Telerehabilitation Research Articles

Determinants of participation in cardiac telerehabilitation during the first surge of COVID-19

Background Participation rates in cardiac rehabilitation (CR) are low. In multiple trials, telerehabilitation (TR) has been demonstrated to be effective. Still, real-life evidence is scarce. During the first surge of the COVID-19 pandemic our centre deployed a TR programme. This study aimed to characterise the patient population that had, for the first time, the opportunity to participate in cardiac TR and to analyse if there were determining factors for participation or non-participation in TR. Methods All patients enrolled in CR in our centre during the first wave of the COVID-19 pandemic were included in this retrospective cohort study. Data was collected from the hospital electronic records. Results 369 patients were contacted in the setting of TR. 69 patients could not be reached and were excluded from further analysis. 208 (69%) patients that were contacted agreed to participate in cardiac TR. No significant differences in baseline characteristics were seen between TR participants and TR non-participants. A full model logistic regression did not reveal any significant determinants on participation rate in TR. Conclusion This study demonstrates that the rate of participation in TR was high (69%). Of the analysed characteristics, none was directly correlated with the willingness to participate in TR. Further research is needed to further assess determinants, barriers and facilitators of TR. Also, research is needed on better delineating digital health literacy and on how to reach also those patients that are less motivated and or less digitally literate.

Actual status and future directions of cardiac telerehabilitation.

Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the recent COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions.

Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study.

Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care. This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice. A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions. Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1%) and occupational therapists (n=434, 60%). Only 28.1% (203/723) reported receiving specific training in TR, with 1.2% (9/723) indicating that it was part of their professional education. Approximately 19.5% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers. Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education.

Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors

Objective: To identify the factors influencing the implementation of telerehabilitation (TR) in a post-stroke early supported discharge (ESD) rehabilitation program as perceived by clinicians and managers. Methods: A descriptive qualitative design was used in collaboration with a Canadian ESD stroke rehabilitation program. After 15 months of pre-COVID-19 implementation and 4 months of COVID-19 implementation, 9 stakeholders (7 clinicians, 1 coordinator and 1 manager) from an ESD program participated in 2 focus groups online or an individual interview. Qualitative data were coded and analyzed semi-deductively for the pre-COVID-19 and COVID-19 phases using the Consolidated Framework for Implementation Research (CFIR). Results: Four categories emerged related to the CFIR, each with themes: (1) Telerehabilitation, which included “Technology” and “Clinical activities”; (2) Telerehabilitation users, which included: “Clients’ characteristics” and “Clinicians’ characteristics”; (3) Society and healthcare system, which included “Changes related to COVID-19” and “ESD program”; and (4) TR implementation process, which included “Planning” and “Factors that influenced practice change”. Conclusions: Factors impacting TR implementation in the ESD program were found to be numerous and varied according to the pre-COVID-19 or COVID-19 phases. Clinicians’ motivation regarding potential gains for them in using TR was key in its implementation during the COVID-19 period.

Telerehabilitation Initiated Early in Post-Stroke Recovery: A Feasibility Study

Background Enhanced neural plasticity early after stroke suggests the potential to improve outcomes with intensive rehabilitation therapy. Most patients do not get such therapy, however, due to limited access, changing rehabilitation therapy settings, low therapy doses, and poor compliance. Objective To examine the feasibility, safety, and potential efficacy of an established telerehabilitation (TR) program after stroke initiated during admission to an inpatient rehabilitation facility (IRF) and completed in the patient’s home. Methods Participants with hemiparetic stroke admitted to an IRF received daily TR targeting arm motor function in addition to usual care. Treatment consisted of 36, 70-minute sessions (half supervised by a licensed therapist via videoconference), over a 6-week period, that included functional games, exercise videos, education, and daily assessments. Results Sixteen participants of 19 allocated completed the intervention (age 61.3 ± 9.4 years; 6 female; baseline Upper Extremity Fugl–Meyer [UEFM] score 35.9 ± 6.4 points, mean ± SD; NIHSS score 4 (3.75, 5.25), median, IQR; intervention commenced 28.3 ± 13.0 days post-stroke). Compliance was 100%, retention 84%, and patient satisfaction 93%; 2 patients developed COVID-19 and continued TR. Post-intervention UEFM improvement was 18.1 ± 10.9 points (P < .0001); Box and Blocks, 22.4 ± 9.8 blocks (P = .0001). Digital motor assessments, acquired daily in the home, were concordant with these gains. The dose of rehabilitation therapy received as usual care during this 6-week interval was 33.9 ± 20.3 hours; adding TR more than doubled this to 73.6 ± 21.8 hours (P < .0001). Patients enrolled in Philadelphia could be treated remotely by therapists in Los Angeles. Conclusions These results support feasibility, safety, and potential efficacy of providing intense TR therapy early after stroke. Clinical Trial Registration: clinicaltrials.gov; NCT04657770

Factors Affecting Participation in Telerehabilitation Using Transcranial Direct Current Stimulation for Patients with Poststroke Paralysis in South Korea.

Background: The coronavirus disease 2019 pandemic has expanded noncontact health care systems worldwide. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technology that enables treatment monitoring under remote supervision. We investigated the factors affecting patients' decision to participate in telerehabilitation (TR) using tDCS for motor function recovery after suffering a stroke. Materials and Methods: Four medical institutions surveyed 156 patients with poststroke paralysis. The participants were asked whether they would participate in TR therapy using tDCS in the future. We performed logistic regression analysis to examine the factors-demographic data, stroke characteristics, arm function, gait, and cognitive function-that influenced participants' decisions. Results: Of the participants, 66% (103/156) reported that they would participate in TR using tDCS in the future. Participants' monthly salary was a single significant independent factor influencing their decision to participate. Those earning greater than 5 million KRW (4,000 USD) were more likely to engage in TR via tDCS than those earning less than 1 million KRW (800 USD). The most common barriers to participation in telemedicine included the preference for face-to-face treatment and unfamiliarity. The expected medical expenses of TR using tDCS were 46,154 KRW (37 USD) per session. Conclusions: Most participants with poststroke paralysis responded positively to TR using tDCS for hand function recovery. For telemedicine to work effectively in a situation wherein face-to-face rehabilitation is impossible, prior discussion at the governmental level is essential for determining medical finances.

Organizational readiness and rehabilitation professionals' views on integrating telerehabilitation into service delivery and students' clinical training: A qualitative study.

To assess the readiness of healthcare institutions that serve as clinical platforms for Stellenbosch University' rehabilitation students, and to explore the opinions of rehabilitation professionals regarding the integration of telerehabilitation (TR) into service delivery and students clinical training. This study employed a qualitative research design and involved the participation of fourteen rehabilitation managers. Semi-structured interviews were conducted using both face-to-face and online platforms. Thematic analysis was employed to analyse the collected data. The readiness for implementing TR services varies across different dimensions. Facilities faced challenges related to funding for TR equipment and the absence of policies and guidelines, indicating a lack of financial and governance readiness. Rehabilitation professionals demonstrated high attitudinal readiness but low technical readiness due to a lack of knowledge and skills. Rehabilitation students particularly lacked practical experience, confidence, clinical reasoning and decision-making skills further contributing to low technical readiness. Health care institutions are generally not ready for a successful implementation of TR. To improve the readiness, senior management should actively participate and provide financial support, develop policies, guidelines and training programs for rehabilitation professionals. Educational institutions should incorporate TR program into curricula to prepare students to gain practical experience and familiarity with the use of TR technology for their future clinical practice.

Telehealth in Occupational Therapy in India

Background: Telehealth was first used in 1998 and refers to the use of information and communication technologies (ICT) to provide rehabilitation services at a distance. In 2014, the World Federation of Occupational Therapists (WFOT) acknowledged telehealth as an appropriate service delivery model for occupational therapy (OT) services. The WFOT published a telehealth position statement, which defined telehealth as “the use of information and communication technologies (ICT) to deliver health-related services when the provider and the client are in different physical locations.” Objective: The purpose of this review was to analyze the empirical studies on teletherapy in OT over the past 20 years in India and then propose recommendations for future research. This review study was guided by the following research question: What literature exists on telehealth in OT in India? Study Design: A review of literature. Methods: A systematic process was used to search the literature for this review. First, the data sources were identified. The database included Scopus, PubMed, Eric, Emerald, EBSCO, and ScienceDirect, and gray literature (books, unpublished papers, doctoral dissertations, etc.) was done using Google Scholar. Quantitative and qualitative studies were included in the review using Petticrew and Roberts (2006) as the basis. The next step included criteria for assessing the quality of the studies. The search keyword strings were “occupational-therapy” AND “teletherapy,” OR “tele rehabilitation,” OR “telehealth,” OR “virtual-therapy,” OR “online-therapy,” OR “teleconsultation” AND “India,” which appeared in the title, abstract, or keyword fields. The third step included data interpretation and analysis findings. The publication descriptor data were summarized after critical appraisal, study period, research theme, and research method. Certain criteria were followed to select the studies like, only full text journal articles available in English, studies that were produced from January 2001 to December 2021. Recurring themes were identified from the empirical research. Results: We went through all the databases (PubMed, Scopus, Eric, Emerald, EBSCO, Science Direct, and APA Psycinfo) where the total number of identified articles from the searches of these databases was 2260. Duplicate references were removed. We further excluded articles by reading the title, abstracts, and complete articles of the study. The final number of articles in the analysis was five. Conclusion: This study helped to identify the gaps with the intent to inform practice, policy, and future research by comprehensively synthesizing evidence to map a broad, complex, or emerging field of telehealth in OT.

A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review.

This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.

Cerebral palsy in Morocco: state of affairs and challenges

Cerebral palsy (CP) constitutes a major public health problem in Morocco; there is a lack of prevalence and incidence studies. Objectives. The aim of our work is to study and analyze the epidemiological profile of disability, list the challenges and pitfalls concerning the management of CP in Morocco and developing countries, and highlight practical recommendations for health policymakers in terms of CP in particular and disability in general. Material and methods. Authors performed a literature search using MEDLINE, EMBASE, SCIENCE DIRECT, and Google scholar, but also searched in international and local journals to identify articles that examined CP in Morocco. Combination of keywords, such as “Cerebral Palsy” “disability” and “nervous system”, and matching it with “Morocco”, or other developing countries. Outcomes. There are an unsatisfactory number of specialists in physical medicine, lack of good collaboration between specialists involved in CP management and physiotherapists. This situation is more pronounced in small cities and rural areas. However, in Morocco compared to other developing countries, as in Sub-Saharan Africa, the situation is much better. Conclusion. CP is becoming a priority of Moroccan ministry of health and ministry of social affairs and huge improvements are made, mainly in university hospitals, the use of new techniques and reducing the management gap of regional hospitals, and rural areas with the recent use of tele rehabilitation.

Telerehabilitation Approaches for People with Chronic Heart Failure: A Systematic Review and Meta-Analysis

Telerehabilitation (TR) for chronic heart failure (CHF) allows for overcoming distance barriers and reducing exacerbations. However, little is known about TR descriptors, components, and efficacy in CHF. This work systematically reviewed the TR strategies of randomized controlled trials in people with CHF. A meta-analysis was run to test its effect on exercise capacity and quality of life compared to no rehabilitation (NI) and conventional intervention (CI). Out of 6168 studies, 11 were eligible for the systematic review, and 8 for the meta-analysis. TR intervention was individual and multidimensional, with a frequency varying from 2 to 5 times per 8-12 weeks. The TR components mainly included an asynchronous model, monitoring/assessment, decision, and offline feedback. A few studies provided a comprehensive technological kit. Minimal adverse events and high adherence were reported. A large effect of TR compared to NI and a non-inferiority effect compared to CI was registered on exercise capacity, but no effects of TR compared to NI and CI on quality of life were observed. TR for people with CHF adopted established effective strategies. Future interventions may identify the precise TR dose for CHF, technological requirements, and engagement components affecting the patient's quality of life.

Attitude towards tele rehabilitation-based therapy services and its associated factors among health professional working in specialized teaching hospitals in Amhara region, Northwest Ethiopia

BackgroundTele-rehabilitation is part of Tele-health (TH) which provides a rehabilitation service at a distance through using telecommunication technology. The lack of skilled staff, accessibility concerns, high transportation costs, lengthy waiting times, and mobility issues make face-to-face rehabilitation treatment difficult. Therefore, this study aimed to assess attitudes and its associated factors of health professionals towards TR services. MethodAn institutional-based cross-sectional study design was conducted among 408 health professionals from March to April 2021. A simple random sampling technique was applied to select study participants. Epi-data 3.1 versions software was used for data entry, and SPSS version 20 was used for the analysis. A bi-variable and multivariable logistic regression was used to determine factors associated with the attitude of health professionals towards tele-rehabilitation. ResultA total of 408 participants enrolled in the study, with a response rate of 95.5%. The majority 285(69.9%) of health professionals had good attitude towards tele rehabilitation-based treatment services. Good knowledge of tele rehabilitation [AOR = 1.76, 95%, CI: 1.078, 2.879], digitally literate [AOR = 1.74, 95%, CI: 1.028, 2.954], perception on security and privacy [AOR = 0.56, 95%,CI: 0.333, 0.944], and owns smart mobile phone [AOR = 1.9,95%,CI: 1.007, 3.781] were significantly associated with attitude towards tele rehabilitation service. ConclusionIn this study the majority of the respondents had a good attitude towards tele rehabilitation services. Having own mobile, knowledge towards tele rehabilitation, digital literacy, perception on security and privacy to rehabilitation were found to be factors associated with attitude towards tele rehabilitation service. Therefore, the government and other responsible entities should consider enacting systems and strategies to encourage the use of mobile technologies for the management of disability, chronic diseases and for rural patients.

Telerehabilitation acceptance among patients during Circuit Breaker period: A retrospective study.

During the COVID-19 pandemic, telerehabilitation (TR) was viewed as an ideal alternative to minimize infection risks with in-person rehabilitation. However, TR acceptability remains unclear as it is an unfamiliar mode of interaction for most patients. We aim to retrospectively: (i) review the uptake rate of TR among patients, and (ii) explore their perceived barriers and facilitators of the service. A cross-sectional retrospective study was conducted among eligible patients who were offered TR. Research data was extracted from medical records. Additionally, an anonymous patient satisfaction survey was conducted among the successfully enrolled patients, and the feedback was extracted from the form.gov.sg server. 24·2% of the 314 eligible patients were successfully enrolled into TR. Preference for in-person rehabilitation was the top reason cited for declining the service. Among the 157 patients who declined the service, 38·2% of them preferred in-person rehabilitation over TR. A low uptake of TR services was demonstrated, with preference for in-person rehabilitation being the majority cited reason for decline. Reconciling the differences in patients' perceptions between in-person rehabilitation and TR may improve uptake rates.

Effectiveness of tele rehabilitation in the management of adults with stroke: a mini review

Background: Tele rehabilitation can deliver rehabilitation services with the use of technology to increase patient options, deliver services more efficiently and overcome geographical barriers to healthcare access. Despite its popularity, there is conflicting evidence for its effectiveness. Therefore, the aim of this systematic review was to update the current evidence base on the effectiveness of tele rehabilitation for stroke. Objective: We aimed to provide an updated systematic review on the efficacy of tele-rehabilitation interventions for stroke survivors. Method: PubMed, Google scholar, Physiotherapy Evidence Database (PEDro), Cochrane Library were searched, and the studies which were RCT, had tele-rehabilitation interventions, Published in English language, had moderate to high methodological quality (PEDro scoring 5 or more than 5). Results: Out of 218 studies, 04 randomised controlled trials met the eligibility criteria and quality assessment and were selected for the present systematic review. A diverse range of interventions were delivered through a variety of tele rehabilitation systems. Summarized findings from the heterogeneous evidence base indicate that tele rehabilitation may have a positive impact on a range of primary and secondary outcomes. Conclusion: Tele rehabilitation, as an alternate form of rehabilitation for people with stroke, shows potential. This updated systematic review provides evidence to suggest that tele-rehabilitation interventions have either better or equal salutary effects. However, due to methodological and practical concerns, an unequivocal recommendation cannot be made. Findings from this review may inform future policies and practices regarding the use of tele rehabilitation for stroke patients.

Characteristics, Components, and Efficacy of Telerehabilitation Approaches for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Chronic obstructive pulmonary disease (COPD) is at the top of the list of non-communicable diseases with related rehabilitation needs. Digital medicine may provide continuative integrated intervention, overcoming accessibility and cost barriers. We systematically searched for randomized controlled trials on telerehabilitation (TR) in people with COPD to profile the adopted TR strategies, focusing on TR models and the main rehabilitation actions: monitoring and assessment, decision, and feedback. Additionally, a meta-analysis was run to test the TR effect on functional capacity, dyspnea, and quality of life compared to no intervention (NI) and conventional intervention (CI). Out of the 6041 studies identified, 22 were eligible for the systematic review, and 14 were included in the meta-analyses. Results showed a heterogeneous scenario in terms of the TR features. Furthermore, only a small group of trials presented a comprehensive technological kit. The meta-analysis highlighted a significant effect of TR, especially with the asynchronous model, on all outcomes compared to NI. Moreover, a non-inferiority effect of TR on functional capacity and quality of life, and a superiority effect on dyspnea compared to CI were observed. Finally, the studies suggested a high rate of TR adherence and high safety level. TR is an effective strategy to increase and maintain functional capacity, breath, and quality of life in people with COPD. However, a consensus on the essential elements and features of this approach needs to be defined, and the effect of long-term maintenance merits further investigation.

Overcoming adversity: Building a remote interdisciplinary neurorehabilitation service during the COVID-19 pandemic

The COVID-19 pandemic necessitated rapid change in neurorehabilitation delivery at the Defence Medical Rehabilitation Centre (DMRC), with a reduction in inpatient capacity. An interdisciplinary remote working group developed a novel neurorehabilitation telerehabilitation (TR) model. The plan, do, study, act (PDSA) model was used to develop and monitor activity in the changing pandemic context and to identify clinical outputs, key themes and learning points. Eight PDSA cycles were performed, including video outpatient clinics, multidisciplinary team meetings, virtual ward rounds and TR for patients at home. Ten patients and 21 staff members provided feedback. Qualitative themes emerged including information technology, consultation environment, access to clinical notes and record keeping, clinical considerations, consent, patient and staff feedback, and feasibility. COVID-19 accelerated the implementation of TR at DMRC, allowing maintenance of service during lockdown. TR was acceptable to patients but placed a significant burden on staff. Practical suggestions for establishing a TR service are provided alongside challenges and limitations.

Effectiveness of motor-cognitive dual-task exercise via telerehabilitation in Alzheimer’s disease: An online pilot randomized controlled study

ObjectiveIt is important to investigate the effectiveness of delivering the rehabilitation service using remote communication technologies, for conditions that face-to-face treatment is not possible. This study aimed to investigate the effectiveness of exercise treatment via home-based telerehabilitation (TR) in Alzheimer’s disease (AD). MethodsTwenty participants who were diagnosed as having the early-middle stage of AD were randomized into a TR group and control group. The TR group received real-time motor-cognitive dual-task exercise treatment via video conferencing, and the control group received no intervention for 6 weeks. The primary outcomes were Mini-Mental State Examination, Timed Up&Go Test, and the 5 Times Sit&Stand Test, and the secondary outcomes were One-leg Stance Test (OLST), Katz Activities of Daily Living Scale (Katz-ADL), Functional Independence Measure, Geriatric Depression Scale-Short Form, Beck Anxiety Scale, Zarit Caregiver Burden Inventory (ZCBI) and the Warwick Edinburgh Well-being Scale. Outcomes were measured at baseline and post-treatment. ResultsThere was a significant difference in the mean change between the groups in favor of the TR group in all primary and secondary outcomes (p < .05), except for the ZCBI and OLST(p > .05). There was no significant difference in the comparison of the primary outcome measures between the groups in post-treatment results (p > .05); significant differences in all secondary outcome measures were observed in favor of the TR group (p < .05), except for the OLST, Katz-ADL, and ZCBI (p > .05). ConclusionTR may provide a significant change in cognition and mobility, improve functional independence, and caregiver’s well-being, and reduce anxiety and depressive symptoms in people with AD.

Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis.

BackgroundReal-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers.ObjectiveWe aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness.MethodsA literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane’s risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR’s effectiveness based on different treatments, controls, and outcome measures.ResultsThe search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI –0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment.ConclusionsWe found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care.Trial RegistrationPROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289

Recent trends in telerehabilitation of stroke patients: A narrative review.

Stroke is the main reason for disabilities worldwide leading to motor dysfunction, spatial neglect and cognitive problems, aphasia, and other speech-language pathologies, reducing the life quality. To overcome disabilities, telerehabilitation (TR) has been recently introduced. The aim of this review was to analyze current TR approaches for stroke patients' recovery. We searched 6 online databases from January 2018 to October 2021, and included 70 research and review papers in the review. We analyzed TR of 995 individuals, which was delivered synchronously and asynchronously. Findings show TR is feasible improving motor function, cognition, speech, and language communication among stroke patients. However, the dose of TR sessions varied significantly. We identified the following limitations: lack of equipment, software, and space for home-based exercises, insufficient internet capacity and speed, unavailability to provide hands on guidance, low digital proficiency and education, high cognitive demand, small samples, data heterogeneity, and no economic evaluation. The review shows TR is superior or similar to conventional rehabilitation in clinical outcomes and is used as complementary therapy or as alternative treatments. More importantly, TR provides access to rehabilitation services of a large number of patients with immobility, living in remote areas, and during COVID-19 pandemic or similar events.

Telerehabilitation As An Opportunity In Physiotherapy:

Telerehabilitation (TR) represents a new opportunity for physiotherapists to provide acceptable and high quality healthcare to their service users. The emerging evidence in the literature suggests the opportunity to integrate TR into the physiotherapy professional practice, even beyond the COVID-19 emergency, to ensure continuity of care up to the patient’s home and increase access to rehabilitation. One of the areas of application of TR is the management of non-specific low back pain (NLBP). NLBP has a high prevalence rate in the global population and it represents approximately 90% of low back pain cases. It is associated with the risk of chronicization, if not adequately managed, and extremely high costs associated with the treatment. Objective: to develop a proposal for a diagnostic-therapeutic care path (DTCP) on the use of TR in the management of patients with low back pain, taking into consideration the Italian legislation and the best scientific evidence available in the literature. Materials and methods: the bibliographical research in the literature was carried out on the electronic databases MEDLINE, PEDro, Embase, Trip database and Google Scholar was used to access the full-text of some articles. Discussion: the proposed DTCP for the management of the patient with low back pain takes into account the strengths and limitations of TR described in the literature and may represent a national reference model for the application of TR in patients with NLBP who access the outpatient territorial rehabilitation service. However, this proposal needs to be adapted to the specific socio-legislative regional context.