Telerehabilitation Technologies Research Articles

Can tele-physiotherapy help in filling treatment gaps during pandemics in multiple sclerosis?

ABSTRACT Background: Published data demonstrate promising results for rehabilitation in patients with multiple sclerosis (MS), including telerehabilitation technologies. Given the travel limitations during the coronavirus disease 2019 (COVID-19), telerehabilitation may provide a viable alternative to in-person physiotherapy. Objective: To determine the efficacy of telerehabilitation in MS patients during COVID-19. Design/Methods: A total of 42 patients participated in the study of which 24 were followed up till the end of 6 weeks. The investigated group consisted of 15 females and 09 males; the mean age was 42 ± 10 years. The telerehabilitation was provided for a duration of 6 weeks at a frequency of three classes per week. The patients used either laptops or mobile phones for attending these sessions. The inclusion criteria were a 6-minute walk test (with or without assistance). Motor function was evaluated using the Timed Up and Go (TUG) test and the 30-Second Sit-to-Stand (30STS) test. Patients were required to fill out two questionnaires also: 12-item MS Walking Scale (MSWS) and Modified Fatigue Impact Scale (MFIS). All the patient assessments were made by an independent physiotherapist before and after the intervention. Results: There was a statistically significant improvement in motor performance and MFIS and 12-item MSWS. The following results were observed: statistically improved parameters of TUG, 30STS, 12-item MSWS and MFIS. Conclusions: Based on the findings, it is reasonable to infer that the use of telemedicine in the rehabilitation of MS patients is very promising.

Editorial for the Special Issue of the International Journal of Telerehabilitation

This Special Issue of the International Journal of Telerehabilitation, dedicated to the evolving field of telerehabilitation, particularly in the context of cancer care. As we navigate through a period of significant global challenges, the importance of remote healthcare delivery has never been more evident. This issue seeks to highlight the advancements in telerehabilitation technologies, methodologies, and their practical applications in various healthcare settings.

A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions.

Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson's disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions.

TELEREHABILITATION INTERVENTION PROTOCOLS FOR COVID-19 PATIENTS: A SCOPING REVIEW

Introduction: Since the start of the pandemic, it became clear to physical therapists through emerging studies that there are better outcomes in managing the symptoms of COVID-19 patients if they undergo physical therapy; however, face-to-face rehabilitation of COVID-19 patients placed physical therapists at risk of cross-infection. To address this issue, the use of telerehabilitation as a mode of delivery of instruction and patient monitoring was considered. Recent studies have expressed its effectiveness; however, there are still no available standardized protocols for the telerehabilitation of COVID-19 patients. Thus, this study seeks to conduct a comprehensive search of the published literature regarding COVID-19 physical therapy interventions and to map out the current evidence and knowledge gaps surrounding telerehabilitation protocols for COVID-19 patients. Methods: The study has a Scoping Review Design in accordance with the PRISMA-ScR guidelines. In this study, 939 articles were found through searching in the following databases with specific MeSH Terms: PEDRO, PubMed, BioMed Central, & Cochrane Central. These 939 articles were then screened and assessed for their eligibility, specifically, to match the inclusion criteria of the study. Specific details of each of the studies included the following: Title, Author & Country, Digital Technology Used, Research Design, Methodology, Intervention/Program, and Key Findings/Results. Similar details between studies were tallied and were then compared to their existing forms of literature. Results: A total of 9 studies were reviewed after the 939 articles were screened and similar details were tallied as well. A majority of the studies were RCTs followed by Systematic Reviews/Meta-Analysis. The most common interventions used in order were (1) Strengthening Exercises, (2) Deep Breathing Exercises, and (3) Aerobic Exercises. The most used telerehabilitation technology was any internet-connected device that had access to video conferencing. Four of the studies have shown better outcomes as a result of telerehabilitation. Gaps in literature, specifically the lack of studies conducted in developing nations and unevidenced claims of better cost-effectiveness, were consistent in all studies. Discussion: This study was able to map out the available research and the surrounding protocols conducted through telerehabilitation for COVID-19 patients. The current literature shows the most common interventions and outcome measures used during telerehabilitation and that some patients have become better as a result of telerehabilitation. The findings can be used as a basis for creating a telerehabilitation treatment plan and may be used to systematically compare said studies in turn would create a standardized protocol for COVID-19 telerehabilitation.

Exploring the Awareness, Perception, Acceptability and Confidence Level Towards Telerehabilitation among Stroke Patients’ Caregivers in the Federal Territory of Malaysia

Telerehabilitation is the ability to provide distance support, evaluation and intervention to individuals who are undergoing rehabilitation therapy through telecommunication. This study aimed to explore the awareness, acceptability and confidence level towards telerehabilitation among caregivers of cerebral stroke patients in the federal territory of Malaysia. A cross-sectional study was conducted amongst stroke patients’ caregivers from general hospitals in the federal territory of Malaysia. Descriptive statistics were used to analyse the awareness, acceptability and confidence level towards telerehabilitation technology among stroke patients’ caregivers. The correlation between confidence level in using technology devices and their acceptance level of telerehabilitation was assessed by using Spearman correlation analysis. Results showed that 70% of caregivers were aware of the telerehabilitation technology, amongst which 60.5% were willing to use the technology for rehabilitation purposes. Out of all the types of devices, 50% of caregivers demonstrated a high confidence level in using smartphones. However, only 25.7% demonstrated a high confidence level in using video call services for telerehabilitation service. In conclusion, the majority of caregivers in the federal territory of Malaysia demonstrated a positive attitude towards telerehabilitation services for stroke patients.

A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs.

Recent advances in wearable motion sensors, mobile devices, the Internet of Things, and telecommunications have created new potential for telerehabilitation. Recognizing that there is no systematic review of smartphone- or tablet-based balance and gait telerehabilitation technology for long-term use (i.e., four weeks or more), this systematic review summarizes the effects of smartphone- or tablet-based rehabilitation technology on balance and gait exercise and training in balance and gait disorders. The review examined studies written in English published from 2013 to 2023 in Web of Science, Pubmed, Scopus, and Google Scholar. Of the 806 studies identified, 14 were selected, and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was applied to evaluate methodological quality. The systematic review concluded that all 14 studies found balance and gait performance improvement after four weeks or more of balance and gait telerehabilitation. Ten of the 14 studies found that carry-over effects (improved functional movements, muscle strength, motor capacity, cognition, and reduced fear of falling and anxiety levels) were maintained for weeks to months. The results of the systematic review have positive technical and clinical implications for the next-generation design of rehabilitation technology in balance and gait training and exercise programs.

Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review.

Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient's home to objectively measure finger/wrist ROM. Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: "wrist/hand," "rehabilitation," and "telemedicine." Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done. There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments. Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.

Telehealth-based exercise in amyotrophic lateral sclerosis.

The Veterans Health Administration (VHA) has served as a leader in the implementation of telerehabilitation technologies and continues to expand utilization of non-traditional patient encounters to better serve a geographically and demographically diverse population. Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease impacting Veterans at a higher rate than the civilian population and associated with high levels of disability and limited access to subspecialized care. There is growing evidence supporting exercise-based interventions as an independent or adjunctive treatment to maintain or restore function for this patient population; many of these interventions can be delivered remotely by telehealth. The recent advancements in disease-modifying therapies for neuromuscular disorders will likely increase the importance of rehabilitation interventions to maximize functional outcomes. Here, we review the evidence for specific exercise interventions in ALS and the evidence for telehealth-based exercise in neuromuscular disorders. We then use this existing literature to propose a framework for telehealth delivery of these treatments, including feasible exercise interventions and remote outcome measures, recommended peripheral devices, and an example of a current remote group exercise program offered through VHA.

Digital tools in musculoskeletal rehabilitation

The demographic transition in combination with the increasing demands of society and agrowing shortage of skilled workers are leading to ashortage of care in musculoskeletal rehabilitation, especially in times of the pandemic. Digital interventions represent an opportunity to reintegrate patients with musculoskeletal dysfunctions into everyday life. The changes to the legal basis enable physicians and therapists to support the rehabilitation of their patients with reimbursable apps and digital applications and to permanently integrate learned skills into their daily lives. Telerehabilitation technologies, apps, telerobotics and mixed reality offer the opportunity to complement and optimize existing care structures and to redesign specialized therapeutic home visits with modern technology in anew and contemporary way.

Telerehabilitation: An Updated View of Practices, Cost Analysis, and Client Perceptions

Telerehabilitation is an alternative and complementary rehabilitation method in which information and communication technologies are used to remove the distance between healthcare professionals and clients. The COVID-19 pandemic has led to the rapid adoption of telerehabilitation services, limiting the in-person rehabilitation services available all over the world. The restrictions that started with the COVID-19 pandemic also negatively affected rehabilitation services, clients, and healthcare professionals, and it was considered essential to provide services using telerehabilitation technology. Therefore, this review aimed to examine and inform health professionals' telerehabilitation practices such as remote assessment, evaluation, intervention, monitoring, supervision, education, and follow-up during the pandemic. This review aimed to present the practice areas, advantages, disadvantages, perceptions, and cost analysis results of telerehabilitation practices to healthcare professionals, considering the standards the American Telemedicine Association set.

Performing Dynamic Weight-Shifting Balance Exercises With a Smartphone-Based Wearable Telerehabilitation System for Home Use by Individuals With Parkinson's Disease: A Proof-of-Concept Study.

Telerehabilitation technology often helps individuals with Parkinson's disease (PD) to control their balance and improve postural stability. This proof-of-concept study describes the redesign of a smartphone-based wearable balance rehabilitation system, or Smarter Balance System (SBS) intended for in-home use, and determines the number of exercise sessions required to achieve steady-state balance exercise performance by people with PD who performed 6 weeks of in-home dynamic weight-shifting balance exercises. The redesigned SBS supplied real-time multimodal (visual and vibrotactile) biofeedback during dynamic weight-shifting balance exercises (WSBEs). A Technology Acceptance Model (TAM) questionnaire completed by participants validated its acceptability and use. The results of regression analyses of participants' balance exercise performance, based on the average cross-correlations and absolute position errors between the target motion and the exerciser's motion, showed exponential trends, a performance plateau after 3 weeks, and a quasi-steady state performance by the end of 6 consecutive weeks.

Telerehabilitation in Older Thai Community-Dwelling Adults.

To investigate the impact on physical performance and walking abilities associated with fall risk and disability in the senior population, we created a telerehabilitation system. This is a multi-site, community setting, pre−post experimental study. We recruited participants from four rural areas in Thailand. All participants received eight weeks of tele-exercise, three sessions per week, via the telerehabilitation system. After the intervention, all participants underwent the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) test, and the six-minute walk test (6MWT) using a wearable sensor system. A total of 123 participants participated in the study and 2 participants dropped out while conducting the study, thus 121 participants were included in the analysis. In comparison to the baseline, we discovered a considerable improvement in the SPPB score (0.65 ± 0.22, p < 0.001), TUG (−1.70 ± 0.86, p < 0.001), and 6MWT (10.23 ± 7.33, p = 0.007). Our study demonstrates the benefits of telerehabilitation on SPPB, TUG, and 6MWT related to disabilities and fall risk. This telerehabilitation technology demonstrated its viability in the community environment and demonstrated its capacity to offer fundamental components of remote rehabilitation services within the healthcare system.

Digital health systems: SMART-system for remote support of hybrid E-rehabilitation services and activities

The top-priority challenges were faced by the medical rehabilitation system in Ukraine. Particularly important tasks include, first of all, the rehabilitation of patients who have recovered from COVID-19 disease and people with Combat stress reaction. This fact is well understood both by the society and the leadership of the Ministry of Health of Ukraine, which is creating a special working group on this problem. Ukraine has a system of medical and prophylactic institutions designed for psychological and physical rehabilitation of military personnel; these use modern rehabilitation technologies. However, long-term rehabilitation in such centers is not available to everyone. Therefore, the use of telerehabilitation technology for patients with post-traumatic stress disorder and similar disorders in com- bination with a means of objective control of the functional state is extremely important. One of the most effective solutions in medical rehabilitation assistance is remote patient / person-centered rehabilitation. Rehabilitation also needs effective methods for the "Physical therapist – Patient – Multidisciplinary team" system, including the statistical processing of large volumes of data. Therefore, along with the traditional means of rehabilitation, as part of the "Transdisciplinary intelligent information and analytical system for the rehabilitation processes support in a pandemic (TISP)" in this paper, we introduce and define: the revised and completed basic concepts of the hybrid e-rehabilitation notion and its fundamental foundations; the formalization concept of the new Smart-system for remote support of hybrid e-rehabilitation services and activities; and the methodological foundations for the use of services (UkrVectōrēs and vHealth) of the remote Patient / Person- centered Smart-system. The software implementation of the services of the Smart-system has been developed.

Current trends in the organization of rehabilitation care for patients after total hip replacement

The pandemic caused by the novel coronavirus infection COVID-19 dramatically increased the burden on healthcare, which led to the repurposing and limitation of the bed stock in rehabilitation centers. That served as the basis for the search for new approaches to the treatment and routing of patients, including using remote-controlled rehabilitation. The aim of the study was to evaluate the effectiveness and safety of motor rehabilitation in patients after hip replacement with the use of telerehabilitation technologies. Materials and methods: In a retrospective study, 32 patients aged 40 to 75 years who underwent rehabilitation after hip replacement using telemedicine technologies were examined. After discharge from the surgical hospital, all patients were offered a link to receive a program of motor rehabilitation, including exercise therapy complexes and a video clip on the technique of performing these exercises. In addition, online classes with a physical therapy instructor were conducted for patients with technical capabilities. The rehabilitation program started from the first day after surgery and lasted 90 days. To assess the effectiveness of rehabilitation, all patients underwent testing, including questionnaires and mobility tests, which were conducted on the second day and 3 months after surgery. Results: Rehabilitation with the use of telemedicine for patients after hip replacement demonstrates a positive clinical effect, assessed by mobility tests (TUG and the 6‑minute walk test), the EQ-5D quality of life scale, the SF-36 questionnaire and State-Trait Anxiety Inventory test. Conclusion: The criteria for patient inclusion developed by us, special physical therapy programs, and a routing model with remote rehabilitation treatment can become an effective alternative to the full-time rehabilitation, in case of paramedical difficulties for its implementation.

Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review.

BackgroundAn understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature.ObjectiveWe aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients’ perspectives on its usability, utility, acceptability, acceptance, and external variables.MethodsWe searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken.ResultsThe search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors.ConclusionsHome-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians.

Comparing Advanced with Basic Telerehabilitation Technologies for Patients with Rett Syndrome-A Pilot Study on Behavioral Parameters.

The aim of this study is to compare the performances of patients with Rett syndrome that were undergoing advanced telerehabilitation (ATR) and patients that were undergoing basic telerehabilitation (BTR). It was hypothesized that patients that were undergoing ATR training would have better improvement in nearly all the motor and cognitive scale scoring activities that were administered, thus showing reduced disability. A total of 20 young girls and women with a diagnosis of RTT, ranging from age 4 to 31 years old (Median: 12.50; IQR: 9.50–17.25) underwent a pre-test, treatment post-test 1, treatment, and post-test 2 procedure. The treatment consisted of either ATR or BTR, lasting 10 weeks with three sessions a week of about an hour. The results showed that the group with advanced telerehabilitation improved their performance better than the control group only in some neuropsychological measurements. The results are discussed in the light of critical factors of telerehabilitation.

Towards Supporting Data-Driven Practices in Stroke Telerehabilitation Technology

Telerehabilitation technology has the potential to support the work of patients and clinicians by collecting and displaying patients' data to inform, motivate, and support decision-making. However, few studies have investigated data-driven practices in telerehabilitation. In this qualitative study, we conducted interviews and a focus group with the use of data visualization probes to investigate the experience of stroke survivors and healthcare providers with game-based telerehabilitation involving physical and occupational therapy. We find that \hlstudy participants saw potential value in the data to support their work. However, they experienced challenges when interpreting data to arrive at meaningful insights and actionable information. Further, patients' personal relationships with their goals and data stand in contrast with clinicians' more matter-of-fact perspectives. Informed by these results, we discuss implications for telerehabilitation technology design.

Rehabilitation in patients with multiple sclerosis and telerehabilitation technologies during the COVID-19 pandemic in Western Siberia. (4442)

Rehabilitation in patients with multiple sclerosis and telerehabilitation technologies during the COVID-19 pandemic in Western Siberia. (4442)

Development of a Low-Cost, Modular Muscle-Computer Interface for At-Home Telerehabilitation for Chronic Stroke.

Stroke is a leading cause of long-term disability in the United States. Recent studies have shown that high doses of repeated task-specific practice can be effective at improving upper-limb function at the chronic stage. Providing at-home telerehabilitation services with therapist supervision may allow higher dose interventions targeted to this population. Additionally, muscle biofeedback to train patients to avoid unwanted simultaneous activation of antagonist muscles (co-contractions) may be incorporated into telerehabilitation technologies to improve motor control. Here, we present the development and feasibility of a low-cost, portable, telerehabilitation biofeedback system called Tele-REINVENT. We describe our modular electromyography acquisition, processing, and feedback algorithms to train differentiated muscle control during at-home therapist-guided sessions. Additionally, we evaluated the performance of low-cost sensors for our training task with two healthy individuals. Finally, we present the results of a case study with a stroke survivor who used the system for 40 sessions over 10 weeks of training. In line with our previous research, our results suggest that using low-cost sensors provides similar results to those using research-grade sensors for low forces during an isometric task. Our preliminary case study data with one patient with stroke also suggest that our system is feasible, safe, and enjoyable to use during 10 weeks of biofeedback training, and that improvements in differentiated muscle activity during volitional movement attempt may be induced during a 10-week period. Our data provide support for using low-cost technology for individuated muscle training to reduce unintended coactivation during supervised and unsupervised home-based telerehabilitation for clinical populations, and suggest this approach is safe and feasible. Future work with larger study populations may expand on the development of meaningful and personalized chronic stroke rehabilitation.

A group-based real-time videoconferencing telerehabilitation programme in recently discharged geriatric patients: a feasibility study.

Exercise at home and improvement in the ability to undertake daily tasks are highly valued by older people after hospitalisation. New telerehabilitation (TR) technologies make it possible to supervise and communicate with exercising participants through videoconferencing equipment. This technology has been shown to be both feasible and effective in Danish chronic obstructive pulmonary disease patients in terms of basic mobility, safety, social interactions and patient perception. This study sought to examine whether it was feasible to carry out TR through home exercises in groups. Both medical and hip-fracture home-dwelling patients aged 65years and older admitted to the Emergency Department (ED) and Department of Geriatrics for acute reasons were asked to participate in the study just before their discharge. The inclusion criteria were normal cognitive function, being dependent on a walking aid and computer users before hospitalisation. At discharge, 333 patients were consecutively screened for participation. Of those, 300 patients were excluded. Thirty-three patients met the inclusion criteria. They had a mean age of 82.3years (± 7.8) and 76% were women. Nine patients agreed to participate, but seven withdrew. The most frequent explanation was exhaustion in the continuation of hospitalisation. It was not possible to conduct a videoconference TR study in a geriatric population, as many were excluded and those who were eligible withdrew after inclusion. During the COVID-19 pandemic, TR may be an important tool for isolated older persons to hinder functional decline. Aspects such as recruitment procedures and IT solutions designed for older people must be considered.