telehealth

Posted on Pain Management

Telehealth-delivered diet and exercise program eased pain and triggered weight loss

Participants report reduced pain and weight loss


Combined diet and exercise Telehealth program saw 80 per cent of participants experience reduced knee pain with an average weight loss of approximately 10.2 per cent. CREDIT PEAK Consulting

New research investigating the benefits of telehealth-delivered exercise and diet programs has found 80 per cent of participants experienced improvement in pain and an average of 10 per cent in loss of body weight, with one man shedding 39 kilograms. 

More than 400 individuals with knee osteoarthritis participated in the Better Knee, Better Me trial, developed by the University of Melbourne in partnership with Medibank and Austin Health.

Published in the Annals of Internal Medicine today, the study shows researchers evaluated two six-month telehealth-delivered exercise programs, one with and one without a weight-loss dietary program, compared with an information-only control group.

During the trial, participants in the intervention groups were provided support from physiotherapists and dietitians via Zoom and a suite of resources. Those in the exercise plus diet group also received meal replacements so they could undertake a ketogenic low energy diet.

Compared to the group that only received information, both intervention programs resulted in benefits for pain, function and quality of life. Compared to the exercise-only program, the combined exercise and diet program led to additional benefits – including a greater reduction in pain, greater improvements in physical function, lower use of pain medications, and significant weight loss. After both programs, participants were also less willing to undergo knee joint replacement surgery.

Lead researcher and Director of the Centre for Health, Exercise and Sports Medicine at the University of Melbourne Professor Kim Bennell, said participants lost on average 10.2 kilograms over a six-month period with four out of five participants achieving significant improvement in pain. She said 30 per cent of participants lived in regional and rural Australia.

“We are proud to have developed a program that has a strong regional and rural representation and is based on a trial which made a real difference in the lives of participants. Particularly during these times of pandemic-related travel restrictions, it is crucial Australians are able to access home-based treatments to manage their osteoarthritis symptoms, no matter where they live or what COVID restrictions are in place.”

Participant Matthew Boyd, from Toowoomba in Queensland, said his knee pain had become unbearable and was struggling to do the things he enjoyed, leading to a decline in physical activity and an increase in his weight.

“Since taking part in Better Knee, Better Me, I feel amazing. I have lost 16kg which has decreased the weight load on my knees, and my pain. I no longer take any pain relief for my knee pain, which has meant I have been able to return to all the physical activities I wasn’t able to do over the past five years. The pain in my knees no longer dictates my daily routine and I am back moving in a way I haven’t done in years,” Mr Boyd said.

Around 2.1 million Australians are currently living with osteoarthritis. The prevalence of osteoarthritis is expected to increase by 58 per cent by 2032 due to an ageing population and rising obesity rates.

Medibank Head of Member Health Service and Design Catherine Keating said Medibank wants to provide its customers with healthcare that gives them more choice and control in how they receive their care. 

“It’s part of our focus on taking the lead on driving preventative health because we know our customers want personalised support to improve their health and wellbeing.”

Posted on Arthritis

Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia

Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia
Cognitive behavior therapy conducted by telephone may ease arthritis-related insomnia


A new study revealed that a talk therapy practice conducted by telephone could help older adults who have arthritis-related insomnia sleep better. The study was published in the Journal of the American Geriatrics Society.

Why does this matter?

Insomnia is a difficulty in falling or staying asleep. It affects more than 14 million Americans aged 65 and older. It may lead to daytime problems such as tiredness or fatigue, poor concentration, and daytime sleepiness.

Osteoarthritis (OA) is the most common form of arthritis. It can cause or worsen sleep problems. Older adults may develop arthritis after years of wear and tear on their joints, often due to normal physical activity or past injuries. About half of Americans over the age of 65 have been told they have arthritis by their healthcare provider.

What is Cognitive Behavior Therapy?

Cognitive behavioral therapy (CBT) is a type of talk therapy. It can be a fast-acting, long-lasting treatment for insomnia in older adults. In fact, studies suggest that CBT is one of the most effective therapies for insomnia. During CBT sessions, you learn to develop new sleep habits and to identify and change any unhelpful sleep habits.

What the Researchers Learned from this Study

The researchers’ interest in this study was inspired by earlier studies that showed strong evidence that  cognitive behavioral therapy is an effective treatment for insomnia. A growing body of evidence suggests that CBT is an especially successful treatment for insomnia that is related to arthritis discomfort.

However, CBT treatment typically requires weekly visits to a therapist’s office, often over several months. For older adults who have insomnia and arthritis, attending therapy sessions in person can be difficult or even impossible.

In this new study, researchers showed that having brief CBT sessions over the telephone was effective for improving arthritis-related insomnia and fatigue over 12 months. They said that the results of their trial showed that telephone CBT reduced the clinical and financial burdens of in-person, arthritis-related CBT insomnia treatment.

Research has shown that telephone CBT can also successfully treat smoking cessation and depression. These results have prompted some health insurance providers to cover CBT phone treatment for certain conditions.

How the Researchers Conducted this Study

The researchers recruited 325 adults aged 60 and over who had moderate to severe insomnia and arthritis pain. The participants were randomly selected to receive one of two treatments. One group received six CBT telephone sessions each week for eight weeks. These participants received coaching on sleep restriction, sleep hygiene, and learned how to restructure their sleep behavior. Participants also got homework assignments to perform.

Participants in the second treatment group received information about sleep and arthritis but did not receive any CBT sleep coaching. Both groups kept sleep diaries.

The researchers collected information on how the participants rated their general health and quality of life according to standard questionnaires. The participants ranked their insomnia status as well as their arthritis pain, stiffness, and ability to function.

After the sessions ended, the researchers said that the people in the CBT group showed improvements in sleeplessness and pain compared to those in the education-only group. They estimated that the cost for the CBT sessions was about $200 per person.

Study Limitations

According to the researchers, no studies exist to show whether CBT for arthritis-related insomnia is a cost-effective treatment. Experts say that there is a strong need for further study in this area. The researchers suggest that further study will help insurers and health care providers decide upon the best treatment decisions and evaluate the cost-effectiveness of CBT telephone treatment for arthritis-related insomnia.

What this Study Means for You

The researchers concluded that phone-delivered CBT significantly improved sleeplessness and pain without increasing total healthcare costs. The researchers said that their findings should encourage healthcare practitioners to consider telephone CBT treatment of insomnia for older adults who also have arthritis.

Posted on Autism

Study suggests telehealth screening of some infants could aid in early autism support

Telehealth
Telehealth


New UC Davis MIND Institute research suggests that telehealth evaluation could help improve access to care for infants with an elevated likelihood of autism. The study, published recently in Autism, found that telehealth approaches in the first year of life could help families facing barriers to care such as geographic distance and long waitlists and aid in early diagnosis and intervention.

“The goal is not to diagnose infants with autism,” said Meagan Talbott, assistant professional researcher in the Department of Psychiatry and Behavioral Sciences and a MIND Institute faculty member. “It is to provide a developmental evaluation to help bridge the gap that we know parents face when they first notice symptoms until their children ultimately receive an autism diagnosis.”

Talbott notes that many families seeking early evaluations for autism face long provider waitlists, must often travel to centers with appropriate expertise and are frequently told by providers to “wait and see.”

Since specialized services for autism are generally tied to having a formal diagnosis, there are usually years between when parents first have questions and when they can access services.

“This results in significant stress for families and delayed support to infants and their caregivers. We hope this study shows one way that we can help improve families’ access to early evaluations and early services and support them,” said Talbott.

Developmental evaluations via telehealth

The study involved 41 infants, ages 6-12 months, whose parents had concerns about social communication or autism. They were recruited nationally in three cohorts. One quarter of the infants had siblings with autism.

Talbott’s team used the TEDI (Telehealth Evaluation of Development for Infants), a protocol for conducting behavioral assessments that they previously developed. It uses a parent-coaching model to engage parents and infants in a specific set of interactions such as peek-a-boo, playing with toys and reading a book over 45-90 minutes. The examiner scored social communication, play, imitation and other developmental domains. Parents also filled out a series of questionnaires. All families were also sent a small kit of toys needed for the assessment, including blocks, a soft book, rattles, a small blanket and bubbles.

The majority of infants demonstrated elevated likelihood of autism on both the parent-reported questionnaires and examiner-rated behavior. This included decreased communication skills and delayed achievement of developmental milestones. Caregivers’ ratings of the usefulness of the TEDI evaluation were very positive.

The findings may also help to expand infant autism research beyond sibling studies, which have dominated the field. “We hope developing these tools for telehealth will help us to expand infant research beyond the sibling context and help us to understand early development in other groups,” explained Talbott.

What’s next for telehealth evaluation?

“My vision is that in the future, if a family has a concern about their infant’s development, we could incorporate a telehealth evaluation like this as a second-level screener to help families figure out whether pursuing a full autism diagnostic assessment makes sense for their infant,” Talbott explained. “We’re very lucky in Sacramento that we have the MIND Institute, but there are many places where families are pretty far from somebody who has our level of expertise.”

The research team will soon start working with community members, families, pediatricians and other providers involved in early autism intervention to find out how developmental evaluation and monitoring via telehealth may fit into the existing care system. In the future, they hope to develop additional online programs to pair with these evaluations to further support families during this early period.

Talbott’s work started before the COVID-19 pandemic, but she noted it was nice to have already done the telehealth legwork. “The pandemic illustrated how critically important telehealth can be,” Talbott said.