Telehealth Use in Occupational Therapy During the COVID-19 Pandemic: Scoping Review.

BACKGROUND: The COVID-19 pandemic disrupted the delivery of in-person occupational therapy (OT) services on a global scale, accelerating the adoption of telehealth. During this time, there was a surge of OT-focused research on the use of telehealth. Synthesizing this literature can be helpful to inform routine practice and to prepare for future disruptions to in-person care, including natural disasters, severe weather, and pandemics.

OBJECTIVE: This scoping review maps the literature on telehealth in OT during COVID-19, focusing on setting, study design, participants, clinical fields, modalities, interventions, outcomes, benefits, barriers, and facilitators.

METHODS: Using Arksey and O'Malley's framework and Joanna Briggs Institute guidelines, we searched seven databases and Google Scholar for peer-reviewed articles. Eligibility criteria included English and French papers reporting on telehealth-delivered OT services during COVID-19, across all ages, conditions, settings, and participant groups.

RESULTS: From 4,810 records screened, 43 articles were included. Most articles originated from high-income economies and were descriptive (e.g., cross-sectional surveys, qualitative studies, and experiential reports). Participant groups were diverse, including OTs (including students and OT assistants), clients, caregivers, and others (teachers). The clinical fields in which telehealth was most studied were in pediatric neurodevelopmental/mental health, followed by adult mental health (including dementia). When specified, telehealth was used to delivery physical rehabilitation, coaching/education/training; activities of daily living interventions, assessment, health promotion/wellness, monitoring/follow-up, cognitive or behavioral interventions, social support, consulting, to address leisure, and supervision. When reported, most articles described synchronous telehealth, while the remaining described a mixed approach. When documented, a range of platforms were used, with Zoom being the most frequently mentioned. Only 17 of 43 studies (40%) reported measurable outcomes; among these, most reported statistically significant results. Reported benefits included accessibility and convenience, personalization and contextualization, continuity of care, safety and comfort, caregiver engagement, and social support. Perceived barriers included absence of physical presence, technology challenges, telehealth literacy, skills, and attitudes, home environment constraints, client and caregiver related factors, and organizational challenges. Facilitators included digital health skills, training, and peer support, adaptations to home and interventions, technology-related enablers, caregiver involvement, communication and rapport, intervention resources, and organizational and system-level support.

CONCLUSIONS: Telehealth helps to increase access to OT; however, therapists face barriers in using this approach particularly for some interventions and populations. More research and context specific guidance are needed to support the implementation of telehealth across diverse populations, clinical fields, and practice contexts.