Is telehealth an effective and feasible option for improving falls-related outcomes in community-dwelling adults with neurological conditions? A systematic review and meta-analysis. (January 2023)

• Record Type: Journal Article
• Authors: Thwaites, Claire; Nayyar, Rohini; Blennerhassett, Jannette; Egerton, Thorlene; Tan, Jasmine; Bower, Kelly
• Is Part Of: Clinical rehabilitation. Volume 37:Number 1(2023)
• Page Start: 17
• Page End: 46
• Publication Date: 2023-01
• Subjects: Telemedicine -- videoconference -- neurological rehabilitation -- stroke -- multiple sclerosis -- Parkinson's disease -- falls prevention -- postural balance; Medical rehabilitation -- Periodicals; 617.03
• DOI: 10.1177/02692155221133468
• Languages: English
• ISSNs: 0269-2155

Abstract

Objective: To determine the effectiveness of telehealth interventions in reducing community falls risk or rates compared to equivalent in-person interventions in adults with neurological conditions. Data Sources: Eight electronic databases, trial registries and search engines were searched for the concepts 'falls', 'neurological conditions', and 'telehealth', limited to English language, from inception until August 2022. Review methods: Search for original research where the intervention was delivered via synchronous videoconferencing with the aim of reducing falls and falls-related outcomes. Screening and risk of bias assessment were completed by two independent researchers. Outcome data included falls rates, falls-related outcomes, safety, feasibility, and acceptability. Risk of bias was assessed using the ROB-2 and ROBINS-I tools. Quality of evidence was rated with the grading of recommendations, assessment, development and evaluation (GRADE) approach. Results: Seventeen studies with 581 participants were included; six were randomised controlled trials. Risk of bias ranged from low to high. Only one study ( n = 76) reported falls and did not find differences between telehealth and in-person physiotherapy. There was low-quality evidence that telehealth interventions improve balance outcomes more than face-to-face interventions (pooled between-group mean difference 2.48 Berg Balance Scale units, 95%CI 0.77 to 4.20). Fear of falling was not different between intervention delivery modes. Conclusion: Findings suggest that telehealth delivered falls prevention interventions are safe, feasible and acceptable in community-dwelling adults with neurological conditions, however, data related to effectiveness in reducing falls is limited. Low-quality evidence suggests that telehealth may deliver similar or better outcomes for standing balance in this population. PROSPERO Registration: (CRD42021240167).