Telerehabilitation May Help Children Feel Less Anxious

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Telerehabilitation — the delivery of rehabilitation care from a distance using technology — may make children with cystic fibrosis (CF) feel less anxious or depressed, have a more positive body image, and also improve their ability to walk farther, a small study found.

However, the levels of anxiety and depression reported by their caregivers were no different from those who cared for patients who did not engage in a rehabilitation program.

The study, “The effect of telerehabilitation on quality of life, anxiety and depression in children with cystic fibrosis and caregivers: A single-blind randomized trial,” was published in the journal Pediatric Pulmonology.

CF leads to the buildup of thick, sticky mucus. When it clogs in the lungs, it can cause difficulty breathing and infect airways.

Exercise, done regularly, is encouraged and can help keep the airways clear. However, engaging in regular exercise may increase the spread of infections when done in groups or at the hospital. When done at home, it may be difficult to follow a schedule consistently over long periods of time.

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Telerehabilitation has emerged as a possible solution to improve access to rehabilitative care. Now, a team of researchers in Turkey set out to understand how a short-term rehabilitation program may affect a child’s levels of anxiety and depression as well as quality of life.

Parents of children with CF often worry about them engaging in activities such as sports and exercise, but are less concerned if those pursuits are used as part of their children’s rehabilitation program. To that end, the researchers also looked at the levels of anxiety and depression in each child’s main caregiver.

The study included 28 children with CF, mean age 9.8, and their caregivers. The children were divided into two equal groups to receive either rehabilitation or no rehabilitation at all (the control group). The program was comprised of three weekly sessions of a combination of high-intensity interval training in the form of a letter game and postural exercises via Zoom, an online videoconferencing tool. The sessions were spread over the course of 12 weeks (about three months).

To measure levels of anxiety and depression, the researchers used a tool called the Anxiety and Depression Scale in Children-Revised. In the beginning of the study, the mean score for generalized anxiety disorder was 6.3 points, which decreased to 3.4 points after the rehabilitation program. Likewise, the mean score for major depressive disorder decreased from 6.2 to 3.9 points. The scores also were lower than those in the control group, which were 6.6 points (for anxiety) and 7.8 points (for depression) at the end of the study.

These findings indicated that the use of telerehabilitation may make children with CF feel less anxious or depressed.

However, there were no changes in the levels of anxiety and depression experienced by the caregivers, as measured using the State-Trait Anxiety Inventory and the Beck Depression Inventory tools.

Next, the researchers looked at the children’s quality of life, as reported by their caregivers. They observed a change in the mean body image scores of the rehabilitation group, which improved from 78.5 to 86.5 points. However, at the end of the study, these scores did not differ from those of the control group.

The researchers also applied a six-minute walk test to determine functional performance or fitness. They found that children in the rehabilitation group were able to walk a longer distance at the end of the study (483.1 vs. 431.8 meters, or 528 vs. 471 yards) and that this distance was greater than that walked by the control group (405.7 meters, or 443 yards).

“This study has shown that a telerehabilitation approach that includes postural and high-intensity exercises can improve anxiety, depression and functional performance in patients with CF,” the researchers wrote.

No improvements were observed in forced expiratory volume in one second, a measure of lung function.

“This single-centered and small-scale study can help to establish similar treatment modalities in other CF centers,” the researchers concluded, adding that “larger-scale studies are needed for more robust results.”

As part of the study’s limitations, the team mentioned that not being able to monitor heart rate was “a major setback” and that interventions able to do so remotely “would be healthier.”