Telerehabilitation Research Articles

A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke.

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program.Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports.Results: Enrollees (n = 13) were median age 61 (IQR 52–65.5), and 129 (52–486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3–56.7) h. Non-compliance doubled during weeks 7–12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5–12.5) points in the arm and 1 (−0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached.Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR.Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.

Social Network Structure Is Related to Functional Improvement From Home-Based Telerehabilitation After Stroke.

Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based TR program for stroke patients and evaluated which social factors might be related to motor gains and reduced depressive symptoms.Methods: Stroke patients (n = 13) with arm motor deficits underwent supervised home-based TR for 12 weeks with routine assessments of motor function and mood. At the 6-week midpoint, we mapped each patient's personal social network and evaluated relationships between social network metrics and functional improvements from TR. Finally, we compared social networks of TR patients with a historical cohort of 176 stroke patients who did not receive any TR to identify social network differences.Results: Both network size and network density were related to walk time improvement (p = 0.025; p = 0.003). Social network density was related to arm motor gains (p = 0.003). Social network size was related to reduced depressive symptoms (p = 0.015). TR patient networks were larger (p = 0.012) and less dense (p = 0.046) than historical stroke control networks.Conclusions: Social network structure is positively related to improvement in motor status and mood from TR. TR patients had larger and more open social networks than stroke patients who did not receive TR. Understanding how social networks intersect with TR outcomes is crucial to maximize effects of virtual rehabilitation.

Demographic Characteristics and Functional Levels of Patients With Fragility Fractures Who Accept Tele-rehabilitation as an Alternative to Face-to-face Home Rehabilitation

There is a gap in the evidence on telerehabilitation (TR) for people with fragility fractures. It is unclear whether this group with recent falls who are often frail with cognitive changes will accept tele-rehabilitation and functional gains can be achieved using this approach. Prospective observational study of consecutive patients admitted with femoral or pelvic fracture to a hospital-based home rehabilitation service (HRS) between January and November 2017. Using tablets, multidisciplinary rehabilitation was provided via videoconferencing and use of exercise apps. Patients chose a face-to-face visit or TR. Information on demographic characteristics, functional levels, the total number of therapy sessions, TR episodes, reasons for non-acceptance of TR, and patient-reported experience using TR was collected. Fifty-two patients with hip and pelvic fractures were admitted to the HRS and 35 (67.3%) received TR. Patients who did not accept TR were older, frailer and more likely to be female than those who received TR. Of the 17 who did not receive TR, 6 were deemed unsuitable by staff due to hearing, vision or cognitive problems and 3 refused. The TR group achieved acceptable functional gains. In the TR group on average, participants had 13.63 (± 7.29) home visits however they only elected to have 3.43 (± 2.48) sessions delivered via TR. TR was acceptable to a subset of hip fracture patients but face-to-face was the preferred mode of delivery. More research is needed to understand patients’ preferences and beliefs, and the influence of clinician attitudes on uptake of TR.

Opportunities and barriers for telerehabilitation during Coronavirus outbreak

Opportunities and barriers for telerehabilitation during Coronavirus outbreak

Effectiveness of Tele-rehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis.

Background:Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR).Methods and Results:We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients’ functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I2 = 93%). It also improved patients’ quality of life (Minnesota Living with Heart Failure Questionnaire: MD −6.62; CI 95% [−11.40; −1.84]; I2 = 99%). No major adverse events were reported during TR exercise.Conclusion:TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.

Telerehabilitation: An Alternative Service Delivery Model for Pediatric Neurorehabilitation Services at a Tertiary Care Center in India

Background: Neurorehabilitation is facing a unique challenge as COVID-19 circumstances magnify the access and resource barrier in healthcare provision; and are causing disruption in the continuity of care of children with disability. An affirmative action is required as a ‘Disability-inclusive response to the COVID-19 crisis.’ This study thus aimed to determine if Telerehabilitation (TR) model of service delivery is a feasible and effective alternative for pediatric neurophysiotherapy. Methodology: This is a clinical trial conducted on children diagnosed with developmental delay or neurological condition and referred for Physiotherapy at a tertiary care center. Clinical consultation was provided remotely with the use of real time interactive technology. Outcome indicators used were: 1)Timely receipt of physiotherapy services; 2) Child’s clinical outcomes; and 3) Familiy’s acceptability and satisfaction with the provision of TR. Results: With regards to feasibility, the most common issues faced during TR sessions were technical; lack of time with mother; child’s medical illness, etc. Children’s clinical outcomes showed improvement reported as ‘acquisition of developmental skills’ and ‘the use of appropriate functional behaviors to meet their needs’. Families showed satisfaction with TR services however, expressed the need for in-person sessions. Conclusion: In the current scenario, TR may enhance the capacity of families to meet the needs of their child with a disability by connecting them with health care providers, resources and supports; thus ensuring continuity of care. While guidelines to tackle this unprecedented situation continue to develop, TR demonstrates the potential as an alternative rehabilitation strategy thereby ameliorating the impact of social distancing on underprivileged children. However, some psychosocial factors act as barriers to feasibility of TR in pediatric population.

Global Online Interest in Telehealth, Telemedicine, Telerehabilitation, and Related Search Terms Amid the COVID-19 Pandemic: An Infodemiological Study

Background. Catalyzed by the coronavirus disease 2019 (COVID-19) pandemic that restricted non-essential travel, awareness of the value of telehealth increased among healthcare providers and consumers. Telerehabilitation, a subset of telehealth and telemedicine, refers explicitly to the remote provision of rehabilitation services. However, since the majority were new to the concept of telerehabilitation, which was commonly interchanged with other related terms (e.g., telehealth, telemedicine, teletherapy, telecare, telepractice, etc.), and relevant internationally recognized guidelines were not available pre-pandemic, many turned to online resources to learn more about it. However, such might create confusion with the terminologies. Objective. This infodemiological study aimed to examine the trends of global online interest in telehealth, telemedicine, telerehabilitation, and related search terms. The authors hypothesized an abrupt rise in stakeholders' awareness regarding the virtual method of delivering or accessing healthcare, including rehabilitation services, during the pandemic. Method. Using Google Trends™, we obtained and analyzed the trends of global online interest in telehealth, telemedicine, telerehabilitation, and other related search terms from 2004 to October 2020. Results. The frequencies of searches for “telehealth,” “telemedicine,” and “telerehabilitation” peaked in March 2020, which coincided with the lockdown in many countries, including the Philippines. The term “telehealth” was more frequently searched in western countries, while “telemedicine” was relatively common in eastern countries. Among the terms synonymous with telerehabilitation, “teletherapy” was most commonly used worldwide, with “teletherapy speech” being the most searched related topic. The Philippines had the most significant number of times the term “telerehabilitation” was searched in the past decade. Conclusion. During the COVID-19 pandemic, there is an overall global demand for the acquisition of knowledge related to telehealth, telemedicine, telerehabilitation, and related search terms. Of particular interest, tele rehabilitation, however, varied in terminologies across countries, with “teletherapy” mainly being used worldwide and “telerehabilitation” being primarily searched in the Philippines. Therefore, arriving at a consensus across professional societies and operationally defining different interrelated terms could help streamline our current or future guidelines and programs.

Addressing the changing rehabilitation needs of patients undergoing thoracic surgery.

The rehabilitation needs of individuals undergoing thoracic surgery are changing, especially as surgical management is increasingly being offered to patients who are at risk of developing functional limitations during and after hospital discharge. In the past rehabilitative management of these patients was frequently limited to specific respiratory physiotherapy interventions in the immediate postoperative setting with the aim to prevent postoperative pulmonary complications. In the past two decades, this focus has shifted toward pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. While there is increased interest in (p)rehabilitation interventions the majority of thoracic surgery patients are however currently on their own with respect to progression of their exercise and physical activity regimens after they have been discharged from hospital. There are also no formal guidelines supporting the referral of these patients to outpatient rehabilitation programs. The current evidence regarding rehabilitation interventions initiated before, during, and after the hospitalization period will be briefly reviewed with special focus on patients undergoing surgery for lung cancer treatment and patients undergoing lung transplantation. More research will be necessary in the coming years to modify or change clinical rehabilitation practice beyond the acute admission phase in patients undergoing thoracic surgery. Tele rehabilitation or web-based activity counseling programs might also be interesting emerging alternatives in the (long-term) postoperative rehabilitative treatment of these patients.

The Effect of an Interactive Tele Rehabilitation Program on Balance in Older Individuals

Objective: To investigate the effect of a home-based interactive telerehabilitation program on balance performance in older people, and to compare the results with a nonsupervised home exercise (NHE) program. Subjects and Methods: A total of 50 participants (35 females), aged 65–90 years, were included in the study. The subjects were randomly assigned to one of three groups as the interactive telerehabilitation home exercise group (ITHE), NHE group or control group. The ITHE and NHE groups exercised three times per week for 8 weeks. The outcome measures were the Berg Functional Balance Scale (BBS), Timed Up and Go Test (TUG), Sway Balance Mobile Application, Trait Anxiety Inventory (TAI), and the World Health Organization Quality of Life Instrument-Older Adults Module (WHL). Results: In the control group, no difference was observed in the TUG and BBS scores, at the end of the 8 weeks compared with preexercise (pre-ex), whereas these scores increased significantly in the NHE (TUG: P < 0.001, BBS: P < 0.001) and ITHE groups (TUG: P < 0.001, BBS: P = 0.003). The WHL scores increased significantly in all three groups, and no difference was observed in the TAI scores. There was a significant difference in SWAY score only in the telerehabilitation group compared with pre-ex (P < 0.001). Conclusions: Although NHE and ITHE were effective on the improvement of balance, mobility and reduction of fall risk in older individuals, this effect was found to be greater in the ITHE group. Quality of life increased in all groups, but no change in anxiety level was observed.

Commentary: Conquering insurmountable challenges: The importance of tele-rehabilitation.

Commentary: Conquering insurmountable challenges: The importance of tele-rehabilitation.

Commentary on: Effect of a comprehensive E-rehabilitation Intervention alongside conventional stroke rehabilitation on disability and Health-Related quality of life: A Pre-Post comparison.

Missing (Letter).

Effects of Tele Rehabilitation on Occupational Therapy Services in the Coronavirus Disease 2019 Era: An Umbrella and Mapping Review with Meta–Meta-Analysis

Effects of Tele Rehabilitation on Occupational Therapy Services in the Coronavirus Disease 2019 Era: An Umbrella and Mapping Review with Meta–Meta-Analysis

Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research.

Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.

PIN166 Health-Related Quality of Life (HRQOL) Outcomes and Potential Interventions in Patients Diagnosed with COVID-19.

To identify evidence on the Quality of life measures and potential interventions in patients diagnosed with COVID-19. A systematic literature review was conducted based on a reproducible search strategy designed to identify HRQoL outcomes in COVID-19 patients. Evidence indexed in Embase/MEDLINE (until 30th June 2020) and clinical trials.gov (until 8th July 2020) was screened for inclusion per pre-defined criteria. 621 abstracts were screened followed by an evaluation of 91 full text citations. 10 studies were finally included and analysed. Among included studies, a study conducted in China investigated the effect of respiratory rehabilitation on pulmonary function, functional status (6-minute walk distance), QoL (SF-36 scores), functional independence and mental status (Self-rating depression and anxiety scales) in elderly patients. The QoL scores showed statistically significant improvement in the patients receiving respiratory rehabilitation besides improvement in the anxiety associated with COVID-19 diagnosis and isolation. Another study investigated the effect of progressive muscle relaxation (PMR) on anxiety and sleep quality and reported significant improvement in sleep quality and anxiety scores based on sleep state self-rating scale (SRSS) and Speilberger State-trait Anxiety scale (STAI). A case report examined the benefits of DBT (Dialectical behavior therapy) based psychological intervention on a pregnant patient and reported improvement in psychological features with reduction in HAMD-17 (Hamilton Depression scale 17), HAMA (Hamilton Anxiety scale) and MADRS (Montgomery-Asberg Depression rating scale) scores. Other ongoing studies Investigated interventions like pulmonary physiotherapy, pulmonary and motor rehabilitation, post discharge tele rehabilitation (resistive training, breathing and aerobic exercise) and behavioral interventions. A majority of these involved EuroQoL assessment. COVID-19 is unfolding as a complex illness affecting multiple organs with currently unknown long-term effects. Interventions aimed at managing physical and mental QOL measures are necessary particularly in hospitalized patients. These interventions need to be potentially combined with hospitalization and post discharge management protocols.

Tele-Rehabilitation for Individuals with Multiple Sclerosis and Mobility Disorders—A Feasibility and Pilot Study

Objective: To determine the feasibility of conducting an 8-week physical therapist (PT)-guided tele-rehabilitation (TR) program for persons with multiple sclerosis (MS) and mobility deficits. Design, setting, and participants: This feasibility study had a pre–post-intervention, non-randomized design. Nine subjects with a confirmed diagnosis of MS without a clinical exacerbation in the last year were selected from the MS Center of Excellence at UF Health Jacksonville (UFHJ). Inclusion criteria included demonstrated mobility deficits on initial examination, basic computer competency, and a home with high-speed internet connection. Examinations were performed face-to-face, pre–post-intervention in the Neurology Research Clinic at UFHJ. TR was delivered to the patient’s homes in Florida and South Georgia. Intervention: An informed consent was obtained prior to initial examination. Self-reported measures included quality of life (QOL) and fatigue. Mobility measures included timed 10-m walk, five times sit to stand, and Berg balance scale. Following inclusion, home safety was evaluated and computer equipment was installed. TR intervention utilized the Jintronix® web-based platform system with a kinetic camera that demonstrated selected exercises by an avatar, allowing for real-time feedback on the quality of performance as well as tracking of adherence. The individualized exercises were assigned by the evaluating PT based on the initial assessment. Subjects participated in weekly TR visits with the prescribing PT to further monitor and adjust the therapy program. Main outcome measures: Primary outcome measures were patient satisfaction, safety, and compliance. Secondary outcome measures were projected travel cost, self-reported fatigue and QOL, and mobility testing measures. To compare the TR effect on mobility, a comparator persons with MS group was selected retrospectively. Eight persons with MS referred from the MS Center at UFHJ for outpatient (OP) PT from January 2018 through September 2019 were identified by UFHJ electronic database search for ICD 10 code G35. The inclusion criteria for mobility deficits and functional measurements were the same as those in TR group. Results: Eight subjects completed the TR program with no adverse events. They reported satisfaction, demonstrated compliance, and saved $8,487 in projected travel costs. All TR subjects noted improvement in self-reported fatigue, QOL, or mobility measures. Improvement in mobility measures had wide variability but did not differ between TR and OP groups. Conclusions: The 8-week PT-monitored TR program was shown to be feasible, safe, and well received by persons with MS. Larger studies focused on specific dysfunction leading to mobility deficits and longer intervention times will be necessary to determine efficacy.

Multi-Lateral Teleoperation Based on Multi-Agent Framework: Application to Simultaneous Training and Therapy in Telerehabilitation.

In this paper, a new scheme for multi-lateral remote rehabilitation is proposed. There exist one therapist, one patient, and several trainees, who are participating in the process of telerehabilitation (TR) in this scheme. This kind of strategy helps the therapist to facilitate the neurorehabilitation remotely. Thus, the patients can stay in their homes, resulting in safer and less expensive costs. Meanwhile, several trainees in medical education centers can be trained by participating partially in the rehabilitation process. The trainees participate in a “hands-on” manner; so, they feel like they are rehabilitating the patient directly. For implementing such a scheme, a novel theoretical method is proposed using the power of multi-agent systems (MAS) theory into the multi-lateral teleoperation, based on the self-intelligence in the MAS. In the previous related works, changing the number of participants in the multi-lateral teleoperation tasks required redesigning the controllers; while, in this paper using both of the decentralized control and the self-intelligence of the MAS, avoids the need for redesigning the controller in the proposed structure. Moreover, in this research, uncertainties in the operators' dynamics, as well as time-varying delays in the communication channels, are taken into account. It is shown that the proposed structure has two tuning matrices (L and D) that can be used for different scenarios of multi-lateral teleoperation. By choosing proper tuning matrices, many related works about the multi-lateral teleoperation/telerehabilitation process can be implemented. In the final section of the paper, several scenarios were introduced to achieve “Simultaneous Training and Therapy” in TR and are implemented with the proposed structure. The results confirmed the stability and performance of the proposed framework.

Knowledge, Attitude, and Barriers to Telerehabilitation-Based Physical Therapy Practice in Saudi Arabia.

(1) Telerehabilitation (TR) is a part of telemedicine involved in providing rehabilitation services to people in remote locations. TR in physical therapy in the kingdom of Saudi Arabia is still in its infancy and its implementation may pose different challenges in the physical therapy settings. The purpose of this nation-wide survey is to explore physiotherapists (PTs) knowledge, attitudes, and barriers towards implementation of TR in physical therapy settings; (2) Methods: A 14 item questionnaire was developed and mailed to PTs working in hospitals and rehabilitation centers across 13 provinces in Saudi Arabia; (3) Results: 347 PTs responded. Results are as follows: 58.8% (n = 204) of PTs reported that they had sufficient knowledge about TR. About31.7% (n = 110) of PTs reported that their hospital and rehabilitation center had installed TR, yet only 19.9% (n = 69) utilized the TR facility. Image-based TR was more frequently used (n = 33) as compared to sensor-based TR (n = 29) and virtual reality TR (n = 10).The main barriers were technical issues and cost related to implement TR in physical therapy settings; and (4) Conclusions: There is a relatively high number of PTs with self-reported knowledge about TR, however facilities and usage were limited. The main barriers were technical issues, staff skills, and the high cost involved in the introduction of TR in the PT-based health care settings.

Balancing Access with Technology: Comparing In-Person and Telerehabilitation Berg Balance Scale Scores among Stroke Survivors.

Purpose: Stroke survivors living in rural and remote communities experience challenges in accessing specialized rehabilitation services. Access to balance assessment after stroke is an essential aspect of the physiotherapy assessment. Telerehabilitation (TRH) can eliminate access disparities; however, adoption into practice has been limited. Our primary objective was to examine agreement between Berg Balance Scale (BBS) scores obtained through TRH and those obtained through traditional in-person assessment of community-dwelling individuals with stroke. Method: Two raters administered the BBS to 20 community-dwelling individuals with stroke, using both TRH and traditional in-person approaches. The order of assessments and rater assignment was randomized. Interrater reliability between the methods was assessed using Krippendorff's α reliability estimate. A survey was then administered to examine the participants' perceptions of the two means of assessment. Results: Excellent interrater agreement was found between TRH and in-person assessment (κ=0.97; 95% CI: 0.96, 0.99), and responses regarding patients' perceived hearing and understanding of instructions as well as perceived safety were comparable. In addition, the vast majority of participants agreed or strongly agreed that they would use TRH for future physiotherapy sessions. Conclusions: The results of this study support administration of the BBS using TRH technology; this could improve access to balance assessment for stroke survivors in rural and remote communities.

Estrategias de rehabilitación en los pacientes pediátricos con infección por Sars-CoV-2/Covid-19

Objetivo. Realizar una revisión de la literatura sobre rehabilitación en niños en tiempos de la pandemia por Covid-19, sintetizando las recomendaciones expuestas por los documentos de consenso internacional y la bibliografía reciente. Además, exponer la manera como estas recomendaciones se puedan aplicar bajo la forma de un protocolo multidisciplinar desde la tele-rehabilitación.Materiales y métodos. Se realizó una búsqueda bibliográfica de la literatura existente y de los consensos internacionales centrados en el diagnóstico, la presentación clínica y la rehabilitación en niños durante la pandemia por Covid-19, desde el 01 de enero de 2020 al 31 de mayo del 2020, en las bases de datos e Pubmed, Science Direct, Clinical Key, Embase y Ovid. Con base en estas recomendaciones se ofrecen pautas para ser implementadas en la modalidad de telerehabilitación en niños.Resultados. Se encontró un total de 471 artículos de los cuales 34 cumplieron con los criterios de inclusión.Conclusiones. La rehabilitación infantil plantea el objetivo de disminuir la limitación de la actividad y mejorar la participación en todos los entornos. A casusa de la pandemia actual, la necesidad de confinamiento ha llevado a que buena parte de la rehabilitación se implemente en casa, mediante ayudas tecnológicas conocidas como ‘tele-rehabilitación’. No hay que olvidar que esta modalidad de tratamiento debe ser interdisciplinar y enfocada en la prevención de problemas a mediano y largo plazo. El impacto del Covid-19 aún es incierto y la rehabilitación no debe parar, pues el objetivo es brindar herramientas para conseguir la máxima funcionalidad de todos los niños.

Telerehabilitation for Older Adults

Telerehabilitation (TR) uses technology to deliver physical and cognitive rehabilitation. TR supports many clinical categories pertaining to geriatric patients. Benefits from TR include reduced travel demands, longer consultation durations, and greater access to specialists for older patients. Despite these advantages many older adult patients and clinicians are reluctant to select TR as part of their care. The aim of this review is to summarize the evidence supporting the use of TR in the care of older adult patients.