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BackgroundThe delivery of physiotherapy via telehealth could provide more equitable access to services for patients. Videoconference-based telehealth has been shown to be an effective and acceptable mode of service delivery for exercise-based interventions for chronic knee pain; however, specific training in telehealth is required for physiotherapists to effectively and consistently deliver care using telehealth. The development and evaluation of training programs to upskill health care professionals in the management of osteoarthritis (OA) has also been identified as an important priority to improve OA care delivery. ObjectiveThis study aims to explore physiotherapists’ experiences with and perceptions of an e-learning program about best practice knee OA management (focused on a structured program of education, exercise, and physical activity) that includes telehealth delivery via videoconferencing. MethodsWe conducted a qualitative study using individual semistructured telephone interviews, nested within the Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis randomized controlled trial, referred to as the PEAK trial. A total of 15 Australian physiotherapists from metropolitan and regional private practices were interviewed following the completion of an e-learning program. The PEAK trial e-learning program involved self-directed learning modules, a mock video consultation with a researcher (simulated patient), and 4 audited practice video consultations with pilot patients with chronic knee pain. Interviews were audio recorded and transcribed verbatim. Data were thematically analyzed. ResultsA total of five themes (with associated subthemes) were identified: the experience of self-directed e-learning (physiotherapists were more familiar with in-person learning; however, they valued the comprehensive, self-paced web-based modules. Unwieldy technological features could be frustrating); practice makes perfect (physiotherapists benefited from the mock consultation with the researcher and practice sessions with pilot patients alongside individualized performance feedback, resulting in confidence and preparedness to implement new skills); the telehealth journey (although inexperienced with telehealth before training, physiotherapists were confident and able to deliver remote care following training; however, they still experienced some technological challenges); the whole package (the combination of self-directed learning modules, mock consultation, and practice consultations with pilot patients was felt to be an effective learning approach, and patient information booklets supported the training package); and impact on broader clinical practice (training consolidated and refined existing OA management skills and enabled a switch to telehealth when the COVID-19 pandemic affected in-person clinical care). ConclusionsFindings provide evidence for the perceived effectiveness and acceptability of an e-learning program to train physiotherapists (in the context of a clinical trial) on best practice knee OA management, including telehealth delivery via videoconferencing. The implementation of e-learning programs to upskill physiotherapists in telehealth appears to be warranted, given the increasing adoption of telehealth service models for the delivery of clinical care.

BackgroundPeople with chronic obstructive pulmonary disease (COPD) who are less active have lower quality of life, greater risk of exacerbations, and greater mortality than those who are more active. The effectiveness of physical activity interventions may facilitate the addition of game elements to improve engagement. The use of a co-design approach with people with COPD and clinicians as co-designers may also improve the effectiveness of the intervention. ObjectiveThe primary aim of this study is to evaluate the feasibility of a co-designed mobile game by examining the usage of the game, subjective measures of game engagement, and adherence to wearing activity trackers. The secondary aim of this study is to estimate the effect of the game on daily steps and daily moderate-to-vigorous physical activity (MVPA). MethodsParticipants with COPD who were taking part in the co-design of the active video game (n=9) acted as the experiment group, spending 3 weeks testing the game they helped to develop. Daily steps and MVPA were compared with a control group (n=9) of participants who did not co-design or test the game. ResultsMost participants (8/9, 89%) engaged with the game after downloading it. Participants used the game to record physical activity on 58.6% (82/141) of the days the game was available. The highest scores on the Intrinsic Motivation Inventory were seen for the value and usefulness subscale, with a mean of 6.38 (SD 0.6). Adherence to wearing Fitbit was high, with participants in both groups recording steps on >80% of days. Usage of the game was positively correlated with changes in daily steps but not with MVPA. ConclusionsThe co-designed mobile app shows promise as an intervention and should be evaluated in a larger-scale trial in this population.

BackgroundWorldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. ObjectiveThe aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). MethodsGoogle Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. ResultsFrom a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). ConclusionsTo our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use.

COVID-19 restrictions prompted change to clinical placements for students, including a move to a remote supervision model where students, clinical educators, and patients were geographically remote from each other but connected via videoconferencing technology. A total of seven students and 11 clinical educators from occupational therapy and speech pathology participated in focus groups, reflecting on their experiences and perceptions of the rapid transition to remote supervision. Qualitative data were analyzed using a thematic analysis approach. No participants had experience with remote supervision prior to COVID-19. Three key themes were generated from the data: (a) key considerations, processes, and suggestions for remote supervision, (b) impact of remote supervision on relationship development, and (c) development of student professional competencies within the model. This study provides insights and practical considerations for implementing remote supervision and confirms this model can effectively meet students' supervision needs and support the development of professional competencies.

Objectives: This study explored a new telehealth educational and development psychologist (EDP) service 10 provided as part of a multidisciplinary team to rural families. We aimed: (1) to examine the role and process changes made in telehealth consults compared to in-person consults, and (2) to evaluate the satisfaction of key stakeholders with the telehealth service. Method: We used an exploratory qualitative case study design involving care observations, semi-structured interviews and satisfaction surveys. Participants were (i) one EDP, four multidisciplinary team (MDT) members and six service managers 15 employed by BUSHkids, a not-for-profit health service in Queensland, Australia; and (ii) 23 parents of 20 children enrolled in the service. Results: Telepsychology involved major additions to in-person roles and processes, including the creation of a telehealth facilitator role. Key role and process changes were identified: (1) extending MDT roles to assist the EDP with clinical data collection and extending parent roles to act as co-therapists; (2) increased clinician processes focused around maintaining 20 therapeutic presence through verbal interaction strategies and creating shared virtual spaces; and (3) increased routines and documentation demonstrated in extra EDP preparation time, additional technology sub-routines, and more correspondence between team members. Service satisfaction was rated as moderate-high by the EDP, MDT, and parents. Conclusions: Telepsychology, while requiring significant practice change, was an acceptable way to delivery educational and developmental psychology services.

Background: Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). Maintenance of functional communication and swallowing over time is challenging for the person with PD and their families and may lead to social isolation and reduced quality of life if not addressed. Speech and language therapists (SLTs) face the conundrum of providing sustainable and flexible services to meet the changing needs of people with PD. Motor, cognitive and psychological issues associated with PD, medication regimens and dependency on others often impede attendance at a centre-based service. The access difficulties experienced by people with PD require a disruptive service approach to meet their needs. Technology-enabled management using information and telecommunications technologies to provide services at a distance has the potential to improve access, and enhance the quality of SLT services to people with PD. Aims: To report the status and scope of the evidence for the use of technology in the management of the communication and swallowing disorders associated with PD. Methods & Procedures: Studies were retrieved from four major databases (PubMed, CINAHL, EMBASE and Medline via Web of Science). Data relating to the types of studies, level of evidence, context, nature of the management undertaken, participant perspectives and the types of technologies involved were extracted for the review. Main Contribution: A total of 17 studies were included in the review, 15 of which related to the management of communication and swallowing disorders in PD with two studies devoted to participant perspectives. The majority of the studies reported on the treatment of the speech disorder in PD using Lee Silverman Voice Treatment (LSVT LOUD®). Synchronous and asynchronous technologies were used in the studies with a predominance of the former. There was a paucity of research in the management of cognitive-communication and swallowing disorders. Conclusions & Implications: Research evidence supporting technology-enabled management of the communication and swallowing disorders in PD is limited and predominantly low in quality. The treatment of the speech disorder online is the most developed aspect of the technology-enabled management pathway. Future research needs to address technology-enabled management of cognitive-communication and swallowing disorders and the use of a more diverse range of technologies and management approaches to optimize SLT service delivery to people with PD.

Background: Organizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation– Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation. Methods: An empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics. Results: The 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12–18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams. Conclusions: These findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount. Objectives: To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in‐person assessments on a battery of TMD physical tests. Method: A repeated‐measures study design was undertaken. Thirty‐six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in‐person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests. Results: Agreement between telehealth and in‐person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter‐ and intra‐rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in‐person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty‐six individual measures produced substantial to near perfect agreement (PABAK = 0.65–0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18–0.29). Conclusion: There is high level of agreement between telehealth and in‐person measurements of TMJ physiological movement and pain provocation tests. [ABSTRACT FROM AUTHOR]

Objectives Conversational agents (CAs) with emerging artificial intelligence present new opportunities to assist in health interventions but are difficult to evaluate, deterring their applications in the real world. We aimed to synthesize existing evidence and knowledge and outline an evaluation framework for CA interventions. Materials and Methods We conducted a systematic scoping review to investigate designs and outcome measures used in the studies that evaluated CAs for health interventions. We then nested the results into an overarching digital health framework proposed by the World Health Organization (WHO). Results The review included 81 studies evaluating CAs in experimental (n  = 59), observational (n  = 15) trials, and other research designs (n  = 7). Most studies (n  = 72, 89%) were published in the past 5 years. The proposed CA-evaluation framework includes 4 evaluation stages: (1) feasibility/usability, (2) efficacy, (3) effectiveness, and (4) implementation, aligning with WHO's stepwise evaluation strategy. Across these stages, this article presents the essential evidence of different study designs (n  = 8), sample sizes, and main evaluation categories (n  = 7) with subcategories (n  = 40). The main evaluation categories included (1) functionality, (2) safety and information quality, (3) user experience, (4) clinical and health outcomes, (5) costs and cost benefits, (6) usage, adherence, and uptake, and (7) user characteristics for implementation research. Furthermore, the framework highlighted the essential evaluation areas (potential primary outcomes) and gaps across the evaluation stages. Discussion and Conclusion This review presents a new framework with practical design details to support the evaluation of CA interventions in healthcare research. Protocol registration The Open Science Framework (https://osf.io/9hq2v) on March 22, 2021. [ABSTRACT FROM AUTHOR]

Introduction: In‐person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time‐intensive responsibilities. The COVID‐19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co‐developed and evaluated a web‐based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions. Methods: A mixed‐methods exploratory sequential design applied modified experience‐based co‐design methods (physiotherapists [n = 13], clinic administrators [n = 2], and people with musculoskeletal conditions [n = 7]) to develop an evidence‐informed toolkit. Semi‐structured workshops were conducted, recorded, transcribed, and thematically analysed, refining the toolkit prototype. Subsequently, the toolkit was promoted via webinars and social media. The usability of the toolkit was examined with pre‐post surveys examining changes in confidence, knowledge, and perceived telehealth competence (19 statements modelled from the theoretical domains framework) between toolkit users (>30 min) and non‐users (0 min) using chi‐squared tests for independence. Website analytics were summarised. Results: Twenty‐two participants engaged in co‐design workshops. Feedback led to the inclusion of more patient‐facing resources, increased assessment‐related visual content, streamlined toolkit organisation, and simplified, downloadable infographics. Three hundred and twenty‐nine physiotherapists from 21 countries completed the baseline survey, with 172 (52%) completing the 3‐month survey. Toolkit users had greater improvement in knowledge, confidence, and competence than non‐users in 42% of statements. Seventy‐two percentage of toolkit users said it changed their practice, and 95% would recommend the toolkit to colleagues. During the evaluation period, the toolkit received 5486 total views. Discussion: The co‐designed web‐based Musculoskeletal Telehealth Toolkit is a professional development resource that may increase physiotherapist's confidence, knowledge, and competence in telehealth. [ABSTRACT FROM AUTHOR]

Objective: To investigate the self-reported confidence of final year Australian physiotherapy students and recent graduates in their capability to deliver care via videoconferencing. Design: A national cross-sectional survey Participants: Australian physiotherapy students enrolled in their final year of an entry-to-practice physiotherapy program and recent graduates (graduating year 2020 or 2021) from an entry-to-practice physiotherapy program. Methods: Participants were recruited via email invitation from their university, direct invitation during a lecture/tutorial and advertisements on social media. Participants rated their confidence (using 4-point Likert scales) in performing 60 individual core capabilities across seven domains from an international core capability framework developed for physiotherapists delivering quality care via videoconferencing. Data were dichotomised with 'moderately confident' and 'extremely confident' deemed as 'confident' and 'slightly confident' and 'not confident' deemed as 'not confident'. Results: 343 participants from 20 (out of 25) Australian universities offering entry-to-practice physiotherapy programs completed the survey. The most common program participants were enrolled in/completed was a Bachelor of Physiotherapy (61%, n=209). Overall, most (75-100%) participants were confident in the domain 'delivery of telehealth', many (51-74%) were confident in domains of 'patient privacy and confidentiality', 'patient safety', 'assessment and diagnosis', 'care planning and management', and some (25-50%) were confident in 'technology skills' and 'compliance' issues. Conclusion: Findings from this study highlight areas where final year entry-to-practice physiotherapy students and recent graduates may need additional support and training to deliver quality care via videoconferencing. These findings can inform the content of telehealth physiotherapy curricula. [ABSTRACT FROM AUTHOR]

Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia. Prospective mixed method service evaluation study. Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis. Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency. A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants. [ABSTRACT FROM AUTHOR]