Table 2 General characteristics of the included studies investigating the use of telemedicine in the context of CAIM (n = 62)

Addington et al., 2018 [25]

USA

To conduct a pilot trial of internet-based, cancer-adapted yoga for women receiving breast cancer treatment

Pilot trial

Videoconferencing

Yoga

Feasibility and acceptability as indicated by 1. quantitative: enrollment rate, retention, adherence, satisfaction; 2. qualitative: feedback from program evaluation forms and telephone interviews

Data from qualitative interviews can inform development of future trials

Recruitment and retention of women due to technological difficulties, scheduling conflicts, treatment related fatigue, forgetfulness due to “chemo brain.”

Small sample size, no control group

Technological and cancer-related barriers remain in internet-based oncology interventions

Armin et al., 2020 [26]

USA

To create guided imagery program material that is inclusive, including for men and racial/ethnic minority tobacco users

RCT

Telephone

Guided Imagery

In the development phase: small group and individual semi-structured interviews to understand how participants perceived the program. Pilot test: patient satisfaction on 1–5 Likert scale

Program development was informed by experts, community members, small group interviews, and focus groups. Feedback from pilot testing enabled improved program delivery

Lack of participant understanding of quit lines may be a barrier to using them

Lack of representativeness of the sample, “real time” rapid revisions limited the ability to make significant changes that may have improved outcomes

This study is the first of its kind to gather qualitative information on a telephone-delivered, guided-imagery intervention, while respecting cultural diversity

Berman et al., 2009 [27]

USA

To assess the feasibility of delivering self-care tools to older adults via the internet and to document changes in pain and ability to manage chronic pain

RCT

Website

Mind–Body Training

Pain using the BPI, self-efficacy using the PSEQ, depression using the CES-D, anxiety using the STAI-6,

self-care, self-awareness to pain using the PAQ, awareness of, and satisfaction and use of the intervention

The intervention appealed to various age groups. The characteristics volunteer participants may be helpful for identifying target populations and developing outreach strategies

Study participants were more likely to be female, suggesting the intervention may be more likely to appeal to women than men

Small sample size, short length of intervention (6 weeks), improvements potentially due to social desirability effects or starting with more severe pain

Older adults with chronic pain can benefit from a short-term, online bind-body intervention

Bombardier et al., 2013 [28]

USA

To determine whether an intervention to increase physical activity might be an effective treatment for major depression in people with MS

RCT

Telephone

Physical activity

Depressive symptom using the HAM-D, SCID, SCL-20, and PANAS. Significance was considered at least a 50% reduction in the HAM-D compared to the wait-list control group

Telephone-delivered interventions can help overcome common barriers to participation. The intervention had low dropout rate, high treatment adherence, and appears safe, tolerable, and feasible

No attention control group. The wait-list control group was offered the intervention after the 12-week assessment, so it was not possible to compare outcomes between groups at 24 weeks

The appropriateness of this intervention for those with greater MS-related disability, more severe depression, or increased suicidal risk is uncertain. A subjective, self-report measure of physical activity was used

Telephone-based counseling has potential to promote physical activity in people with MS, and can help overcome some barriers to speciality care

Cavalera et al., 2019 [29]

Italy

To test the efficacy of an online MBI to improve QoL, psychological well-being, sleep, and fatigue in people with MS

RCT

Website, Skype videoconferencing

Meditation

QoL using the MSQOL-54. Secondary outcomes of anxiety and depression assessed with the HADS, fatigue assessed with the MFIS, sleep measurements obtained with MOSS scale

Adequate sample size, active control group, accessible for those with physical disabilities

Technological issues for at least one participant each session, such as slow internet connections and the interaction with the computer interface

Complete participant blindness wasn’t possible. Potential sample bias as only those with an electronic device were selected

An online MBI could be an effective psychological treatment for the promotion of well-being in those with MS, although the lack of lasting effects requires development of new strategies

Cheung et al., 2018 [30]

China

To design a Qigong app for delivery of training to the general public in Hong Kong and to examine usability and acceptance of the app

Pilot trial

Mobile app

Qigong

Usability of the app using the SUS, user acceptance measured in terms of attitude, perceived usefulness, intention to use, and satisfaction. Objective measures of usability using app navigation tasks, and noting success rate and task time

End users were involved in the early stages of design, allowing developers to identify important design challenges. Overall usability scores were within an acceptable range

Those of older ages gave lower ratings for usability and perceived ease of use, while experienced smartphone users had less intention to use the app and were less satisfied it

Convenience sample, most participants were female, and no qualitative feedback was obtained during the main test

Evidence found that usability and acceptance of a training app can enhance participants’ access and motivation to practice Qigong

Davis et al., 2015 [31]

USA

To assess the feasibility of providing mindfulness training online to smokers

Pre-post intervention

Telephone, web-based videos and audio recordings

Mindfulness training

Feasibility measures: phone call completion and length, video completion, website time, minutes of daily meditation, and mindfulness practice. Self-report measures: nicotine dependence using the FTND, mindfulness using the FFMQ, and depression using the DASS. Abstinence measures: carbon monoxide breath test at baseline, 4- and 24-weeks post-quit attempt

Provides evidence for a novel intervention for smokers. Has potential for large-scale dissemination, and may complement quit-lines well

While behavioural treatment was intensive, pharmacotherapy was relatively non-intensive, study was insufficiently powered for a few of the outcome measures

Small sample size, lack of a control group, potential selection bias as participants were required to have internet access and were selected from a pool of individuals who didn’t have time for in-person sessions

Web-based mindfulness training is feasible for smokers. Further study may be beneficial

Dimitropoulos et al., 2017 [32]

USA

To report on the feasibility of using telehealth for direct intervention in a Prader–Willi syndrome sample

Prospective cohort

Videoconferencing

Play based therapy

Parents’ acceptability of the program using the modified BIRS, and open-ended questions regarding limitations of the telehealth mode

The BIRS has strong psychometric properties. Children enjoyed the program, and parent acceptability reports were congruent with study metrics for feasibility and acceptability

Troubleshooting technological issues, difficulty finding a conducive “space” and time for intervention sessions, and the need to adjust protocol when children were noncompliant or emotionally upset

Small sample size, and telehealth may only be suitable for those at least minimally verbal, able to attend without in-person support, and do not have significant behavioural concerns. Not all parents completed the BIR survey

Findings support using telehealth in rare disorders, and delivering interventions directly to children with developmental delays

Donesky et al., 2017 [33]

USA

To determine the feasibility and clinical outcomes of an 8-week home-based yoga program, conducted via video-conferencing in a sample of patients with both COPD and HF

Controlled non-randomized trial

Videoconferencing

Yoga

Physical function defined as muscle strength and endurance, QoL using the St. George’s Respiratory Questionnaire and the KCCQ, and symptoms of depression, dyspnea, and insomnia evaluated at baseline and after study completing using the PHQ-8, the Dyspnea-12 questionnaire, and the GSDS

Participants were adherent, able to safely participate, and found classes enjoyable. Conducting assessments at home minimized missing data, and increased intervention access for this frail population

Technical issues such as with log-in, delays in connecting to the server, frozen screens, and audio or video. Some older, income-restricted adults had slow internet access, and lack of basic technical understanding

Small sample size, risk of sample bias as a convenience sample was used, reports of vital signs before and after tele-yoga sessions were not observed and there is a possibility they were fabricated to please investigators

Despite frailty, participants were able to safely perform yoga in the home setting. However, technical issues were an important hindrance to participation

Ezenwa et al., 2016 [34]

USA

To test feasibility of a guided audio-visual relaxation intervention protocol for reducing stress and pain in adults with SCD

RCT

Tablet audio-visual videos

Guided relaxation

Stress and pain using the stress intensity scale and the PAIN-ReportIt software program, respectively. Acceptability using the study acceptability scale, android acceptability scale, and an open-ended exist interview guide

Provides evidence of non-drug strategies to reduce stress, participants could use the mobile guided relaxation anywhere and anytime, and this approach can include those whose condition precludes them from travelling for research visits

Patients did not use the intervention for a total of 13 days as intended. Patients suggested the guided relaxation be customized for SCD

The mechanism through which the intervention was effective may have been via relaxation rather than stress reduction. Data was not collected from those that lost the study tablet

The study protocol appears feasible and shows promise. The results warrant a larger efficacy trial

Ferraris et al., 2020 [35]

Italy

To retrospectively describe the use of remote monitoring by e-mail during the first year of follow up on cKD in patients with GLUT1-DS and DRE

Retrospective

E-mail

Ketogenic diet

Control visits 1 month after cKD initiation, then at 3, 6, 9, and 12 months. Measurements of fasting blood ketones, compliance to the prescribed diet, and screening for potential adverse effects. All emails exchanged between the patient’s family and the keto-team during follow-up periods were analyzed

Email can be read and accessed from different sites, it enables better two-way communication between hospital specialists and other colleagues, and rapid assistance can be provided to patients

Lack of palatability of ketogenic food, qualitative and quantitative restrictions in meal preparation can be burdensome, adherence may limit participation in daily social activities for patients and families

Retrospective design, limited sample size and follow-up period, an inability to detect telephone contacts that integrate monitoring, and the lack of a control group

Constant remote e-monitoring could be a feasible and effective way for better cKD management, especially for those who live far from the treatment centre

Freeman et al., 2014 [36]

USA

To compare the effects of an intervention “envision the rhythms of life” delivered live or via telemedicine compared to waitlist control on QoL for breast cancer survivors

RCT

Videoconferencing, phone calls

Guided imagery

General health-related QoL using the SF-36 PCS and MCS scores, breast cancer-specific QoL, fatigue, perceived cognitive function, spiritual well-being, psychological distress, and sleep disturbances. Outcomes measured at baseline, 1 month, and 3 months after treatment

The program comprehensively addresses many facets of QoL. Improvements in cognitive function, fatigue, sleep disturbance, and mental health related and breast cancer-related QoL were considered clinically significant

Adherence to home practice could not be documented, limiting the ability to examine “dose effect.”

Small sample size, staffing limitations, lack of active control group, no examination of social support, making it difficult to examine or control for change in social support during study

Telemedicine is an effective and viable method to deliver a group intervention aimed at improving QOL in breast cancer survivors

Gardner-Nix et al., 2014 [37]

Canada

To investigate the effectiveness of a MBCPM program developed for a severe chronic pain population

Non-randomized control trial, original research

Videoconferencing through Ontario Telemedicine Network

Mindfulness training

Evaluated at week 1 and 10 for QoL, perceived usual pain levels, pain catastrophizing, and suffering using the SF-36, pain intensity using the numerical rating scale, the pain catastrophizing scale, and the PRISM test

N/A

High attrition rate, possibly due to participant not having to pay for the course

Absence of randomization, patients had mixed pain conditions, and self-report data

Telemedicine supports the delivery of the MBCPM program, and was effective in improving mental health and suffering

Golebowicz et al., 2015 [38]

Israel

To examine the feasibility and effectiveness of a tele-biofeedback ergonomic intervention

programme among computer operators suffering from WRMSD in the workplace

Pre-post test

Remote tele-biofeedback sessions

Ergonomic biofeedback programme

Difference in pre- and post-intervention MSD scores, which included UES detected by physical examination, and pain reported in the SNQ. Bad posture risk factors were assessed by the RULA, and the DCSQ assessed psychosocial job characteristics

Unique remote communication between participants and researchers. Findings strengthen knowledge regarding the correlation between ergonomic biofeedback and reduction of pain for computer operators

The participant dropout rate was high due to poor compliance, and lack of cooperation with the examiner

Small sample size, lack of control group, not possible to differentiate between the various components of the intervention to single out telebiofeedback as an effective component

Biofeedback seems to be feasible and efficient for computer operators who suffer from WRMSD

Green et al., 2020 [39]

USA

To describe the rapid deployment of telehealth, particularly real time video conference, for chiropractic services as a response to COVID-19

Retrospective description

Videoconferencing

Chiropractic care

Described how real-time videoconferencing is operationalized, as well as the apparent effectiveness and satisfaction with the online practice

The client company and the Stanford Health Network were able to work closely together, which lowered barriers to telehealth such as insurance and company reimbursement concerns

Procedures with muscle stretch reflexes or passive range of motion cannot be performed during telehealth visits

Findings are a snapshot during the COVID-19 pandemic and the response described in this paper is likely to evolve with the expansion of telehealth and telehealth laws

Real time videoconferencing can be quickly implemented for chiropractic services, and implications for providers are described

Guétin et al., 2016 [40]

France

To assess the pain- and anxiety-reducing effects of the Music Care application in patients undergoing coronarography

Uncontrolled observational study

Mobile app

Music therapy

Before and after app use, participants rated current pain intensity and anxiety on 10-point visual analogue scales. Satisfaction was rated after the session

The music was solely recorded for this app, avoiding potential memory effects or later conditioning, distinguishing the app from other interventions

Men exhibited no to very low pain in association with the procedure, so analysis on the intervention’s pain-reducing effects in men was not able to be performed

Preintervention ratings of anxiety were quite low within participants

The smartphone based Music Care application is easy to use in reducing anxiety in patients undergoing coronarography

Hansen et al., 2015 [41]

Iceland

To determine the feasibility of using audio relaxation technique, music intervention, nature video appl with music, and nature video app without music in a clinical setting

RCT

Mobile app technology

Music therapy

Assessed state anxiety using the state version of the STAI-Form Y, pain levels using the NRS, and self-efficacy using the GSE

This novel study indicates that the Icelandic adult population is open to alternative ways of healing

There was inconsistency of nursing staff pre- and post-operatively since research assistants were not always available to work with all the participants; nurses may differ in how they administer pain medication

Small/medium sample size, control group participants did not answer baseline questions, and the free access to popular mobile technology may have lured participants to take part, creating bias

Despite non-significant findings between five groups, valuable trends towards significance and confirmed feasibility in a clinical setting were noted

Hasan et al., 2019 [42]

United Kingdom

To assess whether hypnotherapy by Skype may overcome the lack of availability of gut-focused hypnotherapy which is an effective treatment for IBS

Pre-post

Videoconferencing

Hypnotherapy

IBS severity using the IBS symptom severity score, IBS noncolonic symptom score, IBS QoL score, and HADS scores for anxiety and depression

Skype therapy increases access, as 71% of subjects claimed they would not have been able to have this form of treatment otherwise

11.8% of participants found the audio quality to be good in only half the sessions due to disturbance in network connection

Mean depression scores were not above normal range at baseline. Hypnotherapy cannot be considered as a stand-alone treatment

Skype hypnotherapy appears to be a good alternative (although slightly less effective) to face-to-face treatment in subjects who

would find it difficult to otherwise access treatment

Hernandez et al., 2018 [43]

USA

To determine feasibility and acceptability of an Internet-based positive psychological intervention in hemodialysis patients with comorbid depressive symptoms

A single-arm pre-post pilot trial

Website

Mindfulness training

Feasibility using recruitment rates, refusal rates, retention rates and non-compliance /adherence rates. Acceptability using qualitative ratings of content, modality of delivery, and whether it was enjoyable, comprehensible and beneficial. Assessed depression, kidney disease QoL, and dietary adherence

Fills a critical gap in science by taking advantage of current technologies that can improve cost-effectiveness and can more easily propagate wide dissemination

Primarily text-based delivery of information may create undesirable friction or cognitive burden. This population also has a need for personal reflection exercises that don’t require extensive typing due to restrictive arm movement

Non random sampling, small sample size, and an inability to have a longer follow-up period

An innovative Internet-based positive psychological intervention represents a feasible and useful therapeutic option for hemodialysis patients with depressive symptoms

Horneber et al., 2018 [44]

Germany

To report on all telephone consultations with cancer patients or their relatives held between 1999 to 2011 along with the results from a nested feedback survey

Retrospective analysis

Telephone

CAM consultation service

Assessed substance of telephone consultations including reasons for interest in CAM consultations, the topics discussed in calls, and satisfaction with the service

Participants particular perceived the service as helpful because researchers did not hesitate to highlight risks of CAM, or where their benefits were uncertain

Relied on consultants’ documentation, which are inherently influenced by different communication styles and prioritizing of issues. Consulting about CAM cannot be separated from consulting about conventional care

Only one-third of callers completed the feedback survey, potential for sampling bias as people with higher levels of engagement in their own health or care of another person were more likely to ask for a consultation

Consulting about CAM addresses important unmet needs from cancer patients and their relatives

Houweling et al., 2015 [45]

Switzerland

To compare differences in outcomes, in spinal, hip, and shoulder pain patients who initiated care with MDs vs DCs

Retrospective double cohort

Videoconferencing

Chiropractic manipulation

Pain, patient’s global impression of change, satisfaction, and use of health-care services. Information on health care costs was extracted in a subsample from the database of an insurance provider

The first study in Switzerland to compare health outcomes and cost for patients consulting differing first-contact care providers

Although differences in pain relief scores were significant, they are likely not of clinical significance

Low response rate, lack of standardized validated outcome measures, limited or missing information on clinical/demographic characteristics

Spinal, hip, and shoulder pain patients had clinically similar pain relief, greater satisfaction levels, and lower overall cost if they initiated care with DCs, compared to MDs

Hu et al., 2013 [46]

Taiwan

To develop a cloud system to integrate EMRs and encourage communication between medical workers, and improve the quality of traditional Chinese medicine offered to hospitalized patients in medical centres

Technology development

Cloud system

Traditional Chinese medicine

Effectiveness of the system evaluated qualitatively and quantitatively by time spent preparing for acupuncture and time needed for keeping acupuncture records, punctuality of removing needles, time-saving in data integration after treatment, percentage of unremoved needles, accuracy of patient identification, human resource management, and impact on access of medical information

There is great improvement in operating efficiency shown by quantitative measures, but qualitative measures also indicate the superiority of the cloud system. Data synchronization is automatic

For wide application of the cloud system, Wi-Fi penetration rate needs to be raised, which poses a problem for many hospitals in Taiwan

The cloud system is limited to android operating systems, and servers used must be reliable and trustworthy

The contribution made by the cloud system to the traditional Chinese medicine service is multi-dimensional: cost-effective, environment-protective, performance-enhancing and more

Huberty et al., 2017 [47]

USA

To report the satisfaction and perceptions of an online yoga intervention in women who have experienced a stillbirth

Post intervention, cross-sectional and semi-structured interviews

Videos

Yoga

Experiences, perceptions, and satisfaction through surveys and semi-structured interviews

Was the first study to explore a home-based modality for management mental health in women after a stillbirth. The strategy can be largely disseminated with little resources

Barriers to participating included technical issues, lack of instructor feedback, and the lack of autonomy with the delivery approach

The number of non-completers was the same as completers (n = 26)

Online-streamed yoga may be a useful approach to deliver yoga to women who have experienced a stillbirth

Hucker et al., 2014 [48]

Australia

To evaluate an online treatment for female sexual difficulties as it relates to relationship functioning

Pre-post, cross-over design, original research

Online videos and chat groups

Mindfulness training

Sexual dysfunction or distress using the sexual function scale, personal assessment of intimacy in relationships scale, female sexual function index, and female sexual distress scale

Cross-over design, and treatment gains were maintained at 3-month follow-up

The treatment group lost 44% of participants. Relationship satisfaction scales did not address aspects such as division of labour, and financial conflict which may explain non-significant differences

Small sample sizes, potential sample bias due to the use of volunteers, and data was self-reported

The intervention resulted in significant improvement in sexual intimacy and communication, and in emotional intimacy for study group 1. Most improvement were maintained at follow-up

Kahn et al., 2016 [49]

USA

To evaluate effects of a web-based, self-directed program of instruction in mind–body-based wellness skills for veterans and their relationship partners on mental health and wellness outcomes

4-arm RCT, original research

Videos

Mindfulness and contemplative practice training

A survey package was administered at baseline, 8 weeks, and 16 weeks, including PSS, BDI, PCL-C, SCS, RSES, MSPSS, PSQI, and RDAS scales. Also assessed use of the intervention

Both veterans and partners use of the program surpassed hypothesized time of use, and there was a benefit for both men and women veterans and their partners

The instructional program did not include video closed captioning or verbatim transcripts of the audio instruction, and thus could not accommodate users with hearing limitations

The impact on clinically defined populations remains to be assessed, the follow-up period was limited to 16 weeks, and participants were required to attend an in-person launch meeting which could have caused exclusion of potential applicants

Both veterans and partners were able to learn and make sustained use of a range of wellness practices taught in the Mission Reconnect program for this population

Kemper et al., 2017 [50]

USA

To assess the dose–response relationship between the number of hours of online mind–body skills training for health professionals and relevant outcomes a year later

Natural experiment, original research

Online educational program – video based learning

Mind–body training

“Dose” of the intervention, type, number, frequency and length of mind–body practice, stress, burnout, absenteeism, mindfulness, resilience, and compassion

Findings demonstrate that the impact mind–body skills training on outcomes appears stable at least 12 months after training, and “dose” evaluation and training type may yield clinically relevant information

No data collected at baseline due to the fact that the study was conducted as an educational evaluation, and there may be differences in benefits for novice compared to experienced meditators

The study was conducted at one academic institution, there may be self-selection bias, and self-report measures were used

Mind–body skills training affect self-reported personal and professional behavior for at least 1 year after training. Increasing doses of training are associated decreased levels of negative outcomes

Kim et al., 2020 [51]

Korea

To introduce the Korean Medicine telemedicine center as a treatment option for COVID-19 patients

Retrospective review, original research

Telemedicine centre

Herbal medicine and mindfulness meditation

Collected characteristics of participants using electric medical charts, such as demographics, residence, number of treatments conducted, treatment periods and prescription periods

This is the first report in Korea to record changes in residence transition status of patients

N/A

Retrospective descriptive analysis and does not reflect information on the improvement of symptoms of patients

Telemedicine operation in response to infectious diseases in Korea is considered meaningful for efficient use of medical resources, patient management and preventing infection spread

Krampe et al., 2016 [52]

USA

To evaluate a Fuze video conferencing software connecting nursing students with older adults during a therapeutic dance-based activity

Experimental, original research

Videoconferencing

Dance therapy

Feasibility including visual and audio quality, engagement between older adults, and nursing students’ overall satisfaction. Also assessed engagement, and overall satisfaction

The group was intentionally kept small to assess initial feasibility and identify areas for improvement. Engagement lessons were learned

The audio and video components had delays, or was sometimes blurry. Some older adults were overwhelmed having to watch the screen and dance leader at the same time

N/A

Fuze is a feasible, engaging, and satisfying approach for dance-based therapy, with better audio and visual performance than Skype

Krampe, & Musterman, 2013 [53]

USA

To report a process used to introduce nursing students to a group of older adults using video call technology during a dance-based therapy session

Experimental, original research

Videoconferencing

Dance therapy

Watched participants engage and interact and gather feedback after the sessions

There was great enthusiasm from the nursing students. This study has implications for community and long-term care clinical settings, and can be replicated with minimal resources

A larger screen would be more beneficial, and it was difficult to hear the nurse and instructor over the music

Small sample size

Dance-based therapy can engage nursing students with older adults, and skype is an innovative option for patient care

Krout et al., 2010 [54]

Australia

To engage music therapy university students in collaborative song writing utilizing Skype software

Nonrandomized cross-over design, original research

Videoconferencing

Music therapy

Conducted interviews, and collected student written reflections on their experiences, such as perceived contributions the activity had to their learning

Teleconferencing via Skype fostered song writing experiences as opposed to hindering them, and the experience was not much different than collaborating face to face

Poor resolution inhibited communication through misjudged facial expressions, and there were some auditory delays

N/A

Online song-writing may offer creative solutions for facilitating song-writing between persons who are not able to do so in person and face to face

Kubo et al., 2019 [55]

USA

To assess feasibility and preliminary efficacy of a mobile/online-based mindfulness intervention for cancer patients and their caregivers to reduce distress and improve QoL

RCT, original research

Website or mobile app

Mindfulness training

Retention and adherence, and participant-reported data on distress, anxiety, depression, pain, QoL, sleep, fatigue, mindfulness, and posttraumatic growth before and immediately after the intervention. A post-intervention qualitative interview was conducted

The program does not require hiring of teachers, or a secure physical location for classes, making it widely scalable and cost-effective

The study was not powered to examine dose–effect of meditation, and it is possible that patients did not experience significant changes in mindfulness due to high baseline scores

The rate of mobile device and internet use may be higher in this population compared to the general population, no active control group, and only one person was coding transcripts which may risk bias of the results

Provides preliminary evidence regarding the feasibility of a commercially available self-paced mindfulness program for cancer patients undergoing or who have recently completed chemotherapy

Kwon et al., 2020 [56]

Korea

To introduce a Korean Medicine doctor’s pilot mental health instruction manual in telemedicine for COVID-19

Health-care Manual, original research

Videos

Mind–body medicine

N/A

N/A

Youtube videos have one-way characteristics, but mind–body modalities are more effective in interactive communication environments

Since the creation and implementation of the manual was conducted during a pandemic, it was insufficient to consider it as a proper outcome indicator

Mindfulness is a promising intervention that may be combined with telemedicine. The telemedicine manual can provide insights into intervention development

Lee et al., 2020 [57]

Korea

To determine whether short-term effects from a previous 8-week online mind body training study persist up to a month after the end of the intervention

Non-randomized controlled study, original research

Videos

Mind–body training

Occupational stress using the KOSS, stress response, emotional intelligence, the Korean version of the CDRS, the Korean version of the coping strategy indicator, and Korean version of the PANAS, and the Korean version of the state-trait anger expression inventory at baseline, 8 weeks (end of training), and 12 weeks (1 month post-intervention)

Results show that the effects on stress response, resilience, and the use of an adaptive coping strategy lasted for a month after the end of the program

It is possible that cognitive measures are less influenced by meditation than emotional measures

Volunteer recruitment risks sampling bias, and findings are restricted to female subjects

Findings provide evidence

for the long-lasting beneficial effects of an 8-week mind–body training

course. An online format can provide a cost-effective solutions for

employees at worksites

Lester et al., 2020 [58]

USA

To examine the feasibility, acceptability, preliminary effect, and durability of a mind–body videoconferencing program for youth with neurofibromatosis against an experimental educational control

Single-blind pilot RCT, original research

Videoconferencing

Mind–body training

Feasibility and satisfaction assessed post-intervention. Physical health and psychological QoL, social relationship QoL, depressive symptoms, anxiety symptoms, and the NRS for pain assessed post-treatment and at 6-months follow-up

The sample was

graphically diverse, attrition was low, and satisfaction was similar between youth with neurofibromatosis and educational controls

N/A

Small sample size, wide confidence intervals, and possibility that participants may have guessed the treatment condition despite being masked

The intervention was well accepted, highly feasible, and resulted in sustained improvement in QoL, demonstrating adolescents are receptive to and benefit from learning resiliency skills in groups via live video

Mussman, 2016 [59]

USA

To investigate the feasibility of utilizing a four-week online ehealth yoga video series to provide adults with a potential mechanism for stress management

Mixed method, original research

Videos

Yoga

Dose of exposure, perceived stress, satisfaction, intention to continuing practice of yoga, whether it was recommended to others, and qualitative findings for feasibility and acceptability

The feasibility provides evidence that EHealth yoga interventions are worthy of further investigation and provides insight on what can be improved

Completers experienced barriers such as lack of time

Small sample size, study attrition, and use of a convenience sample

Findings support the feasibility of providing online yoga e-health via four weeks of instructions

Ondersma et al., 2019 [60]

USA

To evaluate the feasibility and acceptability of two high-reach technology-based interventions: electronic screening and brief intervention and tailored text messaging, delivered alone or in combination

Exploratory feasibility trial, original research

Text messaging

Cannabis

Patient satisfaction, retention, frequency of cannabis use, and whether they were more likely to quit due to the intervention

All participants fully completed the intervention during their clinic visit, and had high ratings for ease of use, helpfulness, and likely interest to other pregnant women

Acceptability ratings were inconsistent, and it is unclear whether this can be improved with changes to the text content itself, or whether it is a function of passive text messaging being less engaging

Small sample size, and the exploratory nature of the design. Participant self-selection of texting frequency limits comparability of retention

These two high-reach intervention elements showed strong feasibility and modest to high acceptability. Future efforts evaluating efficacy are warranted

Papadaki et al., 2016 [61]

United Kingdom

To explore employees' perceptions of ability to follow the MedDiet, preferences for setting goals if asked to follow the diet, and expectations of an Internet-based, workplace MedDiet intervention

Semi-structured focus groups, original research

Website or mobile app

Mediterranean diet

A semi-structured focus group explored participants’ perceptions on perceived ability to follow the diet, goal-setting preferences, receiving feedback on goal attainment, and expectations of the website promoting the MedDiet

Deductive thematic analysis of focus group transcripts was done by three independent trained researchers

There is a need for a tailored approach to setting specific goals. Some consumed foods such as legumes, olive oil, fish, and red meat are challenging to change

Small sample size, inclusion of self-selected healthy employees with internet access, and high adherence sample which may not represent views of those whom this intervention should ideally target

An Internet-based, workplace MedDiet intervention should address

adherence barriers, utilize a tailored and activate social supports. Findings provide insights for promoting the MedDiet in non-Mediterranean regions

Petersen et al., 2017 [62]

USA

To evaluate the impact of an online spiritual care educational program on pediatric nurses' attitudes toward and knowledge of spiritual care and their competence to provide it to children with cancer at the end of life

Prospective, longitudinal, original research

Website

Spiritual care

Spiritual care competence scale, the spirituality and the spiritual care rating scale

Findings demonstrate potential to improve spiritual care and spiritual care competence in pediatric oncology nurses

N/A

Use of a convenience sample, lack of a control group, potential for self-report bias and self-selection bias, the risk of testing effect with repeated

administration of the same instruments

Online spiritual care educational programs may exert a lasting impact on nurses’ attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life

Reilly-Spong et al., 2015 [63]

USA

To describe the design, rationale and feasibility results of Journeys to Wellness, a clinical trial of mindfulness training delivered in a novel workshop and teleconference format

RCT, original research

Teleconferences

Mindfulness training

Health and attitudes outcomes questionnaire at baseline, 8 weeks (end of intervention), and at 6-months follow-up, which included outcome measures of anxiety, depression, insomnia, health-related QoL, mindfulness, worry, fatigue, and kidney disease QoL. Feasibility and acceptability were also assessed

High attendance and completion strengthen planned comparisons of the telephone-adapted intervention. The interventions were delivered as planned without the need for ad hoc revisions

N/A

Sessions were not audio-recorded for later verification of outcomes. Participants engagement was rated by the leader of the intervention, not an independent rater

Teleconference mindfulness based stress reduction is feasible, and may be useful to people with a wide spectrum of health conditions

Rickhi et al., 2015 [64]

Canada

To evaluate the effectiveness of an 8-week online spirituality informed e-mental health intervention on depression, spiritual well-being, and self-concept, in adolescents/young adults with mild to moderate MDD

RCT, original research

Video modules

Spiritual care

Depression severity, spiritual well-being, and self-concept measures assessed through semi-structured interviews were measured at baseline, 8 weeks, 16 weeks, and 24 weeks. Program completion was assessed post-intervention

The program is effective in reducing depression severity in both younger and older adults, and this is clinically significant and maintained at follow-up

Personal perceptions of spirituality resulted in recruitment challenges, and parents of potential participants questioned whether the program would challenge existing beliefs or religious values

Waitlist control group may result in overestimation of the intervention effects, participants were not blinded, the sample size was reduced due to the need to create two sub-group age samples

The program is an effective, online intervention for youth ages 13–24 with mild to moderate MDD with various life situations and in a limited way on spiritual well-being and self-concept

Rogante et al., 2010 [65]

Italy

To investigate the therapist’s POV on the use of surface electromyography with biofeedback for telerehabilitation, and general acceptability for the patient and therapist

Case study, original research

Surface electromyograph with audio biofeedback

Physical rehabilitation

Functioning based on the Action Research Arm test (ARA), which

has a range 0–57

Can allow the patient to train at any time, more patients can be treated at the same time, and patients considered the treatment highly personalized

The system showed poor software and hardware

usability, mainly because it often required on-site

therapist intervention, and patient tasks were too complex for practical use

A larger study with people in various stages of stroke disease is needed to evaluate clinical effectiveness

There were some differences between the patient and the therapist about the ease of use of the equipment, but there was general agreement on the usefulness of the system, and overall opinion

Rosmarin et al., 2010 [66]

USA

To evaluate the efficacy of a spiritually integrated treatment for subclinical anxiety in the Jewish community

RCT, original research

Website

Spiritual care

General religiousness and life change at pre-treatment. Stress, worry, depression, intolerance of uncertainty, spiritual outcomes, Jewish religious coping, and perceptions of treatment were measured pre- and post-treatment. Satisfaction was assessed post-treatment

First study to investigate efficacy of a spiritual integrated treatment in the Jewish community, and in electronic format. Effect sizes were large for primary and secondary outcomes except for spiritual outcomes

N/A

Reliance on self-report measures of symptoms, generalizability to clinical populations and to face-to-face implementation is not known

Results offer initial support for the efficacy of spiritual integrated treatment for subclinical anxiety symptoms among religious Jews

Rybarczyk et al., 1999 [67]

USA

To compare two mind–body wellness interventions for older adults with chronic illness: classroom versus home instruction

RCT, original research

Videos

Mind–body medicine

Medical symptoms checklist, frequency of sleep difficulties, short-form McGill Pain questionnaire, anxiety, depression, health locus of control scale, health-promoting lifestyle profile, life satisfaction, and satisfaction with the total care they received

A reduction in the number of patients who met the criteria for significant levels of anxiety provide support of clinically meaningful findings. The program had lower cost and greater accessibility

N/A

Did not assess the long-term benefits, potential sample bias due to high levels of attrition (60%) during the recruitment process, and a lack of an active control group

A lower cost, more accessible home study version of a mind–body wellness program can be an effective alternative to classroom instruction

Sarah et al., 2019 [68]

Germany

To investigate the adherence to yoga as an antihypertensive intervention through telerehabilitation

RCT, original research

Telephone

Rehabilitation and yoga

Yoga adherence at six and twelve months, blood-pressure, endothelial function and heart rate, and health-related QoL

Adherence can be doubled by a simple telephone based intervention following inpatient rehabilitation

N/A

Only male patients were used, generalizability is limited as patients were recruited from one inpatient rehabilitation center

For this middle-aged male low-education cohort, a telephone program to enhance yoga practice at home is feasible and effective in supporting long-term adherence as a non-pharmacologic intervention

Seidler et al., 2017 [69]

USA

To investigate feasibility of a telerehabilitation approach to group tango instruction for people with PD, and compare key outcomes from a class taught virtually to an in-person

Controlled, prospective study, original research

Two-way live video and audio conferencing

Dance therapy

Feasibility using participant retention, adherence, and adverse events. Secondary outcomes measured balance, motor sign severity, and gait scored by trained, blinded raters

First study to investigate a telerehabilitation approach to group adapted tango instruction for individuals with PD. The intervention can address barriers to access for individuals living outside of major metropolitan areas

Remote instructors have potentially limited ability to recognize and address safety issues

Small sample size with mild to moderate PD which limits generalizability to people with severe deficits, and exclusion of those with overt dementia limits conclusions for more cognitively involved patients

A telerehabilitation approach to group adapted tango instruction was feasible and produced similar improvements to in-person instruction on measures of balance and motor sign severity in people with PD

Selman et al., 2015 [23]

USA, United Kingdom

To inform intervention refinement for future studies of Tele-interventions in advanced disease populations

Non-randomized control trial, original research

Videoconferencing

Yoga

Semi-structured qualitative interviews between 1 week and 3 months post-treatment, covering symptoms, function, motivations, expectations of participating, views and experiences of yoga, views of the battery of outcome measures, and suggestions for improvement. Assessed dementia, cardiomyopathy, depression, sleep, and interoceptive awareness

Adds to the evidence about designing and evaluating complex interventions based on complementary therapies and seriously ill populations

Some participants had difficulties due to back problems, posture issues, getting off the floor, and preference for a chair-based class. Having to rearrange furniture was inconvenient. Some connectivity issues arose

A convenience sample was used, small sample size, and the control group was not matched in terms of time commitment

Tele-Yoga is an acceptable and appropriate intervention in participants with HF and COPD and further research is warranted to refine the technology used in its delivery

Shrier et al., 2014 [70]

USA

To gather input from youth and providers on how youth who use marijuana frequently may experience frequent mobile self monitoring and responsive messaging

Qualitative, semi-structured interviews, original research

Mobile app

Cannabis

Thematic analysis was used to examine youth and provider perspectives on the mobile intervention. Participants were asked about views on the experience of using a mobile device to answer questions about themselves, and whether they thought youth would find the messages annoying or too repetitive

By repeatedly promoting use of alternative strategies to manage triggers, the messages would encourage real-time practice of new skills and behaviours in response to actual experiences

Both youth and providers thought it would be important to develop more individualized, personal messages

Small sample size from a single geographic region, convenience sample, potential sample bias as participants were willing to inform research on a mobile-device based interventions

Results suggest that mobile technology is a promising tool for brief interventions to reduce youth cannabis use and warrants further development

Simpson et al., 2002 [71]

United Kingdom

To evaluate whether hypnosis could be successfully applied via videoconferencing, with a view to incorporating it in future treatment programmes for patients with mental health problems in remote areas

Pilot study, original research

Videoconferencing

Hypnosis

Feedback was elicited in short interview and qualitative questionnaire format after the session

Patients rated the screen image and sound quality as high. 4 patients expressed a preference for video-hypnosis over face-to-face sessions (3 had no preference)

Factors that interfered with experience included brightness of fluorescent lighting in the room, external noises such as strong winds and banging doors, and the room not being sufficiently warm

Larger, controlled trials will be required to verify results

Provides preliminary results to support the effectiveness and acceptability of video-hypnosis for those living in remote areas

Singh et al., 2017 [72]

USA

To assess the feasibility of using Tele-health technology to train teachers in a rural school district on mindfulness-based procedure, measure the fidelity of the teachers teaching the procedure, and assess effectiveness of the students’ use of the procedure

Pre-post, longitudinal, original research

Social media platforms (WhatsApp and Google Hangouts)

Mindfulness training

Teacher aides collected data using an iPhone app, on verbal and physical aggression acts. Inter-rater agreement was defined as both teacher aides recording the same verbal and physical aggressive acts at about the same time

All 3 teachers were able to successfully learn and practice using the procedure for at least a month before teaching it to students. The procedure is low intensity, and does not require extensive training or expert supervision

Mixed-method data is needed to intensively study feasibility, acceptability, and effectiveness of the intervention

Small sample size

Tele-health may be effective to providing training and therapy to caregivers in remote locations that cannot readily access specialists. The program can be taught to teachers, who can teach their students to successfully use it as a self-management strategy

Stubberud et al., 2020 [73]

Norway

To develop and investigate the usability of a biofeedback treatment smartphone app for adolescent migraine sufferers

Prospective, open-label development and usability study, original research

Mobile app

Biofeedback

Assessed average number of hours of daily smartphone use, general experience with apps, experience with wearable sensors, usability, and physiological measures

The optimizing algorithm makes it better than traditional monitoring, the intervention was developed by multidisciplinary experts, and the target group was involved during the development process

Biofeedback requires several rounds of exposure to master

The first 2 usability cycles were conducted in a controlled environment, which was not fully representative of its intended use, moderate sample size, attrition

An app for young migraine sufferers to receive therapist-independent biofeedback underwent a rigorous development process and usability and feasibility testing. It is now ready for clinical trials

Tan et al., 2013 [74]

USA

To evaluate the feasibility and effects of an innovative treatment for women veterans residing in rural settings suffering from chronic pain and/or depression associated with trauma

Pre-post,

original research

Video-teleconferencing

Biofeedback training

PTSD using the PCL-C, depression, pain intensity and unpleasantness, and sleep disturbances. Also reviewed patient logs detailing date and duration of practice, and pre-post practice ratings of pain intensity and unpleasantness

No technical problems encountered, and the quality of the communication was good. Patient focus groups indicate that treatment via videoconferencing was just as effective as if it had been in-person

Woman veterans presented with multiple symptoms and issues, making it a challenging group to investigate

Small sample size, and the study was not designed to identify factors that predict the use of the “stress eraser” device

It is feasible to provide treatment to women veterans in rural areas using video-teleconferencing technology between larger VA medical centers and facilities at CBOCs in rural settings

Thompson et al., 2015 [75]

USA

To assess the effectiveness of Project UPLIFT for reducing depressive symptoms and preventing the incidence of depressive episodes in adults with epilepsy; and to expand use to three additional states

RCT, cross-over design, original research

Web or telephone

Mindfulness training

Depressive symptoms using four different measures, knowledge and skills for depression, depression coping self-efficacy, self-compassion, the satisfaction with life scale, and QoL

This is one of the first studies demonstrating effectiveness of a preventive intervention for depression that is distance delivered

N/A

Limited power for detecting smaller differences in self-efficacy and self compassion or changes at follow-up, no active control

Distance delivery of group MBCT can prevent episodes of MDD, reduce Depression symptoms and increase life satisfaction in people with epilepsy. This intervention is modifiable for persons with other chronic diseases and other disparity populations

Tkatch et al., 2017 [76]

USA

To test the feasibility of an online mindfulness meditation intervention for community-dwelling older adult caregivers and to evaluate its impact on QoL, caregiver burden, and psychological well-being

Feasibility trial, pre-post study, original research

Phone and web-interface to an online learning platform

Mindfulness training

Caregiver burden using the Zarit Short Burden Interview, QoL, and psychological well-being including stress, anxiety, loneliness, and social support

The inclusion of additional psychological variables added a mechanism for the impact of reduced caregiver burden and mental/pscyhological well-being, improves access for those with transportation limitations, and is relatively low cost

The intervention may not be ideal for all older caregivers because some individuals may prefer an opportunity to utilize resources outside their homes

Small sample size, lack of control group, and potential sampling bias as participants were recruited from an existing caregiver support group

The intervention reduced caregiver burden, perceived stress, anxiety, and loneliness and improved mental well-being. Online interventions offer flexibility for caregivers regardless of their responsibilities

Tucker et al., 2008 [77]

USA

To determine the effects of telephone-based coaching and a weight-loss supplement on the weight and body fat of overweight adults

RCT, original research

Telephone

Exercise coaching and vitamin B-based weight loss supplement

Body fat in grams measured by dual energy x-ray absorptiometry, and body weight measured at three time periods. Assessed compliance post-intervention

Large sample size, random assignment, low dropout rate, use of a placebo and double-blind strategy, and measurement of body fat changes using dual energy x-ray absorptiometry

N/A

Little ethnic diversity, and only a 4-month study duration

Both coaching and supplement treatments, separately and in combination, helped subjects lose weight & body fat. Adults can be motivated to change behaviours over the phone

Uebelacker et al., 2018 [78]

USA

To test the feasibility and acceptability of an online yoga intervention for individuals with mood disorders

Experimental study, original research

Video

Yoga

PANAS for positive and negative affect immediately after viewing the yoga video, feedback questionnaire assessing overall feasibility and acceptability, adherence, dislike vs like, how likely they would be to participate in future online yoga programs, and qualitative feedback

N/A

Attrition possibly due to boredom or disinterest, or lack of sufficient understanding of the materials. Some participants found the positions were slightly difficult, or had technical issues

Only one yoga class provided, relied on self-report measures of adherence, may be too physically challenging for those with physical limitations or that have a difficult time moving

Offers preliminary support that online yoga is well-tolerated, acceptable, and associated with decreased negative affect in a subset of individuals with mood disorders

Vederhus et al., 2020 [79]

Norway

To examine whether a Norwegian Cannabis Cessation app reaches a broader or different user group compared to community-based Cannabis Cessation programs

Cross-sectional, original research

Mobile app

Cannabis

Severity of dependence for cannabis, mental distress using two versions of the Hopkins Symptom Checklist, days of cannabis use, self-efficacy of quitting, and general well-being

Findings suggest that the app reached some people who were not as likely to attend formal services, and who would possibly find it more problematic to seek face-to-face services (i.e. women)

Some app users might have needed more support than an app can offer. The majority of cannabis smokers also used nicotine, implying a need to address nicotine use in treatment. More interactivity might be needed on the app

Cannot interpret causality in a cross-sectional design, and those with sub-threshold cannabis use disorder were excluded from analyses even if they perceived their condition as problematic

The app can be an alternative for those who are not yet prepared to seek treatment in formal healthcare services. The app was able to capture an expanded segment of the cannabis-using population

Vranceanu et al., 2016 [80]

USA

To test the feasibility, acceptability, efficacy, and durability of a mind–body program for neurofibromatosis vs an attention placebo control for neurofibromatosis, both delivered via group videoconferencing

Single-blind RCT, original research

Videoconferencing

Mind–body medicine

Primary outcomes: physical health, psychological QoL. Secondary outcomes: social relationships QoL, environment QoL, depression, anxiety, pain intensity, and pain interference. Assessments occurred at baseline, posttreatment, and at 6 months follow-up

Included a

geographically diverse sample of patients with Type 1 and Type 2 neurofibromatosis, and schwannomatosis, no attrition in the treatment group, and interest in participation and feasibility was superior compared to an in-person pilot trial

N/A

Moderate or small effect sizes went undetected, only half of participants reported moderate to severe pain at baseline, resulting in higher powered analysis for this subsample, only one therapist provided treatment

The intervention delivered via videoconferencing was highly feasible and accepted by patients, and resulted in sustained improvement in QoL

Wang et al., 2011 [24]

Austria, China

To examine the use of tele-acupuncture for quantifying the effects of heart rate variability in poststroke rehabilitation

Pilot study, original research

Internet, software

Acupuncture

Mean heart rate, total heart rate variability, and low frequency/high frequency heart rate variability ratio

Provides evidence that this new methodological procedure of tele-acupuncture has positive effects on heart rate variability and therewith on the state of health

N/A

This is not a randomized clinical trial, and does not use a personalized acupuncture scheme

Based on heart rate variability analysis, tele-acupuncture between China/Harbin and Austria/Graz over a distance of about 8,500 km is no longer a future vision; it has become reality

Wang et al., 2016 [81]

China

To examine the effects of music intervention on sleep quality in community-dwelling elderly people

RCT, original research

Music database on MP3 player, telephone follow-ups

Music therapy

Sleep quality using the PSQI-C assessed at baseline, 1 month, 2 months, and 3 months after study entry

This is the first study that used music among Chinese community-dwelling elderly with poor sleep quality, and contributes new evidence

N/A

The dose of the intervention may vary as use was self-conducted, sleep quality was unable to be measured objectively, and the follow-up period is only 3 months

Music is a safe and effective nonpharmacologic approach for improving the sleep quality among community-dwelling elderly, especially for sleep latency, sleep efficiency, and daytime dysfunction

Yeh et al., 2013 [82]

Taiwan

To investigate the effects of auricular acupressure alone or combined with an interactive Internet-based intervention for the management of menstrual pain and self-care of adolescents with primary dysmenorrhea

Non-randomized control trial, pre-post test, original research

Website

Auricular acupressure

Quality and intensity of pain using the SF-MPQ, and the mental distress questionnaire to assess severity of physiological symptoms

Results show that auricular acupressure combined with interactive Internet instruction is better than auricular acupuncture alone in improving self-care for pri-mary dysmenorrhea

N/A

Non-randomized study has inherent limitations, no control group, the sample was taken from one high school, and long-term effects remain unknown

Auricular acupressure alone or in combination with interactive internet instruction reduced menstrual pain and distress for primary dysmenorrhea. The interactive internet instruction group is better than auricular acupuncture alone for self-care behaviours

Zini et al., 2018 [83]

Italy

To set up an ICT intervention meant to support refractory epilepsy in patients undergoing ketogenic diet treatment at the centre

Observational, original research

Mobile app

Ketogenic diet

N/A

N/A

Intervention still does not address ketogenic diet. Functionality and a decision support system would be beneficial, and would require further testing

N/A

The health application for training patients in managing ketogenic diet also acts as a bridge connecting patients

with the health care staff for coaching and monitoring purposes

Zwart et al., 2000 [84]

USA

To determine whether people receiving lay pastoral telecare would report greater positive change in spiritual well-being and church satisfaction than the control group

RCT, original research

Telephone

Spiritual care

Spiritual well-being scale administered over the telephone, church satisfaction questionnaire

Many strong relationships were developed between callers and callees

Optimal length and frequencies of telephone calls is still unknown; some participants preferred weekly calls while others requested calls once a month or every other week

Telephone administration of the spiritual wellbeing scale has not been tested for reliability or validity. Participant bias is possible when answering post questionnaire

Lay Pastoral Telecare intervention is an effective mode of providing spiritual support of an interpersonal nature to church attenders