During the COVID-19 pandemic, the need to reduce infection rates has prompted medical practitioners to consider innovative forms of care, such as telerehabilitation [1]. Described as rehabilitation administered over telecommunications devices, telerehabilitation is primarily used to assist patients with pronounced physical, cardiac, or neurological conditions [2]. It includes technologies as diverse as transtelephonic ECGs captured during home exercises or virtual reality games designed to assist stroke patients [2]. Before adopting telerehabilitation modalities, however, providers should be well-versed in their benefits and challenges.
Several studies have examined the efficacy of telerehabilitation with varying results. Before evaluating this evidence, it is important to note that most telerehabilitation studies have focused on synchronous rehabilitation techniques [3]. Furthermore, many studies are limited in scope, given their small sample sizes, short follow-up times, and brief discussions of barriers [1].
For patients who require physiotherapy following upper limb interventions or total arthroplasty, telerehabilitation appears to have promising benefits [1]. Researchers have also reported positive telerehabilitation outcomes for patients with chronic nonmalignant musculoskeletal pain [1]. As for patients in need of neurorehabilitation, findings appear contradictory [4]. While some studies report better outcomes for neurology patients following telerehabilitation in comparison to in-person rehabilitation, others report no substantial difference between the two techniques [4]. Similar findings have been reported for cardiac patients [4]. While it is unclear whether telerehabilitation is preferable to in-person rehabilitation, the fact that telerehabilitation seems at least as effective as in-person care is reassuring.
Telerehabilitation has many benefits that further endorse its adoption. For one, costs associated with telerehabilitation tend to be lower than those associated with in-person care [3]. Internet connections and smart devices are not prohibitively expensive in many cases, and changes to government-funded and private insurance policies have accommodated the use of virtual medical modalities [1, 3]. Additionally, telerehabilitation can increase the likelihood that patients will adhere to their treatment plans in the long term while promoting a better quality of life, physical state, and mental function [3].
Despite its versatility and demonstrated benefits, telerehabilitation also poses certain difficulties worth considering before adopting these technologies. Technologies may fail, as occurred in one study analyzing the SAPHIRE stationary bike system [2]. During 27% of the 39 training sessions completed, the ECG connection faltered, impairing data collection [2]. Moreover, the transition to telerehabilitation techniques, particularly in a region with limited resources, can be difficult [5]. Not only may costs be prohibitive, but patient and practitioner attitudes can also impede a community’s likelihood of accepting telerehabilitation [5]. External challenges also pose significant problems. They include but are not limited to concerns about data security, uncertain medicolegal implications, and non-standardized guidelines [5].
To ensure the best possible transition to these technologies, establishing evidence-based awareness of telerehabilitation’s advantages and shortcomings is a necessary step [5]. Medical practitioners should receive adequate training in the relevant technologies [5]. Establishing an optimal telerehabilitation regime might require extensive patient-physician collaboration, so practitioners should be attentive to patients’ preferences and creative in the face of demotivation [6]. By being adaptable, physicians can use telerehabilitation to provide patients with successful remote care.
References
[1] A. Turolla et al., “Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer?,” Physical Therapy, vol. 100, no. 8, p. 1260-1264, August 2020. [Online]. Available: https://doi.org/10.1093/ptj/pzaa093.
[2] A. Peretti et al., “Telerehabilitation: Review of the State-of-the-Art and Areas of Application,” JMIR Rehabilitation and Assistive Technologies, vol. 4, no. 2, p. 1-9, July-December 2017. [Online]. Available: https://doi.org/10.2196/rehab.7511.
[3] J. P. Bettger and L. J. Resnik, “Telerehabilitation in the Age of COVID-19: An Opportunity for Learning Health System Research,” Physical Therapy, vol. 100, no. 11, p. 1913-1916, November 2020. [Online]. Available: https://doi.org/10.1093/ptj/pzab053.
[4] P. Seron et al., “Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview,” Physical Therapy, vol. 101, no. 6, p. 563-564, June 2021. [Online]. Available: https://doi.org/10.1093/ptj/pzab053.
[5] C. F. D. Leochico, “Adoption of telerehabilitation in a developing country before and during the COVID-19 pandemic,” Annals of Physical and Rehabilitation Medicine, vol. 63, no. 6, p. 563-564, June 2020. [Online]. Available: https://doi.org/10.1016/j.rehab.2020.06.001.
[6] I. Fioratti et al., “Strategies for a safe and assertive telerehabilitation practice,” Brazilian Journal of Physical Therapy, vol. 25, no. 2, p. 113-116, March-April 2021. [Online]. Available: https://doi.org/10.1016/j.bjpt.2020.07.009.