JMIR Publications

ABSTRACT

Background:

Telehealth has rapidly developed over the past 20 years, so it is essential we identify effective telehealth technologies for implementation in clinical practice. In response to COVID-19 there is increasing momentum behind the development and delivery of telehealth. Therefore, to assess the anticipated exponential growth in telehealth it is important we accurately capture how telehealth was used in specific fields of mental health prior to COVID-19.

Objective:

The aim of this review was to highlight how, prior to COVID-19, telehealth had been used (i.e. assessment, treatment, monitoring) with clinical samples in the neurodevelopmental (NDD) field, including for patients with NDD, their families, and healthcare professionals (HCPs). In order to identify which technologies may show greatest clinical and cost-effectiveness for implementation into health services post COVID-19 the review evaluates the technologies for effectiveness, cost efficiencies, and readiness for clinical adoption. The quality of the evidence and gaps in the literature are also considered to guide future work.

Methods:

A systematic search of the literature was undertaken (April 2018 - updated until December 2019) using the following databases: Medline, Web of Science, Scopus, CINAHL Plus, Embase, and PsycInfo. Data extracted included the type of technology, how the technology was used (assessment, treatment, monitoring), participant characteristics, reported outcomes and the authors’ views on clinical effectiveness, user impact, feasibility and acceptability, service delivery efficiencies and economic impact, and readiness for clinic adoption. A quality review of the research is also reported.

Results:

A total of 42 studies met the inclusion criteria. These included participants and/or their families with autism spectrum disorders (ASD; n=22), attention deficit hyperactivity disorders (ADHD; n=8), ADHD and/or ASD (n=3), communication disorders (n=7), and tic disorders (n=2). The majority of studies were with children/young people and/or their caregivers. The focus of most studies was treatment (n=33), rather than assessment (n=4) or monitoring (n=5). In terms of clinical effectiveness, telehealth services were usually equivalent to controls (e.g. face-to-face services or services without therapist input), costs were generally not reported but when they were telehealth was seen as being cost-effective. The quality of the studies varied, with many having small sample sizes and inadequate control groups.

Conclusions:

The use of telehealth has the potential to increase the availability of treatment, decrease waiting times for diagnosis, and aid in the monitoring of NDD, post COVID-19. Further research, with more robust and adequately powered study designs as well as consideration of cost-effectiveness and efficiency savings, is needed. The review highlights the extent of the use of telehealth technologies prior to COVID-19 and the movement to invest in remote access to treatments.