact on service delivery

6 months

Treatment Details

Interventions

• Training Intervention and Program of Support (TIPS)

Trial Overview The study tests a Training Intervention and Program of Support (TIPS) aimed at increasing the use of family-centred telehealth (FCT) in pediatric rehab. It evaluates therapists' desire versus actual use of FCT practices, adaptations needed for different sites, factors influencing FCT adherence, service wait-times impact, family-centeredness improvement and cost-effectiveness.

Participant Groups

Group I: Telehealth Experimental Treatment 1 Intervention

The proposed pre-post study will evaluate the implementation and effectiveness of a Training Intervention and Program of Support (TIPS) to enhance the adoption of family-centred telehealth in pediatric rehabilitation centres across Canada. TIPS is a multifaceted intervention, comprised of the following: 1) a 10-hour intensive training program offered to participating therapists at each site over a one-month period, including 4 hours of self-paced learning modules and a 6-hour mandatory interactive webinar; and 2) an 11-month program of support which is composed of monthly mentoring meetings at each site led by the local therapist champion, and a national virtual community of practice facilitated by 3 national knowledge brokers - an occupational therapist, a physiotherapist and a speech-language pathologist - experienced in family-centred telehealth in pediatric rehabilitation, offered simultaneously to all participating therapists across Canada.

Training Intervention and Program of Support (TIPS) is already approved in Canada for the following indications:

Approved in Canada as Training Intervention and Program of Support (TIPS) for:

• Pediatric rehabilitation
• Family-centred services

Who Is Running the Clinical Trial?

Université de Sherbrooke

Lead Sponsor

Trials

317

Recruited

79,300+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Findings from Research

This study evaluates a training intervention and support program (TIPS) aimed at enhancing the adoption of family-centered telerehabilitation (FCT) among pediatric therapists across 20 sites in Canada, with data collection expected to start in September 2022 and conclude by September 2024.

The research will assess the effectiveness of TIPS on therapists' adoption rates, service wait times, and families' perceptions of service quality, providing valuable insights into the implementation of telehealth in pediatric rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training Intervention and Program of Support for Fostering the Adoption of Family-Centered Telehealth in Pediatric Rehabilitation: Protocol for a Multimethod, Prospective, Hybrid Type 3 Implementation-Effectiveness Study. Hurtubise, K., Gaboury, I., Berbari, J., et al.[2022]

Telerehabilitation using videoconferencing significantly helped families caring for individuals with prolonged reduced consciousness, as more patients in this group remained at home and returned for rehabilitation compared to a control group.

Families using videophone support reported that their needs were better met, indicating that this approach can enhance caregiver support and potentially improve the overall care experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telerehabilitation support for families at home caring for individuals in prolonged states of reduced consciousness. Hauber, RP., Jones, ML.[2019]

The Nossa Casa Institute in Brazil is pioneering efforts to enhance awareness and support for families of children with cerebral palsy (CP) through knowledge translation initiatives, including an interactive online workshop focused on family-centered service (FCS) principles.

The workshop successfully engaged families, healthcare professionals, and researchers in discussions about FCS, empowering families to actively participate in their children's rehabilitation and advocate for better care, with plans for future national conferences to further these connections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Information and Empowerment of Families of Children With Cerebral Palsy in Brazil: The Knowledge Translation Role of Nossa Casa Institute. Airoldi, MJ., Vieira, BS., Teplicky, R., et al.[2022]

Telerehabilitation can effectively maintain therapeutic relationships and provide support for families during pediatric rehabilitation, as shown by feedback from 67 sessions involving children averaging 11.3 years old.

Therapists reported a stronger ability to maintain therapeutic alliances compared to achieving other goals, indicating that while telerehabilitation is effective, there may be challenges in delivering certain aspects of care, especially for younger children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation. Krasovsky, T., Silberg, T., Barak, S., et al.[2021]

The virtual family conference significantly improved carers' knowledge about stroke, satisfaction with information provided, and their confidence and preparedness for transitioning the patient to community care, based on evaluations from 87 carers across 48 conferences.

This intervention not only reduced the stress associated with caregiving but also effectively organized follow-up care, demonstrating the efficacy and feasibility of using virtual platforms for family involvement in stroke rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning. Ritsma, BR., Gariscsak, PJ., Vyas, A., et al.[2023]

The study involving 16 parents of children with motor difficulties found that a telerehabilitation intervention was generally acceptable, with positive feedback on its suitability and perceived benefits.

Factors such as the clarity of the intervention, the child's involvement, and the therapeutic relationships formed influenced how acceptable the telerehabilitation was, particularly for families without confirmed diagnoses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability of a Multimodal Telerehabilitation Intervention for Children Ages 3-8 Years with Motor Difficulties: Results of a Qualitative Study. Dostie, R., Gaboury, I., Trottier, N., et al.[2023]

This scoping review analyzed 18 studies on the acceptability of telerehabilitation interventions by pediatric physical and occupational therapists, revealing significant gaps in understanding how these interventions are received by patients and families.

Despite assessing various aspects of acceptability, the review concluded that there is still a lack of comprehensive knowledge about pediatric telerehabilitation, indicating a need for more focused research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability of Pediatric Telerehabilitation Interventions Provided by Physical Therapists and Occupational Therapists-A Scoping Review. Dostie, R., Gaboury, I., Cinar, E., et al.[2022]

A systematic review of 23 randomized control trials found that pediatric telerehabilitation interventions can lead to improved outcomes in 56.1% of cases, particularly when they focus on parental skills and children's behavioral functioning.

Effective telerehabilitation interventions often last more than 8 weeks, utilize a coaching approach, and are conducted at least once a week, suggesting these characteristics should guide future studies in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review. Camden, C., Pratte, G., Fallon, F., et al.[2021]

Telerehabilitation utilizes digital technologies to deliver a wide range of rehabilitation services, including evaluation, monitoring, and education, making it accessible across various patient populations and settings such as homes and clinics.

The guidelines developed by the American Telemedicine Association aim to help practitioners provide effective and secure telerehabilitation services based on client needs and current evidence, promoting the development of discipline-specific standards.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

American Telemedicine Association's Principles for Delivering Telerehabilitation Services. Richmond, T., Peterson, C., Cason, J., et al.[2022]

A new specialty-specific telehealth practice guide for rehabilitation services has been developed in Saudi Arabia to support occupational therapy, physical therapy, and speech and language pathology, especially during the COVID-19 pandemic.

This guide is based on established telehealth guidelines and aims to standardize tele-evaluation, teleintervention, and teleconsultation practices, potentially benefiting other Middle Eastern countries as well.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth Clinical Practice Guide for Occupational Therapy, Physical Therapy, and Speech and Language Pathology: A Saudi and Middle Eastern Guide. Almubark, BM., Majrashi, N., Alghusun, N., et al.[2022]

Telerehabilitation has been shown to be more effective than traditional rehabilitation methods for children and adolescents, leading to better disease control, improved quality of life, and higher treatment adherence based on a review of nine studies.

Despite its effectiveness, there is a lack of research on telerehabilitation specifically for children and adolescents in Brazil, highlighting the need for further studies and investment in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth application on the rehabilitation of children and adolescents. dos Santos, MT., Moura, SC., Gomes, LM., et al.[2022]

References

1. Canada pubmed.ncbi.nlm.nih.gov

Training Intervention and Program of Support for Fostering the Adoption of Family-Centered Telehealth in Pediatric Rehabilitation: Protocol for a Multimethod, Prospective, Hybrid Type 3 Implementation-Effectiveness Study. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Telerehabilitation support for families at home caring for individuals in prolonged states of reduced consciousness. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Information and Empowerment of Families of Children With Cerebral Palsy in Brazil: The Knowledge Translation Role of Nossa Casa Institute. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation. [2021]

5. England pubmed.ncbi.nlm.nih.gov

The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Acceptability of a Multimodal Telerehabilitation Intervention for Children Ages 3-8 Years with Motor Difficulties: Results of a Qualitative Study. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Acceptability of Pediatric Telerehabilitation Interventions Provided by Physical Therapists and Occupational Therapists-A Scoping Review. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

American Telemedicine Association's Principles for Delivering Telerehabilitation Services. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Telehealth Clinical Practice Guide for Occupational Therapy, Physical Therapy, and Speech and Language Pathology: A Saudi and Middle Eastern Guide. [2022]

11. Brazil pubmed.ncbi.nlm.nih.gov

Telehealth application on the rehabilitation of children and adolescents. [2022]