Competencies required by patients and health professionals regarding telerehabilitation: A scoping review

Tools and devices for telerehabilitation in pediatric and adult cystic fibrosis patients: a scoping review

BACKGROUND

Cystic fibrosis (CF) is a genetic disorder affecting multiple organs, primarily the lungs. Rehabilitation is crucial in managing respiratory symptoms. Telerehabilitation, which provides remote rehabilitation services via digital platforms, gained importance during the COVID-19 pandemic. Despite its growing use, there is little clarity on the available tools and devices for CF telerehabilitation.

OBJECTIVE

This scoping review aims to map the existing tools and devices used in telerehabilitation for pediatric and adult CF patients.

METHODS

The review was conducted following the Joanna Briggs Institute methodology, using the PRISMA-ScR checklist. Comprehensive searches were performed across seven databases, alongside grey literature. Studies involving CF patients and telerehabilitation interventions were included. Data were extracted and analyzed both numerically and thematically.

RESULTS

Eighteen studies were included, involving 622 CF patients. The review identified 10 platforms, seven telemonitoring devices, and three rehabilitation devices. Most studies focused on motor rehabilitation with individual, synchronous sessions. Commonly used platforms included Zoom, Skype, and Google Meet, while only three studies used platforms specifically designed for CF.

CONCLUSIONS

Telerehabilitation for CF is in its early stages and less developed than for other conditions. There is a need for dedicated platforms and devices that address CF patients' specific motor and respiratory needs. Future efforts should focus on developing these tools to improve patient engagement and outcomes.

Prerequisites and Barriers to Telerehabilitation in Patients With Neurological Conditions: A Narrative Review

BackgroundA field of study that uses telerehabilitation (TR) is neurorehabilitation; however, standards for medical and technological applications, medicolegal and ethical regulations, and other aspects of neuro-TR are still being developed.ObjectiveTo address the prerequisites and barriers for implementing TR in neurorehabilitation in the light of present findings.MethodsA narrative review was conducted based on specific questions about the prerequisites for neuro-TR and barriers to its implication. According to a foreground search strategy in the context of neurorehabilitation using TR in neurological patient population, PubMed, EMBASE and Cochrane databases were searched and reviewed.ResultsBarriers and prerequisites for neuro-TR were mostly grouped under the categories of administrative/organizational, human (beneficiaries/providers), technical, and ethical. Apart from the technical framework, knowledge and the presence of an administrative leader responsible for overseeing TR are crucial prerequisites. The internet and technological constraints rank highest among the barriers.ConclusionSince neuro-TR is relatively new with minimal guidelines and regulations, highly technologic, and lack of established practices, it is imperative to determine and fully comprehend the criteria for its uses. After the prerequisites are established, it is imperative to recognize and address implementation constraints, which may differ depending on the community's infrastructure and neurologic condition.

Research, education and practice of tele-neurorehabilitation in low and middle-income countries: A Scoping Review

BackgroundTele-neurorehabilitation (TNR) allows for remote delivery of rehabilitation services for those with neurological disabilities. Despite growing global interest and uptake, its adoption remains challenging in Low-and-Middle-Income-Countries (LMICs).ObjectiveTo explore available literature on the nature of training and education, research and practice of TNR in LMICs.MethodsFollowing PRISMA-ScR guidelines and predefined selection criteria, four databases were screened. Quality assessment was performed using the Joanna Briggs Institute tools. Relevant data was extracted to using a data extraction form in Microsoft Excel and were narratively synthesised under Education/training, Research and Clinical Practice of TNR.ResultsWe identified no formal structured training courses/programs for TNR users/providers. Sessions were mainly delivered as part of a research project. The included studies highlighted the need to engage stakeholders in TNR research and improve digital-literacy among healthcare providers/users. Development and use of clinical decision-making-tools, models of TNR suitable for varied populations and prior area-mapping were a few suggestions for clinical/research practice.ConclusionThere is an immense need to develop academic/structured programs for TNR to build capacity among providers/users in LMICs. Practice must adhere to principles of safety, effectiveness, and based on high quality clinical-guidelines suitable to the context to ensure optimal uptake and practice of TNR in LMICs.

Developing a competency model for telerehabilitation therapists and patients: Results of a cross-sectional online survey

Telerehabilitation is a new form of care that provides digital access to rehabilitative services. However, it places many demands on the users-both patients and therapists. The aim of this study was to determine the requirements and competencies needed for successful usage, identify person- and context-specific differences and develop a competency model. We conducted two cross-sectional online surveys with telerehabilitation patients and therapists from Germany during June-August 2023. The adjusted dataset of 262 patients and 73 therapists was quantitatively analyzed including descriptive and bivariate statistics. Group differences were assessed using t-tests or U-tests. The development of two telerehabilitation competency models was guided by a competency modeling process. The surveys show that patients need to gather program information before program start, follow therapist's instructions, adapt therapy, deal with health problems, as well as motivate and remind oneself during the program. Therapists need to inform and instruct patients, adapt therapy, carry out technical set-up and support, give medical support, guide and monitor patients, give feedback, motivation and reminder, as well as documentation. The competency model for patients includes 23 and the model for therapists 24 core competencies, including various required areas of knowledge, skills, attitudes and experiences. The three most relevant competencies for patients are self-interest in the program, self-awareness and self-management. Also, disease severity, age, and language abilities can enable successful execution. Program type, technology affinity, and age significantly influence the rated relevance of competencies. The three most relevant competencies for therapists are therapeutic-professional skills, medical and telerehabilitation knowledge. The type of therapy practiced and language abilities can enable successful execution. Therapist's age, technology affinity, and job type significantly impact the rated relevance. The models should be applied to develop tailored training formats and support decisions on the selection of suitable therapists and patients for telerehabilitation.

Needed competence for registered nurses working at a patient-centred telehealth service aimed to engage and empower people living with COPD: A five-month participatory observational study

BACKGROUND

The global population of older aged 65 and over is increasing, which means an increase in people living with long-term health conditions and multimorbidity. Implementing new digital health technologies enables increased patient empowerment and responsibility, and the ability to respond to changes in their condition themselves, with less involvement of healthcare professionals. Important parameters need to be addressed for this digitally enabled empowerment to be successful, these include increased individual and organizational health literacy, the establishment of joint decision-making activities among patients and healthcare professionals, and efforts that target the individual's ability to manage their condition, which include education to increase skills and providing technology for self-monitoring.

OBJECTIVE

To identify needed competencies of digital healthcare professionals to be able to provide the needed services to service users with chronic obstructive pulmonary disease in a 24/7 digital healthcare service.

METHOD

Five registered nurses' work was observed weekly for five months. In total 13 participatory observations were conducted. Data from the observations was transcribed and analysed through inductive content analysis.

RESULTS

Five main categories were identified in the analysis; 1) tasks, 2) communication, 3) the relationships between the registered nurses, 4) service users, and 5) technology. These categories contain different competencies needed for registered nurses working in a digitalized healthcare system.

CONCLUSIONS

Future digital healthcare professionals will require several competencies, to be able to deliver proper care in a digital health community that goes beyond traditional healthcare competencies, including social, technological, and communication skills.

Impact of telehealth on stroke survivor-caregiver dyad in at-home rehabilitation: A systematic review

AIM

To examine studies involving the impact of telerehabilitation (TLR), tele-training and tele-support on the dyad stroke survivor and caregiver in relation to psychological, physical, social and health dimensions.

DESIGN

A systematic review was conducted.

DATA SOURCES

The following electronic databases were consulted until September 2023: PsycInfo, CINAHL, Eric, Ovid, PubMed, Scopus, Cochrane Central and Web of Science.

REVIEW METHODS

It was conducted and reported following the checklists for Reviews of PRISMA 2020 Checklist. Critical evaluation of the quality of the studies included in the review was performed with the Joanna Briggs Institute Checklists.

DATA SYNTHESIS

A total of 2290 records were identified after removing duplicates, 501 articles were selected by title and abstract and only 21 met the inclusion criteria. It included 4 quasi-experimental studies, 7 RCTs, 1 cohort study and 9 qualitative studies. The total number of participants between caregivers and stroke survivors was 1697, including 858 stroke survivors and 839 caregivers recruited from 2002 to 2022. For a total of 884 participants who carried out TLR activities in the experimental groups,11 impact domains were identified: cognitive/functional, psychological, caregiver burden, social, general health and self-efficacy, family function, quality of life, healthcare utilization, preparedness, quality of care and relationship with technology.

CONCLUSIONS

The results support the application of telehealth in the discharge phase of hospitals and rehabilitation centres for stroke survivors and caregivers. TLR could be considered a substitute for traditional rehabilitation only if it is supported by a tele-learning programme for the caregiver and ongoing technical, computer and health support to satisfy the dyad's needs.

IMPACT

Designing a comprehensive telemedicine programme upon the return home of the dyad involved in the stroke improves the quality of life, functional, psychological, social, family status, self-efficacy, use of health systems and the dyad's preparation for managing the stroke.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Perspectives of Decision Support System TeleRehab in the Management of Post-Stroke Telerehabilitation

Stroke is the main cause of disability among adults. Decision-making in stroke rehabilitation is increasingly complex; therefore, the use of decision support systems by healthcare providers is becoming a necessity. However, there is a significant lack of software for the management of post-stroke telerehabilitation (TR). This paper presents the results of the developed software "TeleRehab" to support the decision-making of clinicians and healthcare providers in post-stroke TR. We designed a Python-based software with a graphical user interface to manage post-stroke TR. We searched Scopus, ScienceDirect, and PubMed databases to obtain research papers with results of clinical trials for post-stroke TR and to form the knowledge base of the software. The findings show that TeleRehab suggests recommendations for TR to provide practitioners with optimal and real-time support. We observed feasible outcomes of the software based on synthetic data of patients with balance problems, spatial neglect, and upper and lower extremities dysfunctions. Also, the software demonstrated excellent usability and acceptability scores among healthcare professionals.

The Effectiveness of Preoperative Outpatient and Home Rehabilitation and the Impact on the Results of Hip Arthroplasty: Introductory Report

A total hip replacement is the treatment of choice for end-stage hip osteoarthritis. Rehabilitation performed before surgery (called prehabilitation) is used to improve the results of surgical treatment. However, the results of studies have not unquestionably confirmed the effectiveness of preoperative rehabilitation and its impact on the outcome of surgery. The aim of this study is to assess the effectiveness of preoperative outpatient and home rehabilitation in relation to a control group not subject to these forms of influence. A total of 61 patients qualified for primary hip arthroplasty were randomly assigned to a group with outpatient rehabilitation before surgery, exercises performed at home, or a group without any intervention before surgery. Three weeks after surgery, the patients were re-qualified and underwent three weeks of outpatient rehabilitation in the day rehabilitation department. The patients from all three groups were evaluated in terms of functionality and pain using point scales upon enrolment in the study, on admission to the day rehabilitation department, and after 3 weeks of rehabilitation in the department. A total of 50 subjects completed the study. The study results did not reveal statistically significant differences between preoperative rehabilitation and no intervention. Patients rehabilitated at home gave up self-therapy more often than those undergoing outpatient rehabilitation.

STASISM: A Versatile Serious Gaming Multi-Sensor Platform for Personalized Telerehabilitation and Telemonitoring

Telemonitoring and telerehabilitation have shown promise in delivering individualized healthcare remotely. We introduce STASISM, a sensor-based telerehabilitation and telemonitoring system, in this work. This platform has been created to facilitate individualized telerehabilitation and telemonitoring for those who need rehabilitation or ongoing monitoring. To gather and analyze pertinent and validated physiological, kinematic, and environmental data, the system combines a variety of sensors and data analytic methodologies. The platform facilitates customized rehabilitation activities based on individual needs, allows for the remote monitoring of a patient's progress, and offers real-time feedback. To protect the security of patient data and to safeguard patient privacy, STASISM also provides secure data transmission and storage. The platform has the potential to significantly improve the accessibility and efficacy of telerehabilitation and telemonitoring programs, enhancing patients' quality of life and allowing healthcare professionals to provide individualized care outside of traditional clinical settings.