A Pilot Trial of Telerehabilitation for Chronic Stroke Survivors: A Case-series Study of Three Individuals.

Background: We designed a telerehabilitation (TR) program for stroke patients based on reports from other countries and adapted the program for use by individual patients. Herein, we describe the clinical courses of three stroke survivors who used the TR program. Cases: All three individuals were community-dwelling chronic stroke survivors. Patient 1 (P1) was a 50-year-old man who presented with severe paralysis of the right upper and lower extremities caused by left cerebral hemorrhage. Patient 2 (P2) was a 56-year-old woman who presented with severe paralysis of the left upper and lower extremities caused by right cerebral hemorrhage. Patient 3 (P3) was a 55-year-old man who presented with severe paralysis of the left upper and lower extremities caused by right cerebral hemorrhage. The TR program was conducted through a web conference system that allowed therapists and patients to interact with each other. The intervention consisted of 30-min sessions every 2 weeks for 6 months. The clinical courses and outcomes of the patients differed, but we identified positive changes in physical activity (number of steps) and participation (expansion of life-space) in addition to improvements in functional impairments (e.g., motor paralysis and balance order) in each patient. All three patients were highly satisfied with the TR program. Discussion: The results observed in this case series suggest that TR programs are a viable intervention in Japan. TR programs can reduce barriers to continued rehabilitation after discharge and can encourage increased activity and participation.

Perspectives of patients with osteoarthritis for using digital technology in rehabilitation at a public community centre in the Cape Metropole area: A qualitative study.

Objectives: To explore the perspectives of people with osteoarthritis (OA) on the use of digital technology into their rehabilitation program, including their awareness, views on accessibility, affordability and willingness to accept digital modalities for rehabilitation delivery. Methods: A qualitative, descriptive design was conducted. Patients with OA who receive care at a public community rehabilitation centre in the Western Cape, South Africa were eligible to participants. Semi-structured interviewed were conducted and Atlas.ti 23 software was used for thematic analysis. Results: The findings showed that the participants had limited awareness and exposure to telerehabilitation (TR), along with minimal digital literacy and skills. They were sceptical about the effectiveness of TR and concerned about the inherent lack of physical interactions with health professionals. However, some acknowledged TR's potential benefits for accessibility, convenience, family involvement and long-term community health improvement. Participants were willing to learn more about TR. Conclusion: Considering the benefits of TR in lower resource settings such as South Africa, investment to increase awareness and patient education and training in TR may assist in enhancing access and quality of care. Resources dedicated to TR and management buy-in in low-and-middle income countries (LMICs) is necessary to facilitate the fit-for-context roll-out of TR.

Supporting delivery of remote pulmonary rehabilitation across different healthcare contexts: A multi-national study.

Purpose: This study aimed to understand factors that health professionals, from a variety of healthcare contexts and countries, believed support remote delivery of pulmonary rehabilitation (PR); and to develop a targeted intervention to support implementation of remote PR. Methods: A 3-phase participatory action-research process was employed, across three study hubs in three countries (NZ, India, USA), representing diverse healthcare delivery contexts. Phase 1 employed focus groups of health professionals working in PR; data were analysed qualitatively with transcripts coded against two implementation frameworks (Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR)). Findings informed development of an online toolbox to support delivery of remote PR (Phase 2), which was evaluated using semi-structured interviews (Phase 3). Results: 20 health professionals participated across all study phases. Factors considered to influence implementation of remote PR were consistent across diverse healthcare contexts and related to staffing availability, skills and confidence, and equipment and technology accessibility. An online toolbox provided support for enhancing knowledge and confidence, but was not able to address all implementation barriers. Discussion: Key factors to support clinicians deliver remote PR are common across different healthcare contexts, suggesting broader telerehabilitation implementation strategies may be applicable across healthcare environments.

Effects of telerehabilitation-implemented core stability exercises on patient-reported and performance-based outcomes in total knee arthroplasty patients: randomised controlled trial.

BACKGROUND: Face-to-face access to exercise programs, including standard exercises (SE) and core stability exercises (CSE), can be challenging for many total knee arthroplasty (TKA) patients. OBJECTIVES: To investigate the effects of adding CSE to SE on patient-reported and performance-based outcomes in TKA patients using telerehabilitation (TR). METHODS: Group 1 (SE, n = 21) and Group 2 (SE+CSE, n = 21). Follow-up included videoconferences (1-8 weeks) and telephone calls (9-12 weeks). Assessments (preoperatively and at 1st, 2nd, and 3rd postoperative months) included; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): functional level, Visual Analogue Scale (VAS): pain intensity, Copenhagen Knee Range of Motion (ROM) Scale (CKRS): knee ROM, Short Form-12 (SF-12) and World Health Organization Quality of Life Brief Version (WHOQOL-BREF): quality of life, 30-s Chair-Stand Test: muscle strength, and Stair Climb Test: locomotor performance. RESULTS: All assessments showed a significant improvement after treatment in group 1 (p < .001, Cohen's d = 0.315 to 0.959) and group 2 (p < .001, d = 0.445 to 0.901). There was no significant difference between groups in knee flexion ROM (p > .05). Group 2 achieved better results in functional level (p = .001 to 0.003,d = -0.334 to 1.207), pain intensity (p = .030,d = -0.334), knee extension ROM (p = .015,d = -0.374), quality of life (p = .001 to 0.046,d = -0.308 to -1.366), muscle strength (p = .002 to 0.016,d = -0.779 to -1.030), and locomotor performance (p = .004 to 0.009, d = 0.404 to 0.954). CONCLUSION: SE and SE+CSE via TR enhance patient-reported and performance-based outcomes in post-operative TKA patients, with CSE providing additional benefits. These results support using CSE in TR programs for TKA and encourage further research on TR.

Combined Treatment of Face-to-Face Physical Therapy and Telerehabilitation in Workers with Whiplash Syndrome.

Objective: Interventions through telerehabilitation have shown positive effects in various clinical conditions, facilitating the return to work of the working population. This study aimed to compare conventional, center-based physiotherapy versus an intervention combining home- and center-based treatment for whiplash syndrome in workers enrolled in a mutual insurance company, evaluating differences in the number of face-to-face sessions and the duration of sickness absence. The secondary aim was to assess the acceptability and usability of the telerehabilitation intervention. Methods: The study population (n = 387) comprised workers aged 16 to 65 years who required physiotherapy due to whiplash (ICD-9 847.0). The main outcome variable was the number of face-to-face sessions. The duration of sickness absence was also calculated. A survey was also conducted to determine patient acceptance and usability of the platform. The analyses were adjusted for sex, age, occupation, and the center where the physiotherapy treatment was administered. Results: The number of face-to-face physiotherapy sessions dropped significantly, from 9 to 7, due to the implementation of telerehabilitation. This decrease was not associated with a longer duration of sickness absence. The difference in the median duration of sickness absence between patients who had not undergone telerehabilitation and those who had undergone telerehabilitation was -1 [95% CI= (-6 to 2)]. Conclusion: Telerehabilitation reduces the number of face-to-face physiotherapy sessions needed, which can reduce the care burden in physiotherapy centers and avoid the need for patients to travel (with a corresponding reduction in transportation costs), without increasing the duration of sickness absence.

The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial.

Lung diseases have profound effects on the aging population. We aimed to hypothesize and investigate the effect of remote pulmonary telerehabilitation and motor imagery (MI) and action observation (AO) methods on the clinical status of elderly chronic obstructive pulmonary disease (COPD) patients. Twenty-six patients were randomly assigned to pulmonary telerehabilitation (PtR) or cognitive telerehabilitation (CtR) groups. The programs were carried out 3 days a week for 8 weeks. The 6-min walk test (6MWT), modified Medical Research Council dyspnea score, blood lactate level (BLL), measurement of peripheral muscle strength (PMS), and electromyography activation levels of accessory respiratory muscles were the main outcomes. There was a statistically significant improvement (p < 0.05) in both groups in the 6MWT distance and in secondary results, except for BLL. Generally, in the mean muscle activity obtained from the electromyography measurement after the program, there were statistically significant increases in the PtR group and decreases in the CtR group (p < 0.05). There was a statistically significant increase in PMS in both groups. An active muscle-strengthening program has the same benefits as applying the muscle-strengthening program to the patient as MI and AO. CtR can be a powerful alternative rehabilitation method in respiratory patients who cannot tolerate active exercise programs.

Effects of an e-Media-Supported, Exercise-Based Phase II Cardiac Rehabilitation in Coronary Artery Bypass Grafting Surgery Patients: A Randomized Controlled Trial.

Background and objective Coronary artery bypass grafting (CABG) surgery patients undergo cardiac rehabilitation (CR) programs postoperatively to improve their course of recovery. The effectiveness of traditional CR programs is hampered by time constraints, financial burdens, transportation issues, and geographic restrictions. The coronavirus 2019 (COVID-19) pandemic and technological advances have led to the emergence of home-based CR programs using e-media, thereby improving accessibility. This study aimed to analyze the effects of e-media-supported, exercise-based phase II CR in post-CABG patients. Methods A single assessor-blinded randomized controlled trial (RCT) was conducted at a tertiary care hospital to analyze the effectiveness of a validated e-media-supported, exercise-based phase II cardiac rehabilitation in CABG Patients. A total of 40 subjects were included in the study based on the inclusion and exclusion criteria. The subjects were then randomly assigned to two groups: the experimental group received e-media-supported exercise and the control group received routine care. The duration of the intervention was three months. The outcome measures used were functional capacity, left ventricular ejection fraction (LVEF), quality of life, and physical activity (PA). Statistical analysis was conducted using SPSS Statistics v. 22.0 (IBM Corp., Armonk, NY). Results After three months of intervention, the mean distance covered during the six-minute walk test (6MWT) showed a significant increase in both the control and experimental groups. The experimental group demonstrated a statistically significant improvement compared to the control group (p<0.001). Furthermore, the experimental group showed significant improvements in the rate of perceived exertion (RPE), LVEF, and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) and Global Physical Activity Questionnaire (GPAQ) scores compared to the control group (all p<0.001). Conclusions Based on our findings, the e-media-supported, exercise-based phase II cardiac rehabilitation is feasible and safe, and significantly improved functional capacity and enhanced quality of life. The PA level of the experimental group was higher than controls at the 12-week follow-up after CABG.

Validation of tele-assessment of disability and health after stroke using WHODAS 2.0 through video call in a middle-income country.

BACKGROUND: The validity, reliability, and accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for face-to-face assessment in the stroke population are well established. However, the validity and reliability of WHODAS 2.0 through tele-assessment remain uncertain. OBJECTIVE: To assess the reliability, agreement, internal consistency, criterion and discriminant validity of WHODAS 2.0 when administered through video calls. METHODS: A longitudinal methodological study included fifty individuals with chronic stroke. Both in-person and video call assessments were conducted, and their sequence was randomized. The reliability was determined using the Intraclass Correlation Coefficient (ICC2,1). Measurement errors were assessed using the standard error of measurement (SEM) and smallest detectable change (SDC). Internal consistency was assessed using Cronbach's α. Criterion validity was determined by conducting Pearson's correlation coefficient analysis between in-person and video call assessments. Discriminant validity was examined using the Receiver Operating Characteristic (ROC) curve to distinguish disability levels, with the Modified Rankin Scale as the reference standard. RESULTS: The participants had a mean age of 56.10 ± 10.8 years, with an equal distribution of genders. Adequate reliability was observed between the two methods (ICC2,1 = 0.88; 95% CI = 0.79-0.93; p < 0.001), and internal consistency was also adequate (Cronbach's α = 0.88). The criterion validity revealed a strong correlation (r = 0.78; p < 0.001). Discriminant validity demonstrated satisfactory accuracy in distinguishing disability levels via video call (AUC = 0.67; p = 0.04). DISCUSSION: This study offers evidence supporting the validity and reliability of the WHODAS 2.0 assessment through video call. Teleassessment using WHODAS 2.0 proves suitable for individuals who have had a stroke, enabling remote evaluation and care.

'Making a connection': a qualitative study of experiences from a cancer telerehabilitation program.

PURPOSE: Specialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilitation program for people with cancer. METHOD: A qualitative study using semi-structured interviews was completed. Twenty-two cancer survivors were purposively sampled from the experimental group of a randomised controlled trial evaluating exercise-based cancer telerehabilitation delivered in groups using synchronous videoconferencing. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed inductively by thematic analysis. RESULTS: 'A feeling of connection' was the overarching theme. Participants perceived they connected with the health service, expert health professionals, and peers through participating in the telerehabilitation program. These connections provided a personalised rehabilitation experience and improved perceptions of physical and emotional well-being. Two subthemes suggested connection was facilitated by (1) the acceptability of telerehabilitation and (2) enhanced accountability to exercise. Participants felt disconnected when they were unable to participate in the program due to cancer treatment and side effects (e.g. fatigue), feeling unwell, and co-morbidities. CONCLUSION: We identified that telerehabilitation facilitated connections that enhanced the reach of exercise to cancer survivors. Our findings support using telerehabilitation to deliver specialised group-based exercise programs alongside more traditional models of care to increase participation in exercise among people with cancer.

Audiophonologopedic Telerehabilitation: Advantages and Disadvantages from User Perspectives.

INTRODUCTION: Technological advancements and the COVID-19 pandemic have highlighted the importance of digital tools for patient care and rehabilitation. This study explores user perspectives on telerehabilitation, comparing it to traditional methods and identifying criteria for determining its suitability for different patients and clinical conditions. METHODS: This study was carried out during the period of May-September 2021. Questionnaires were administered to 48 users in rehabilitation for audiophonologopedic and neurodevelopmental disorders in three rehabilitation centres in central Italy. RESULTS: The user responses predominantly emphasize the benefits of time saving (68.75%) and cost-efficiency (37.5%), specifically regarding time saving due to travel and expenses incurred to go to where the therapy is carried out. The disadvantages include increased distraction (60.42%) in following the instructions remotely and logistic problems (39.58%). Patients with hearing loss were subjected to a larger number of telerehabilitation sessions, positively rating this alternative method. Patients with speech and language delay and autism spectrum disorder (ASD) prefer traditional treatment. DISCUSSION: This study reveals a favourable perception of telerehabilitation as a therapy approach to be regarded as a supplement or temporary option to the irreplaceable face-to-face one. More research, as well as a larger sample sizes, will be useful to increase the significance of the correlations reported in this study.

The Era of Technology in Healthcare-An Evaluation of Telerehabilitation on Client Outcomes: A Systematic Review and Meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to synthesize the evidence and examine the effect of telerehabilitation interventions compared to face-to-face rehabilitation interventions on physical functioning, mental health, and pain reduction among employed individuals, 18 years old and older. METHODS: Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search syntax was created and inputted into Ovid Medline, APA PsycINFO, Ovid Embase, CINAHL, and Scopus. Critical appraisal of the included studies was conducted by two researchers to assess the risk of bias. A meta-analysis was completed for the randomized controlled trials and GRADE was used to determine the certainty of the evidence. RESULTS: A total of 16 out of 4319 articles were included in this review. This systematic review and meta-analysis found no significant differences between telerehabilitation interventions for physical functioning, mental health, and pain reduction outcomes compared to traditional rehabilitation interventions. CONCLUSION: The study findings indicate that telerehabilitation is less effective than in-person care for occupational therapy and physical therapy services. Future research may look at addressing the limitations of the current study to produce more conclusive results, such as exploring the length of the intervention, knowledge and confidence of intervention application, and follow-ups. SYSTEMATIC REVIEW REGISTRATION: This systematic review has been registered with PROSPERO under registration number CRD42022297849 on April 8th, 2022.

The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial.

Background: Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP. Objective: The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP. Methods: This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey. Results: In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89% (24/27) and 81% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference -0.91; odds ratio [OR] 0.78, 95% CI -5.96 to 4.14; P=.72), 4 weeks (mean difference -3.80; OR 1.33, 95% CI -9.86 to -2.25; P=.21), and 8 weeks (mean difference -3.24; OR 0.92, 95% CI -8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean -16.42, SD 7.30) and OBEG (mean -13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95% CI -2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference -0.39; OR 0.44, 95% CI -2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups. Conclusions: Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations.

A home-based hand rehabilitation platform for hemiplegic patients after stroke: A feasibility study.

Background: Patients with stroke often experience weakened upper limbs, making daily tasks difficult to perform. Although rehabilitation devices are available, patients often relapse post-discharge due to insufficient practice. We present a home-based hand telerehabilitation intervention using the iManus™ platform comprising a sensorized glove, a mobile app for the patients, and a therapist portal for monitoring patient progress. Objectives: This research aimed to examine the feasibility, safety, and effectiveness of a home-based telerehabilitation intervention in improving hand function for individuals with mild stroke. A qualitative approach was also used to explore users' experiences, perceived benefits, and challenges associated with using the platform in a home setting. Methods: In this single-case study, we delivered a hand telerehabilitation intervention to a chronic stroke patient with impaired hand function using the iManus™ platform. The intervention consisted of 40 home sessions over eight weeks. We assessed feasibility through user adherence and feedback obtained using a System Usability Scale (SUS) and a semi-structured interview with the participant and their informal caregiver. Safety was evaluated by monitoring pain levels using the Visual Analog Scale (VAS), and efficacy was determined by observing the changes in the fingers' range of motion using the iManus™ platform and clinical outcomes measures, namely the Fugl-Meyer Assessment (FMA) and Jebsen Taylor Hand Function Test (JTHFT). Results: Our participant completed all the assigned sessions, with each averaging 20 min. Usability scored 77.5 out of 100 on the SUS. User feedback from the interviews revealed improved mobility and control over therapy as benefits, indicating room for improvement in the intervention's adaptability and functionality. During the intervention, the participant noted no pain increase, and the telerehabilitation platform recorded range of motion improvements for all finger and wrist joints, excluding wrist extension. The FMA scores were 43 at T0, 53 at T1, and 56 at T2, while the JTHFT scores were 223 at T0, 188 at T1, and 240 at T2. Conclusions: This single case study demonstrated the preliminary feasibility, safety, and efficacy of a novel home-based hand intervention for stroke survivors. The participant showed improved hand functions, good adherence to the program, and reported satisfaction with the intervention. However, these results are based on a single-case study, and further large-scale studies are needed before any generalization is recommended.

Online Intensive Cardiac Rehabilitation Program for Japanese Patients With Coronary Artery Disease　- A Pilot Study Protocol.

Background: A comprehensive cardiac rehabilitation (CR) program is recommended for coronary artery disease (CAD). However, many facilities do not have established programs for dietary guidance and patient education, resulting in an exercise-based CR program and limited efficacy for secondary prevention. Methods and Results: A pilot study will be conducted to develop an online Japanese-style intensive cardiac rehabilitation (J-ICR) program for Japanese patients with CAD and will examine adherence, safety, and efficacy. Twenty-four patients diagnosed with stable CAD will be randomly assigned in a 1 : 1 ratio to either an early or late-phase group. The program will comprise the following four parts: exercise sessions; dietary education centered on "the Japan diet"; mindfulness; and group support, with a frequency of 3 h per session, once a week for 12 weeks (a total of 36 h). The primary endpoint will be program feasibility, determined by examining its adherence. Physical examination and function, stress-coping skills, risk of classic CAD (e.g., lipid profile, glucose tolerance, and blood pressure), and dietary changes will be assessed as secondary endpoints. Conclusions: The online J-ICR program is designed as a comprehensive CR program for Japanese patients with CAD. If this program shows high adherence and an improvement in CAD risk factors, its secondary prevention effect should be verified with appropriately powered randomized trials at multiple centers.

Identifying data elements and key features to design a telerehabilitation system for speech and language disorders in children with hearing impairments in Iran: A cross-sectional study.

Background and Aims: Designing and implementing telerehabilitation systems would require the identification of data elements to meet disabled people's needs. An in-depth study on the identification and validation of data elements can help design and implement telerehabilitation systems successfully. Therefore, this study aimed to identify and validate data elements to design a telerehabilitation system for the speech and language disorders of hearing-impaired children in Iran. Methods: This descriptive cross-sectional study was conducted in three steps including literature review, focused group discussion, and Delphi technique implementation to extract and validate data elements. In the first step, the literature on electronic databases was reviewed to extract the data elements of telerehabilitation systems, and nine studies were selected based on the inclusion criteria. In the second step, a focused group discussion was held to review and classify the extracted data elements. Finally, the Delphi technique was employed to validate the drafted data elements. Results: In total, 352 data elements were extracted from the literature review. Finally, 102 data elements in 10 categories (Demographic and Clinical information of the disabled person, Clinical history, Demographic information of the provider, Customization of exercises, Reminders, Online and offline counseling, and training, Reporting, Key features of the system, Evaluation of the progress of the disabled person) were classified and validated by experts as essential data elements to design a telerehabilitation system for the speech and language disorders of hearing-impaired children. Conclusions: The necessary data elements were proposed as the foundations to design a telerehabilitation system for the speech and language disorders of hearing-impaired children. These data elements help design and implement telerehabilitation systems successfully so that such systems can easily be provided for children with hearing disabilities.

Efficacy of Self-Natural Posture Exercise (SNPE) programs on chronic low back pain: A randomized controlled feasibility trial with waitlist control.

BACKGROUND: Low back pain (LBP) is a significant source of disability and decreased quality of life. The Self-Natural Posture Exercise (SNPE) intervention can be used effectively in many cases, but feasibility and impact has not been fully explored. OBJECTIVE: The current study explores the feasibility and efficacy of face-to-face (FtF) and virtual (Vir) SNPE programs on chronic low back pain. METHODS: This is a randomized single-blinded waitlist control study with 10 participants in the FtF group (age 45.8 ± 2.89) and 9 in the Vir group (age 52.2 ± 2.3). Participants had low to moderate low back pain for > 3 months. Those who would eventually become the Vir group served initially as a waitlist control (Con) group. The FtF group received 12 weeks of in-person exercise training sessions conducted and the Vir group received weekly recorded training videos created by and featuring the same instructor. Measured outcomes included feasibility assessed by rate of retention and rate of attendance, level of low back pain (Oswestry Disability Index, Visual Analogue Scale), quality of life (36-Item Short Form Health Survey 1.0), muscular pressure pain threshold, and muscle tone. Analysis was done via repeated measures ANOVA and Wilcoxon tests. RESULTS: Rates of retention were 80% in the FtF group and 78% in the Vir group. Attendance rates were 88% in the FtF group and 60% in the Vir group. ODI, VAS, and some SF-36 domains improved in both the FtF and Vir groups. Overall, the FtF group improved in more domains and by a larger degree than the Vir group and both groups improved relative to Con. CONCLUSION: A 12-week SNPE program, done virtually or in person, shows promise in improving ODI, VAS, and some SF-36 domains. FtF appears to be more effective. Future studies would benefit from sampling a larger and more diverse population.

Prerequisites and barriers to telerehabilitation in patients with neurological conditions: A narrative review.

BACKGROUND: A 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. OBJECTIVE: To address the prerequisites and barriers for implementing TR in neurorehabilitation in the light of present findings. METHODS: A 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. RESULTS: Barriers 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. CONCLUSION: Since 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.

A rapid review protocol of physiotherapy and occupational therapy telerehabilitation to inform ethical and equity concerns.

Background: Telerehabilitation (TR) has emerged as a feasible and promising approach for delivering rehabilitation services remotely, utilizing technology to bridge the gap between healthcare providers and patients. As new modalities of virtual care and health technologies continue to emerge, it is crucial to stay informed about the growing landscape of virtual care to ensure that telehealth service delivery is ethical and equitable, and improves the quality of services and patient outcomes. Objective: The primary objective of this article is to present the protocol of a rapid review to examine the equity-related aspects surrounding the implementation of TR. This includes a comprehensive analysis of the ethical dimensions and fairness concerns linked to this practice. Methods: A rapid review protocol was developed in accordance with Cochrane Rapid Reviews Methods Guidance. Medline and EMBASE databases were searched between January 2010 and March 2023. Study selection and data extraction will be conducted in two phases (Phase I) by two independent reviewers and subsequently (Phase II) by a single reviewer. Our study will utilize the PROGRESS-Plus and Equitable virtual rehabilitation in the metaverse era framework to identify dimensions where potential inequities may exist within TR interventions. Results: This rapid review is anticipated to enhance our knowledge of TR in the fields of physiotherapy and occupational therapy, with a specific focus on its influence on ethical and equitable practices and providing a foundation for informed decision-making and improved patient care. Conclusion: This rapid review will contribute to the advancement of our understanding of TR within physiotherapy and occupational therapy. Through synthesizing existing evidence, this study not only addresses current gaps in knowledge but also offers valuable insights for future research and clinical practice in TR services.

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

BACKGROUND: Tele-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). OBJECTIVE: To explore available literature on the nature of training and education, research and practice of TNR in LMICs. METHODS: Following 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. RESULTS: We 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. CONCLUSION: There 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.

Effectiveness of an online multimodal rehabilitation program in long COVID patients: a randomized clinical trial.

BACKGROUND: Digital interventions are expected to facilitate the treatment of patients suffering from Long COVID. This trial assesses the effectiveness of a multimodal rehabilitation program -comprising both online and synchronous components- in managing the characteristic symptoms of Long COVID and, consequently, in improving quality of life. It also aims to identify which changes in measured variables from baseline (T0) to post-intervention (T1) predict an improvement in quality of life. METHODS: A blind randomized controlled trial was conducted with two parallel groups: (1) the control group, which received usual treatment from the primary care physician and (2) the intervention group, which received usual treatment in addition to an online multimodal rehabilitation program. The data were collected at two time points: prior to the start of the intervention and three months after it. The main outcome variable was quality of life, encompassing both mental health and physical health-related quality of life. Sociodemographic and clinical variables were collected as secondary variables. RESULTS: A total of 134 participants (age 48.97 ± 7.64; 84.33% female) were included and randomized into the control group (67 participants) and the intervention group (67 participants). Comparative analyses conducted before and after the intervention showed a significant improvement in the mental health-related quality of life of the participants who received the intervention, with a mean increase of 1.98 points (p < 0.05). Linear regression analyses revealed that both received the intervention (b = 3.193; p < 0.05) and an increased self-efficacy (b = 0.298; p < 0.05) were predictors of greater improvement in mental health-related quality of life.