Care at a distance: Understanding lived experiences of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth: A systematic rapid review

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Abstract

Background

Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders.

Objective

We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth; and (2) what clinical implications can be inferred from qualitative studies focusing on lived experiences for how telehealth is delivered in the management of MSK disorders?

Data sources

A comprehensive search of MEDLINE, CINAHL, PsycINFO, ProQuest, and Google Scholar from June 2010 to July 2023. Eligible qualitative and mixed methods studies capturing lived experiences of adults with MSK disorders receiving non-pharmacological interventions via synchronous telehealth were included.

Study methods

Systematic rapid review conducted according to WHO guidelines. Titles and abstracts screened by reviewers independently, eligible studies critically appraised, and data was extracted. Themes summarized using the Consolidated Framework for Implementation Research (CFIR). GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) used to assess confidence in synthesis findings.

Results

We identified 9782 references, screened 8029, and critically appraised 22, and included 17 studies. There is evidence to suggest that the experience of telehealth prior to and during the pandemic was shaped by (1) patient perception of telehealth, (2) existing relationships with practitioners, (3) availability and accessibility of telehealth technologies, and (4) perceptions about the importance of the role of the physical exam in assessing and treating MSK disorders.

Conclusion

The five identified implications could be used to inform future research, policy, and strategy development.

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Most cited references 60

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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura Damschroder, David Aron, Rosalind E Keith … (2009)

Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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Methods for the thematic synthesis of qualitative research in systematic reviews

James Thomas, Angela Harden (2008)

Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers

Quan Hong, Sergi Fàbregues, Gillian Bartlett … (2018)

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Author and article information

Journal

Journal ID (nlm-ta): Digit Health

Journal ID (iso-abbrev): Digit Health

Journal ID (publisher-id): DHJ

Journal ID (hwp): spdhj

Title: Digital Health

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 2055-2076

Publication date (Electronic): 15 March 2024

Publication date Collection: Jan-Dec 2024

Volume: 10

Electronic Location Identifier: 20552076241236573

Affiliations

[1 ]Institute for Disability and Rehabilitation Research, Ringgold 85458, universityOntario Tech University; , Oshawa, ON, Canada

[2 ]Division of Research and Innovation, Ringgold 7948, universityCanadian Memorial Chiropractic College; , Toronto ON, Canada

[3 ]Faculty of Health Sciences, and Institute for Disability and Rehabilitation Research, Ringgold 85458, universityOntario Tech University; , Oshawa, ON, Canada

[4 ]Department of Health Sciences, Ringgold 1190, universityVrije Universiteit Amsterdam; , Amsterdam, The Netherlands

[5 ]Library Sciences, Ringgold 7948, universityCanadian Memorial Chiropractic College; , Toronto ON, Canada

Author notes

[*]Melissa Atkinson-Graham, Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada. Email: Melissa.Atkinson-Graham@ 123456ontariotechu.ca

Author information

Melissa Atkinson-Graham https://orcid.org/0000-0003-3534-0331

Article

Publisher ID: 10.1177_20552076241236573

DOI: 10.1177/20552076241236573

PMC ID: 10943750

PubMed ID: 38495858

SO-VID: 5c3abc50-39b2-4b8c-b638-654dd1cd4071

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date: 18 August 2023

Date accepted : 15 February 2024

Funding

Funded by: Canadian Chiropractic Memorial College;

Funded by: Canadian Chiropractic Research Foundation;

Custom metadata

typesetter ts19

cover-date January-December 2024

Keywords: telehealth,musculoskeletal,rehabilitation,qualitative,systematic reviews,patient experience

Data availability:

Keywords: telehealth, musculoskeletal, rehabilitation, qualitative, systematic reviews, patient experience

Care at a distance: Understanding lived experiences of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth: A systematic rapid review

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Abstract

Background

Objective

Data sources

Study methods

Results

Conclusion

Related collections

Telehealth & Medicine Today

Most cited references 60

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Methods for the thematic synthesis of qualitative research in systematic reviews

The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers

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