Telerehabilitation Interventions Research Articles

Review article: Telerehabilitation interventions for rehabilitation and management of post-COVID-19 patients: A comprehensive review

The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, impacting patients during the disease’s acute and post-acute phases. Telerehabilitation has emerged as a promising approach to address the rehabilitation needs of individuals recovering from COVID-19. This comprehensive review examines the effectiveness and feasibility of telerehabilitation strategies for managing post[1]acute COVID-19 symptoms and promoting recovery. Through a systematic review and meta-analysis, various studies have demonstrated the potential benefits of telerehabilitation interventions in improving functional capacity, exercise perception, and quality of life among post-COVID-19 patients. Telerehabilitation programs have been successfully implemented across primary care settings, offering supervised home-based exercise training that targets physical and respiratory functions. Moreover, innovative tools such as mobile applications have been employed to enhance patient engagement and track progress. While the evidence indicates positive outcomes, there is a need for further investigation to explore the effects of telerehabilitation on additional variables such as cardiopulmonary function, anxiety, depression, and long-term outcomes. Despite limitations, telerehabilitation has shown promise in addressing the persistent symptoms and complications associated with post-acute COVID-19 syndrome. The integration of telerehabilitation into clinical care frameworks has the potential to improve patient access, engagement, and overall recovery during the ongoing pandemic and beyond. Continued research and development are essential to optimize telerehabilitation strategies for long-term COVID-19 management.

Telerehabilitation in Chronic Obstructive Pulmonary Disease (COPD) Management: Exploring Experiences and Effectiveness

Telerehabilitation has emerged as a promising approach to address the challenges posed by chronic obstructive pulmonary disease (COPD) management. This article provides a comprehensive review of telerehabilitation’s characteristics,components, efficacy, patient experiences, and the implications for COPD patients. Telerehabilitation involves the use of telecommunication technologies to remotely deliver rehabilitation services, including exercise training, education, and monitoring, to individuals with COPD. It addresses barriers such as geographical distance and limited access to specialized facilities, making rehabilitation accessible from home. Telerehabilitation encompasses various approaches, including telemonitoring, teleconsultation, and tele-education. Several studies have indicated positive outcomes in exercise capacity, dyspnea, and quality of life when comparing telerehabilitation interventions to standard care or traditional rehabilitation programs. However, challenges related to technology access, digital literacy, and privacy need to be addressed for equitable implementation. Interdisciplinary collaboration among healthcare professionals is essential for the successful delivery of telerehabilitation. Future research should focus on refining the interventions, standardizing the protocols, and evaluating the long-term maintenance effects. By integrating patient-centered approaches and leveraging advancements in digital technologies, telerehabilitation can revolutionize COPD management strategies, enhancing patient outcomes in the modern healthcare landscape.

Effectiveness of telerehabilitation based on real-time intervention between therapist and participants for improving physical function, activities of daily living and quality of life in people with stroke: A systematic review protocol.

There is a call for gathering more evidence on the effectiveness of telerehabilitation in stroke. In particular, a previous systematic review reported substantial variability in the types of technologies used in telerehabilitation interventions. The purpose of this study will be to summarize and synthesize findings on the effects of telerehabilitation based on real-time intervention between therapist and participants for patients with stroke. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. This systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 25 May 2023 (registration number: CRD420234265527). Electronic searches will be performed in the following databases: MEDLINE, Pubmed, Web of Science, PsycINFO and CINAHL electronic databases, using a date range from inception to November 2023. We will include only randomized controlled trials for patients diagnosed with stroke who received telerehabilitation based on real-time interaction between therapist and patients. The exploration will be restricted to publications in the English language. Physical function, activities of daily living and quality of life are the outcomes. We will examine the changes of the outcomes at baseline, at the end of the intervention, and at specific time points during the follow-up after the intervention. This systematic review will provide evidence regarding telerehabilitation for people with stroke.

Nursing interventions for improving quality of life among patients with coronary heart disease after percutaneous coronary intervention: A scoping review

Background: Percutaneous coronary intervention (PCI) aims to improve the quality of life (QoL) for coronary heart disease (CHD) patients, but many patients still have poor QoL. The impact of poor QoL causes long-lasting feelings of frustration, anxiety, fear, and worry that make a person give up or lose enthusiasm for the future. Objective: This study aimed to describe nursing interventions to improve the QoL of CHD patients after PCI. Methods: This research used the scoping review method by including all full-text primary studies written in English and published between 2013 to 2023 from three databases, EBSCO-host, PubMed, and Scopus, and one e-resource, Sage Journals. The keywords used were “coronary artery disease OR myocardial infarction OR cardiovascular disease AND quality of life AND percutaneous coronary intervention OR PCI OR Angioplasty AND Nursing care OR nursing intervention.” Results: A total of eight articles discussed nursing interventions to improve the QoL among CHD patients after PCI. There are two categories of interventions that nurses can carry out: hospital-based (inpatient or outpatient) rehabilitation and cardiac tele-rehabilitation. Conclusions: Hospital-based (inpatient or outpatient) rehabilitation and tele-rehabilitation interventions potentially improve post-PCI patients’ QoL, psychological well-being, cardiovascular capacity, social support, and adherence to CHD rehabilitation program. Standardized intervention guidelines need to be created in the future for each outcome of interest based on evidence-based findings so that specific interventions to improve the quality of life of CHD patients can be applied directly in daily practice.

Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study.

Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required.

Pre-Implementation Analysis of the Usability and Acceptability of a Poststroke Complex Telehealth Biofeedback Intervention.

Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important. To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions. Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study. Community. Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr). Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth. Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs. Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers. Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions. Plain-Language Summary: This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.

The pulmonary rehabilitation effect on long covid-19 syndrome: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID-19 (LC). The impact of PR on LC and a comparison of face-to-face and telerehabilitation approaches was explored. This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non-randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta-analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2. This systematic review and meta-analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi-experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face-to-face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face-to-face group. PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face-to-face and telerehabilitation have similar effects, except for physical quality of life.

Telerehabilitation in Physiotherapy Science: A Scoping Review.

The advancement of computer science technologies and telemedical devices has led to an increase in the use of telerehabilitation (TR) as a therapeutic intervention. In our days, TR interventions can be considered as alternative solutions to face-to-face therapy. The primary aim of this study is to evaluate whether TR can be effective in physiotherapy. This can be adjudicated by investigating the use of the TR applications, their cost effect, and the level of effectiveness each one of them can provide. Randomized controlled trials that were published between 2003 and 2023 in the English language and used TR as the intervention were collected from online databases (MEDLINE, Physiotherapy Evidence Database (PEDro), and Cochrane) to be reviewed. Twenty of them met the criteria and were included in the study. Studies meeting the inclusion criteria were categorized by the body system investigated. Out of the 20 studies that met the inclusive criteria, five are related to the musculoskeletal system, six are related to the nervous system, two are related to proprioception and balance, one is related to the respiratory system, one is related to the cardiovascular system, two are related to pelvic floor control, and three are related to autoimmune disorders. Studies have shown that implementing TR has resulted in significant improvements in terms of functionality, muscle strength, endurance, and self-improvement. Proprioception, autoimmune diseases, and cardiovascular health have shown the most improvement. The most commonly used tools for implementing TR are gamified virtual reality (VR) and digital apps. However, there are some disadvantages, such as the lack of personal contact and the cost involved. We found that TR has the potential to positively impact various health disorders, making it a suitable form of therapy for people who can't receive in-person treatment. Nonetheless, it cannot replace traditional physiotherapy, nor does it hold the same value as it.

Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke

Purpose Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance.

Comparing Telerehabilitation and In-Person Interventions in School-Based Occupational Therapy for Specific Learning Disorder A Randomized Controlled Trial.

This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population. The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests). Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes. In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR's transformative role in enhancing the holistic well-being of children with SLDs.

A rapid review protocol of physiotherapy and occupational therapy telerehabilitation to inform ethical and equity concerns.

Telerehabilitation (TR) has emerged as a feasible and promising approach for delivering rehabilitation services remotely, utilizing technology to bridge the gap between healthcare providers and patients. As new modalities of virtual care and health technologies continue to emerge, it is crucial to stay informed about the growing landscape of virtual care to ensure that telehealth service delivery is ethical and equitable, and improves the quality of services and patient outcomes. The primary objective of this article is to present the protocol of a rapid review to examine the equity-related aspects surrounding the implementation of TR. This includes a comprehensive analysis of the ethical dimensions and fairness concerns linked to this practice. A rapid review protocol was developed in accordance with Cochrane Rapid Reviews Methods Guidance. Medline and EMBASE databases were searched between January 2010 and March 2023. Study selection and data extraction will be conducted in two phases (Phase I) by two independent reviewers and subsequently (Phase II) by a single reviewer. Our study will utilize the PROGRESS-Plus and Equitable virtual rehabilitation in the metaverse era framework to identify dimensions where potential inequities may exist within TR interventions. This rapid review is anticipated to enhance our knowledge of TR in the fields of physiotherapy and occupational therapy, with a specific focus on its influence on ethical and equitable practices and providing a foundation for informed decision-making and improved patient care. This rapid review will contribute to the advancement of our understanding of TR within physiotherapy and occupational therapy. Through synthesizing existing evidence, this study not only addresses current gaps in knowledge but also offers valuable insights for future research and clinical practice in TR services.

Interest in Telerehabilitation Among Patients with Mild to Severe Multiple Sclerosis: Results of the Czech Republic.

Background: Research in telerehabilitation (TR) in neurology tends to focus on patients with low to moderate disability. For neurology patients with severe mobility limitations, TR can help to enable rehabilitation for people whose mobility limitations make it difficult for them to access rehabilitation facilities. The aim of this study is to evaluate the interest of people with neurological disability caused by multiple sclerosis (MS) in TR services. Methods: This electronic survey targeted individuals with MS, specifically those with a higher level of disability. Results: A total of 355 patients with MS (155 with severe disabilities) participated in this study. There was no difference in interest in rehabilitation between people with mild-to-moderate and severe disabilities (p = 0.1258, confidence interval [CI] = 95%). However, we found a higher interest in upper limb exercises (p = 0.0006, CI = 95%) and balance training (p = 0.0000, CI = 95%) among people with higher disability. Conclusion: The results of this study may help to improve the planning and targeting of TR interventions, where a different focus of intervention is appropriate for patients with different levels of disability. This may enable TR to be maximally tailored to patient capabilities and current greatest limitations. For example, for people with severe disabilities, it is appropriate to focus on training the upper limb function to maintain self-sufficiency and implement interventions to prevent falls.

Physical Telerehabilitation interventions for Gait and balance in Multiple sclerosis: A Scoping review

BackgroundGait and balance impairments affects approximately a quarter of people with multiple sclerosis (pwMS) at onset and increases to almost half by five years. Physical rehabilitation has been recognised as the gold standard method to restore physical function in multiple sclerosis (MS). Emerging evidence in the literature is suggesting that a remote therapy rehabilitation platform (Telerehabilitation) is cost-effective, beneficial, and satisfying for patients and health care practitioners. The overarching aim of this review is to identify and summarise the evidence on the different types of telerehabilitation interventions available to manage gait and balance. MethodsThis review followed a methodological framework for conducting scoping reviews. PubMed,Science Direct and Web of Science were searched in April 2023 for relevant published literature. The inclusion criteria were peer-reviewed journal articles written in English which included telerehabilitation interventions for pwMS. Search keywords included multiple sclerosis and telerehabilitation. A reviewer screened titles and abstracts and eligible articles were fully reviewed. The included studies were categorised based on the type of intervention. ResultsEight studies were included in this review. The participants (n = 355) had an average age of 48 years (SD = 9.9) with 50% who had relapsing remitting multiple sclerosis who were living with MS for 12 years on average. Study designs included randomised control trials (n = 3), pilot studies and feasibility studies (n = 4). Two types of interventions were identified: Exergaming (n = 5) and Web-Based Physical Therapy (n = 2) of which exergaming appeared to be optimal in improving gait and balance. ConclusionThis scoping review identified and summarised the evidence on telerehabilitation interventions used for gait and balance in MS. The evidence is showing that telerehabilitation could be used as an alternative to conventional rehabilitation methods for improving gait and balance. More robust trials with larger sample sizes are needed to build on the current evidence to enable telerehabilitation to be integrated into care pathways in the future.

Physical therapists' use of telehealth in older adults within the home health setting: a scoping review protocol.

The objective of this scoping review is to summarize the available information on types of telehealth services provided to older adults when physical therapy is involved in their delivery of care. Methods of clinical assessment and outcomes will also be identified. Information on telerehabilitation interventions for older adults is lacking, yet older individuals can greatly benefit from person-centered care within a home setting. Hence, it is important to synthesize the literature pertaining to telehealth and physical therapy to identify gaps and key implications. This review will consider studies that include adults who are 65 years of age or older, who receive telehealth services within their home, and have a physical therapist involved. Quantitative, qualitative, and gray literature will be included in this review. There will be no language limits. A 3-step search strategy will be followed, in line with the JBI methodology for scoping reviews. Databases to be searched will include JBI Evidence Synthesis , Cochrane Database of Systematic Reviews, MEDLINE (Ovid), CINAHL (EBSCOhost), PRIMO, PubMed Central, PsycINFO (Ovid), LWW Nursing/Medical Journals (Ovid), and OpenGrey. Data will be extracted by 2 independent reviewers. The results will be synthesized, charted, and mapped and the findings will be presented in a peer-reviewed journal. Open Science Framework https://osf.io/9kyus/.

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review

Objective To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. Data sources A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. Methods The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. Results The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. Conclusions This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.

Efficacy and Safety of Respiratory Telerehabilitation in Patients with Long COVID-19: A Systematic Review and Meta-Analysis.

The aim of this review was to identify, map, and synthesize the extent and nature of research activity on the use of telerehabilitation to support Long COVID-19 rehabilitation and examine the efficacy and safety of respiratory telerehabilitation in patients with Long COVID-19. A systematic review and meta-analysis of randomized controlled trials were performed. We included controlled trials that tested the effect of respiratory telerehabilitation interventions in patients with Long COVID-19 versus no intervention, usual care, placebo, or face-to-face intervention. The data were pooled, and a meta-analysis was completed for quality of life, dyspnea, lung function, anxiety and depression, respiratory muscle strength, functional capacity, and lower limb strength. Finally, 10 studies were included. The meta-analysis results show significant differences in favor of respiratory telerehabilitation in quality of life (p = 0.02), dyspnea (p < 0.00001), respiratory muscle strength (p < 0.001), functional capacity (p < 0.0001), and lower limb strength (p = 0.01) but not in lung function (p = 0.28) and anxiety and depression (p = 0.55). In addition, there were no statistically significant differences in adverse effects (p = 0.06) between the telerehabilitation and comparator groups. The results suggest that these interventions can improve quality of life, reduce dyspnea, and increase respiratory and lower extremity muscle strength as well as functional capacity in patients with Long COVID-19.

Economic Evaluation of Telerehabilitation: Systematic Literature Review of Cost-Utility Studies.

Telerehabilitation could benefit a large population by increasing adherence to rehabilitation protocols. Our objective was to review and discuss the use of cost-utility approaches in economic evaluations of telerehabilitation interventions. A review of the literature on PubMed, Scopus, Centres for Review and Dissemination databases (including the HTA database, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database), Cochrane Library, and ClinicalTrials.gov (last search on February 8, 2021) was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were defined in accordance with the PICOS (population, intervention, comparison, outcomes, and study design) system: the included studies had to evaluate patients in rehabilitation therapy for all diseases and disorders (population) through exercise-based telerehabilitation (intervention) and had to have a control group that received face-to-face rehabilitation (comparison), and these studies had to evaluate effectiveness through gain in quality of life (outcome) and used the design of randomized and controlled clinical studies (study). We included 11 economic evaluations, of which 6 concerned cardiovascular diseases. Several types of interventions were assessed as telerehabilitation, consisting in monitoring of rehabilitation at home (monitored by physicians) or a rehabilitation program with exercise and an educational intervention at home alone. All studies were based on randomized clinical trials and used a validated health-related quality of life instrument to describe patients' health states. Four evaluations used the EQ-5D, 1 used the EQ-5D-5L, 2 used the EQ-5D-3L, 3 used the Short-Form Six-Dimension questionnaire, and 1 used the 36-item Short Form survey. The mean quality-adjusted life years gained using telerehabilitation services varied from -0.09 to 0.89. These results were reported in terms of the probability that the intervention was cost-effective at different thresholds for willingness-to-pay values. Most studies showed results about telerehabilitation as dominant (ie, more effective and less costly) together with superiority or noninferiority in outcomes. There is evidence to support telerehabilitation as a cost-effective intervention for a large population among different disease areas. There is a need for conducting cost-effectiveness studies in countries because the available evidence has limited generalizability in such countries. PROSPERO CRD42021248785; https://tinyurl.com/4xurdvwf.

Telerehabilitation in the Finnish Outpatient Rehabilitation Setting from the Perspective of the Socio-Technical Systems Theory.

In the development of effective telerehabilitation (TR) interventions, understanding the various characteristics affecting its practice is essential. Remote connection creates a new technically shaped environment for therapy and, therefore, previous therapy methods do not work the same way as before. The objective of this survey was to describe the practice of TR through the socio-technical theory approach. The 629 respondents to the online questionnaire included music therapists, occupational therapists, speech and language therapists, physiotherapists, and neuropsychologists. The materials consisted of five open-ended questions. The analysis combined data-based and theory-based analysis. In the data-based content analysis, we identified three main categories and eight generic categories, whereas in the theory-based, we categorised the main results according to the Fit Between Individuals, Tasks, Technology, and Environment (FITTE) framework dimensions. TR is everyday-life based, it requires shared participation, and the approach has to include coaching and collaboration with the client and their close associates. The everyday-life environment is one of the main dimensions that affect all the other dimensions. TR can be seen as technology-mediated home-based rehabilitation, as it can integrate rehabilitation into the client's everyday life. In TR, therapy becomes multilateral and it creates a new kind of shared partnership into outpatient therapy.

Effectiveness of adding pain neuroscience education to telerehabilitation in patients with carpal tunnel syndrome: A randomized controlled trial

BackgroundPrevious studies have shown positive results of pain neuroscience education (PNE) combined with exercise in patients with chronic musculoskeletal disorders. However, the effects of this intervention in patients with carpal tunnel syndrome (CTS) admitted to a telerehabilitation program remain unexplored. ObjectiveTo compare the effectiveness of a 6-week telerehabilitation program based on PNE + exercise versus exercise alone on patient-reported outcomes after treatment and at 6-weeks post-treatment follow-up in patients with CTS awaiting surgery. DesignRandomized controlled trial. MethodsThirty participants were randomly assigned to the PNE + exercise or exercise-only group. Outcome measures included pain intensity, pain catastrophizing, kinesiophobia, symptom severity, function, symptoms of anxiety and depression, quality of life, self-perception of improvement. Inferential analyses of the data were performed using a two-factor mixed analysis of variance. ResultsTwenty-five participants completed the study. A significant time × group interaction with a large effect size was observed for kinesiophobia (F = 6.67, p = 0.005, ηp2 = 0.225) and symptom severity (F = 4.82, p = 0.013, ηp2 = 0.173). No significant interaction was observed for the other variables (p > 0.05). A significant difference in self-perceived improvement was observed in favor of the PNE + exercise group after treatment (p < 0.05). Although there were significant and clinically relevant improvements within the PNE + exercise group in pain intensity and catastrophizing, there were no significant differences between the groups. ConclusionsThe addition of PNE to a telerehabilitation exercise program showed short-term improvements in kinesiophobia and symptom severity and greater self-perceived improvement in patients with CTS awaiting surgery. This study highlighted the benefits of including PNE in telerehabilitation interventions for patients with CTS.

Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis.

Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients.