A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial

Determining a capability framework and training requirements to support provision of physiotherapy via telehealth in an Australian public tertiary health setting: a multi-methods study

BACKGROUND

Inadequate clinician training and support is a primary challenge to physiotherapists' adopting telehealth. Training must be underpinned by relevant capability frameworks and co-developed to meet the needs and preferences of the existing physiotherapy workforce.

OBJECTIVE

Establish a capability framework for delivery of care via telehealth and understand training requirements to achieve competency specifically for the publicly funded physiotherapy workforce.

METHODS

Sequential multi-methods study design. Phase 1: Physiotherapists with telehealth experience participated in a 2-round e-Delphi process to establish consensus on core capability framework domains (Round 1, n = 29; Round 2, n = 26). Phase 2: Physiotherapists (n = 35) subsequently rated their current knowledge and confidence for each capability item. Phase 3: Participatory focus groups, involving physiotherapists (n = 37) from six facilities, identified theoretical and practical domains most relevant to local contexts via thematic analysis.

RESULTS

Fifty-three capability items were produced across eight domains (Compliance, Patient privacy and confidentiality, Patient safety, Technology Skills, Telehealth Delivery, Assessment and Diagnosis, Care Planning and Management, Access and Equity). Knowledge and confidence were ranked lowest within the Technology Skills domain (% respondents reporting high levels of confidence = 28.6%-42.9%), and highest in Telehealth Delivery (% respondents reporting high levels of confidence = 54.2% -80%). Focus groups identified technology skills, risk management (patient safety) and superuser support as priority areas for training.

CONCLUSION

Physiotherapists identified additional local training competencies to compliment the 53-item capability framework. Adopting a sequential multi-methods and participatory approach successfully produced a training package framework suitable for implementation in a public outpatient setting.

Exploring participant satisfaction with an eHealth intervention for low back pain and knee osteoarthritis: Enhancing physiotherapy access in rural Australia

INTRODUCTION

Accessing health services in rural Australia is challenging and innovative solutions to meet residents' needs are required. Research into eHealth is crucial as it offers potential solutions to these challenges. The study aimed to assess participants' satisfaction and experience with an eHealth physiotherapy intervention at improving physical function for low back pain and knee osteoarthritis in rural Australia.

METHODS

Telephone surveys collected data on participant satisfaction and experiences. Satisfaction was rated on a scale of 0-10, and the data was presented descriptively and compared between groups (eHealth and usual care) using Mann-Whitney U tests. Participant experiences with the pilot trial were gathered using open-ended questions, categorised and presented descriptively.

RESULTS

75/156 (48%) participants responded to the satisfaction survey. Overall satisfaction was significantly higher for the eHealth group, median = 9 [IQR: 8-10] compared with the usual care group, median = 8 [IQR: 5-9] (p = 0.025). Satisfaction was also significantly higher in the eHealth group for all secondary measures in the study, including accessibility to healthcare practitioner (p = 0.001), time to contact physiotherapist (p = 0.011), cost of intervention (p < 0.001) and distance travelled (p < 0.001). For the pilot experiences, inconvenient aspects such as completing forms/administration and travel were significantly higher in the usual care group, while difficulties with exercises, were significantly higher in the eHealth group (p = 0.005).

CONCLUSIONS

An eHealth intervention for physiotherapy is acceptable to patients with knee osteoarthritis and low back pain in rural Australia. Future telehealth interventions should pay special attention to participant's exercise workload and motivation.

REsource Support To Optimize REcovery (RESTORE) scoping review: Evaluating aftercare resources for burn survivors

BACKGROUND

Burn survivors report limited resources as they transition to their communities after initial hospitalization. The aim of this project is to review literature that identifies resources provided to burn survivors and their supporters after discharge to their communities.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to examine the following literature databases: PubMed, EMBASE, Web of Science, PsycInfo, and CINAHL. The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set for burn injury provided a framework to categorize resource content.

RESULTS

Of the 637 articles screened, 27 met inclusion criteria. Data extraction identified resources categorized into the following ICF components: Body Functions, Activities and Participation, and Environmental Factors.

CONCLUSION

This review uses a conceptual framework to provide an overview of current published resources to support burn survivors following hospitalization. The identified resources addressed content such as health professionals, programs, psychological functioning after burn injury, scar management, and virtual resources. Based on the ICF framework, some gaps in resource content were noted such as pain, thermoregulation, interpersonal relationships, and self-care. Findings reveal relative strengths and gaps in resources, which can be used to better support burn survivors following hospitalization.

Effectiveness of telerehabilitation on the International Classification of Functioning, Disability, and Health framework outcomes during the COVID-19 pandemic: A systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to synthesize and analyze the evidence on the effectiveness of telerehabilitation categorized according to the International Classification of Functioning, Disability, and Health (ICF) outcomes for physical therapy (PT) during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Studies were identified using the Physiotherapy Evidence Database (PEDro), Scopus, PubMed, EMBASE, and other sources of data. Randomized controlled trials comparing telerehabilitation with the control group (i.e., no treatment/usual care) were included. Standard meta-analysis techniques were applied to assess the effectiveness of telerehabilitation. Outcome measures were categorized according to the domains of the ICF.

Results

Among the 134 studies that met the eligibility criteria, the majority of findings demonstrated significant improvements across all domains of the ICF following telerehabilitation as compared to the control group, regardless of participant groups. Only 9 of 134 studies were included in the meta-analysis. Six studies enrolled individuals with COVID-19 and the remaining three enrolled individuals with knee osteoarthritis (OA) who were unable to access services at the clinic. Compared with the control group, the Borg-Rating-of-Perceived-Exertion scale, as reflected in an impairment domain, was significantly lower in individuals with COVID-19 who received telerehabilitation (3 studies, n = 135; standardized mean difference (SMD) -1.82, 95% CI -2.77 to -0.86). Compared with that in the control group, 30-second sit-to-stand test (3 studies, n = 122; SMD 0.88, 95% CI 0.52-1.25) and 6-minute-walking test (4 studies, n = 221; SMD 0.83, 95% CI 0.42-1.24), as reflected to an activity domain, showed significant improvement in the telerehabilitation group. Conversely, there was no effectiveness of telerehabilitation on an activity domain as measured by the timed up and go test in people with knee OA (3 studies, n = 111; SMD -0.45, 95% CI -1.19 to 0.30).

Conclusion

This study provides evidence supporting the effectiveness of telerehabilitation across all domains of the ICF, with significant improvements observed in the impairment and activity domains for individuals with COVID-19. These improvements are particularly evident in the meta-analysis findings such as perceived exertion, leg strength, and functional capacity.

Adverse events associated with the delivery of telerehabilitation across rehabilitation populations: A scoping review

OBJECTIVE

This scoping review aimed to map existing research on adverse events encountered during telerehabilitation delivery, across rehabilitation populations. This includes identifying characteristics of adverse events (frequency/physical/non-physical, relatedness, severity) and examining adverse events by different modes of telerehabilitation delivery and disease states.

INTRODUCTION

Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic for remote service delivery. However, no prior scoping review, systematic review, or meta-analysis has identified and summarized the current primary research on adverse events in telerehabilitation. Understanding adverse events, such as falls during physiotherapy or aspiration pneumonia during speech therapy, is crucial for identifying limitations and optimizing delivery through risk mitigation and quality indicators. This understanding could also help to improve the uptake of telerehabilitation among clinicians and patients. This review addresses this gap by summarizing published literature on adverse events during telerehabilitation.

METHODS

The review followed the Joanna Briggs Institute framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The review protocol was registered and published on Open Science Framework. A comprehensive search across multiple databases (MEDLINE ALL/EMBASE/APA PsycINFO/CENTRAL/CINAHL) was conducted. Screening, extraction, and synthesis were performed in duplicate and independently. Data extraction followed the Template for Intervention Description and Replication framework and also involved extraction on authors, publication year (pre- or post-COVID), population, sample size, and modes of telerehabilitation delivery (asynchronous, synchronous, hybrid). For synthesis, data were summarized quantitatively using numerical counts and qualitatively via content analysis. The data were grouped by intervention type and by type of adverse event.

INCLUSION CRITERIA

This scoping review included qualitative and quantitative studies published between 2013-2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery were included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants were excluded.

RESULTS

The search identified 11,863 references, and 81 studies were included in this review with a total of 3,057 participants (mean age:59.3 years; females:44.6%). Modes of telerehabilitation delivery (whether asynchronous, synchronous or hybrid) used in the studies included videoconferencing (52), phone calls (25), text messaging (4), email (6), mobile apps (10), and internet-based virtual reality systems (3). A total of 295 adverse events occurred during 84,534 sessions (0.3%), with the majority being physical (e.g., falls or musculoskeletal pain), non-serious/non-severe/mild, and unrelated to (i.e., not caused by) to the telerehabilitation provided.

CONCLUSIONS

From the 81 included studies, telerehabilitation was delivered with related adverse events being rare, and mostly characterized as mild/non-severe. A comparable occurrence of adverse events (~30%) was found between asynchronous and synchronous telerehabilitation studies. When categorized by disease type, cardiac telerehabilitation studies had the most frequent adverse events. Detailed reporting of telerehabilitation interventions and adverse event characteristics is recommended for future studies (i.e., use of TIDieR reporting guidelines). Telerehabilitation has the potential to make rehabilitation services more accessible to patients; however, more evidence on the safety of telerehabilitation is needed.

Visual analysis of patient safety research hotspots and trends in the context of telemedicine based on Web of Science

To analyze the research status, hotspots, and trends of patient safety in the context of international telemedicine, and to provide reference for future research in various countries. The literature pertaining to patient safety within the realm of telemedicine was systematically retrieved from the Web of Science core collection database, encompassing the period from January 2010 to December 2023. Visual analysis of publication quantity, primary authorship, and keyword trends was conducted using CiteSpace (6.2R6) software. The geographical distribution of research focus was visualized through VOSviewer software and SCImago Graphica software, while research institutions were depicted using VOSviewer software and Highcharts software. Data organization was facilitated by Excel 2019 software. A total of 5356 related articles were included, and the number of published papers showed an overall upward trend, and the countries and institutions with the largest number of papers were the United States and Harvard University, respectively, and a stable core author research population had not yet been formed in this research field. Through keyword analysis, it can be seen that the research hotspots mainly focus on the research on the influencing factors of patient safety in the context of telemedicine, the research on the application value of telemedicine, and the research on coping strategies that affect patient safety. The research on patient safety in the context of telemedicine in foreign countries has a certain depth and breadth, which has important reference significance for improving the medical quality and patient safety of Internet hospitals in various countries.

Real-time video telerehabilitation shows comparable satisfaction and similar or better attendance and adherence compared with in-person physiotherapy: a systematic review

QUESTION

How does physiotherapy delivered by real-time, video-based telerehabilitation compare with in-person delivery for the outcomes of attendance, adherence and satisfaction?

DESIGN

Systematic review of randomised control trials indexed in PubMed, CINAHL, Embase, Cochrane and PEDro on 12 March 2024.

PARTICIPANTS

Adults aged > 18 years.

INTERVENTION

Physiotherapy delivered via real-time video telerehabilitation.

OUTCOME MEASURES

Attendance, adherence and satisfaction.

RESULTS

Eight studies were included for attendance (n = 1,110), nine studies for adherence (n = 1,190) and 12 studies for satisfaction (n = 1,247). Telerehabilitation resulted in attendance at treatment sessions that was 8% higher (95% CI -1 to 18) and adherence to exercise programs that was 9% higher (95% CI 2 to 16) when compared with in-person physiotherapy. Satisfaction was similar with both modes of delivery (SMD 0.03 in favour of telerehabilitation, 95% CI -0.23 to 0.28). The level of certainty assessed by GRADE ranged from very low to low, primarily due to inconsistency and high risk of bias.

DISCUSSION

Attendance at appointments among participants assigned to telerehabilitation was somewhere between similar to and considerably higher than among control participants. Adherence to self-management with telerehabilitation was better than with in-person delivery, although with some uncertainty about the magnitude of the effect. Reported satisfaction levels were similar between the two modes of treatment delivery. Given the significance of attendance, adherence and satisfaction for successful outcomes, telerehabilitation offers a valuable alternative mode for physiotherapy delivery.

CONCLUSION

Real-time telerehabilitation has potentially favourable effects on attendance at treatment appointments and adherence to exercise programs, with similar satisfaction when compared with traditional in-person physiotherapy.

REGISTRATION

PROSPERO CRD42022329906.

Delivery of Allied Health Interventions Using Telehealth Modalities: A Rapid Systematic Review of Randomized Controlled Trials

Objectives: To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. Study design: A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Eligible trials: Trials were eligible for inclusion if they compared a comparable dose of face-to-face to telehealth interventions delivered by a neuropsychologist, occupational therapist, physiotherapist, podiatrist, psychologist, and/or speech pathologist; reported patient-level outcomes; and included adult participants. Data sources: MEDLINE, CENTRAL, CINAHL, and EMBASE databases were first searched from inception for systematic reviews and eligible trials were extracted from these systematic reviews. These databases were then searched for randomized clinical trials published after the date of the most recent systematic review search in each discipline (2017). The reference lists of included trials were also hand-searched to identify potentially missed trials. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 1. Data Synthesis: Fifty-two trials (62 reports, n = 4470) met the inclusion criteria. Populations included adults with musculoskeletal conditions, stroke, post-traumatic stress disorder, depression, and/or pain. Synchronous and asynchronous telehealth approaches were used with varied modalities that included telephone, videoconferencing, apps, web portals, and remote monitoring, Overall, telehealth delivered similar improvements to face-to-face interventions for knee range, Health-Related Quality of Life, pain, language function, depression, anxiety, and Post-Traumatic Stress Disorder. This meta-analysis was limited for some outcomes and disciplines such as occupational therapy and speech pathology. Telehealth was safe and similar levels of satisfaction and adherence were found across modes of delivery and disciplines compared to face-to-face interventions. Conclusions: Many allied health interventions are equally as effective as face-to-face when delivered via telehealth. Incorporating telehealth into models of care may afford greater access to allied health professionals, however further comparative research is still required. In particular, significant gaps exist in our understanding of the efficacy of telehealth from podiatrists, occupational therapists, speech pathologists, and neuropsychologists. Protocol Registration Number: PROSPERO (CRD42020203128).

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

INTRODUCTION

The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future.

AIM

The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions.

METHODS

To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.

RESULTS

The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure.

CONCLUSIONS

It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.