Effectiveness of telerehabilitation based on real-time intervention between therapist and participants for improving physical function, activities of daily living and quality of life in people with stroke: A systematic review protocol.

BACKGROUND: There is a call for gathering more evidence on the effectiveness of telerehabilitation in stroke. In particular, a previous systematic review reported substantial variability in the types of technologies used in telerehabilitation interventions. The purpose of this study will be to summarize and synthesize findings on the effects of telerehabilitation based on real-time intervention between therapist and participants for patients with stroke. METHODS AND ANALYSIS: This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. This systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 25 May 2023 (registration number: CRD420234265527). Electronic searches will be performed in the following databases: MEDLINE, Pubmed, Web of Science, PsycINFO and CINAHL electronic databases, using a date range from inception to November 2023. We will include only randomized controlled trials for patients diagnosed with stroke who received telerehabilitation based on real-time interaction between therapist and patients. The exploration will be restricted to publications in the English language. Physical function, activities of daily living and quality of life are the outcomes. We will examine the changes of the outcomes at baseline, at the end of the intervention, and at specific time points during the follow-up after the intervention. DISCUSSION: This systematic review will provide evidence regarding telerehabilitation for people with stroke.

Rehabilitation interventions delivered via telehealth to support self-management of rheumatic and musculoskeletal diseases: A scoping review protocol.

BACKGROUND: Telerehabilitation is a term to describe rehabilitation services delivered via information and communication technology. Such services are an increasingly important component for the management of rheumatic and musculoskeletal diseases (RMDs). Telerehabilitation has the potential to expand the long-term self-management options for individuals with RMDs, improve symptoms, and relieve pressures on health care services. Yet, little is known about the variety of interventions implemented, and how they are being evaluated. Thus, this scoping review aims to identify and describe existing rehabilitation interventions delivered via telehealth for RMDs. Specifically, we aim to identify and summarize the key components of rehabilitation, the technology used, the level of health care professional interaction, and how the effectiveness of interventions is evaluated. METHODS: We will conduct this review following the latest JBI scoping review methodology and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). The 'Population-Concept-Context (PCC)' framework will be used, whereby the 'Population' is RMDs (≥18 years); the 'Concept' is rehabilitation; and the 'Context' is telehealth. Developed in collaboration with a subject Librarian, refined PCC key terms will be utilized to search (from 2011-2021) three electronic databases (i.e., Embase, Scopus, Web of Science) for articles published in English. Search results will be exported to the citation management software (EndNote), duplicates removed, and eligibility criteria applied to title/abstract and full-text review. Relevant information pertaining to the PCC framework will be extracted. Data will be summarized qualitatively, and if appropriate, quantitatively via frequency counts of the components comprising the 'Concept' and 'Context' categories of the PCC framework. DISCUSSION: Findings from the proposed scoping review will identify how telehealth is currently used in the delivery of rehabilitation interventions for RMDs. The findings will develop our understanding of such interventions and provide a platform from which to inform future research directions.

The effects of telerehabilitation in adults with complex biventricular congenital heart conditions: protocol for a multi-centre, randomised controlled trial-CH-FIT.

BACKGROUND: Accumulated evidence suggests that exercise training exerts beneficial effects on people with congenital heart conditions. These findings are predominantly derived from small, single-centre exercise trials conducted in outpatient rehabilitation facilities. In recent years, the delivery of exercise interventions remotely has increased through digital communications technology (telerehabilitation). However, very little research to date has been conducted into the efficacy of telerehabilitation in people with a congenital heart condition. AIMS: To evaluate the effects of a telehealth-delivered exercise intervention in people with a history of a surgical biventricular repair due to a congenital heart condition. METHODS: One hundred eligible adolescent (≥ 16 years) and adult participants living with a complex biventricular congenital heart condition will be recruited from four Australian sites and randomised to either (1) a 16-week telehealth-delivered combined (aerobic and resistance) exercise training programme of moderate-to-vigorous intensity or (2) usual care (control group), in a 1:1 allocation, with an 8-month follow-up. OUTCOMES OF INTEREST: The primary outcome will be the change in aerobic capacity expressed as peak oxygen uptake (VO2peak). Secondary outcomes will include changes in vascular function, muscle oxygenation, metabolic profile, body composition and musculoskeletal fitness, neurohormonal activation, neurocognitive function, physical activity levels, dietary and nutritional status, and quality of life. Outcomes will be assessed at baseline, 16 weeks, and 12 months (to determine longer-term maintenance potential). DISCUSSION: If found to be efficacious, telerehabilitation may be an alternative option for delivering exercise, improving health outcomes, and increasing accessibility to exercise programmes. Efficacy data is required to quantify the clinical significance of this delivery mode of exercise. TRIAL REGISTRATION: ACTRN12622000050752 Trial registration date: 17 January 2022 Trial registration URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382635&showOriginal=true&isReview=true Trial registry name: Australian and New Zealand Clinical Trials Registry.

Hand telerehabilitation for polytrauma patients following road traffic accidents.

OBJECTIVE: Aim: This study aimed to examine the characteristics of upper limb and shoulder injuries combined with chest trauma in road accident victims and evaluate the effectiveness of telemedical monitoring and a newly developed telerehabilitation model in patient recovery. PATIENTS AND METHODS: Materials and Methods: Our study incorporated 136 medical records of inpatients who had sustained upper extremity and chest injuries, constituting a retrospective group. Additionally, in the main group, we included 73 patients with similar injuries of the upper extremity and chest. RESULTS: Results: We analyze the functional results between the retrospective group and the main group, providing valuable insights into the effectiveness of traditional rehabilitation versus telerehabilitation. Focusing first on the average time spent on rehabilitation exercises per day, we observe a noticeable difference: while the retrospective group dedicated an average of 29}8 minutes daily, the main group invested more time, averaging 42}4 minutes. The retrospective group reported an average of 12}2 visits, in stark contrast to the main group, which averaged only 4}2 visits. The rehabilitators spent considerably less time with each patient in the main group (92}14 minutes) compared to the retrospective group (263}15 minutes), with a significant difference (p<0.005). The discovery in our study that there was no notable statistical difference in the functional outcomes, as evaluated by QuickDASH scores, between patients undergoing telerehabilitation and those receiving traditional rehabilitation is of significant importance. CONCLUSION: Conclusions: The findings reveal that telerehabilitation can significantly increase patient engagement in rehabilitation exercises, primarily due to its convenience and accessibility.

[The effectiveness of tele-rehabilitation for patients with multiple sclerosis during the COVID-19 pandemic in 2020-2021 was evaluated in this study]. / Effektivnost' telereabilitatsii patsientov s rasseyannym sklerozom v usloviyakh pandemii koronavirusnoi infektsii v 2020­2021 gg.

OBJECTIVE: To evaluate the effectiveness of telerehabilitation (TELEREBT) of patients with multiple sclerosis (MS) in the context of the coronavirus pandemic 2020-2021. MATERIAL AND METHODS: The study included 37 patients with MS who underwent a course of teleRBT. The course included 10 classes of 60 minutes for 10 days with a two-day break. Various questionnaires and scales were used to assess the effectiveness, as well as an assessment of the neurological status. RESULTS: 19 patients refused to participate in the program. The level of disability on the EDSS scale decreased from 4.86±1.19 at the initial level to 4.73±1.12 after the course of teleRBT, while no statistically significant changes were found. CONCLUSION: TeleRPT in patients can be an effective way to correct existing disorders. Further research is required to establish the effectiveness of teleRBT.

Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial.

BACKGROUND: Aging is associated with changes in the musculoskeletal system, including increased susceptibility to spine malalignments. Utilizing corrective exercises with a therapeutic emphasis can be beneficial in the elderly with thoracic spine hyperkyphosis. OBJECTIVE: This study aimed to investigate the effects of six weeks of telerehabilitation-based respiratory and corrective exercises on quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and chest expansion in the elderly with thoracic spine hyperkyphosis. METHODS: In this clinical trial, a total of 40 participants aged 60 and above with thoracic hyperkyphosis were randomly divided into the control (N = 20) and experimental (N = 20) groups. The experimental group performed the corrective exercises for six weeks (3 sessions per week). The control group performed general stretching exercises during the same time period. We measured the outcomes of quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and lung expansion before and after the intervention. Analysis of covariance (ANCOVA) was employed to analyze the data. A P-value ≤ 0.05 was considered statistically significant. RESULTS: Quality of life (P < 0.001, Effect Size (ES): 0.44), chest expansion (P < 0.001, ES: 0.56), thoracic kyphosis angle (P < 0.001, ES: 0.31), craniovertebral (P < 0.001, ES: 0.33), cranial (P < 0.001, ES: 0.38), and shoulder (P = 0.005, ES: 0.20) angles were significantly improved in the experimental group as compared with controls. However, no statistically significant difference was observed between the two groups in terms of physical ability (P = 0.251, ES: 0.04). CONCLUSION: It is therefore recommended that online corrective exercises be used in the rehabilitation protocol to improve the quality of life, posture, chest expansion, and disability in the elderly with thoracic kyphosis.

Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial.

BACKGROUND: Telerehabilitation whether perceived as less effective than in-person care for musculoskeletal problems. We aimed to determine if physiotherapy video conferencing consultations were non-inferior to in-person consultations for chronic knee pain. METHODS: In this non-inferiority randomised controlled trial, we recruited primary care physiotherapists from 27 Australian clinics. Using computer-generated blocks, participants with chronic knee pain consistent with osteoarthritis were randomly assigned (1:1, stratified by physiotherapist and clinic) in-person or telerehabilitation (ie, video conferencing) physiotherapist consultations. Participants and physiotherapists were unmasked to group assignment. Both groups had five consultations over 3 months for strengthening, physical activity, and education. Primary outcomes were knee pain (on a numerical rating scale of 0-10) and physical function (using the Western Ontario and McMaster Universities osteoarthritis index of 0-68) at 3 months after randomisation. Primary analysis was by modified intention-to-treat using all available data. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12619001240134. FINDINGS: Between Dec 10, 2019, and June 17, 2022, 394 adults were enrolled, with 204 allocated to in-person care and 190 to telerehabilitation. 15 primary care physiotherapists were recruited. At 3 months, 383 (97%) participants provided information for primary outcomes and both groups reported improved pain (mean change 2·98, SD 2·23 for in-person care and 3·14, 1·87 for telerehabilitation) and function (10·20, 11·63 and 10·75, 9·62, respectively). Telerehabilitation was non-inferior for pain (mean difference 0·16, 95% CI -0·26 to 0·57) and function (1·65, -0·23 to 3·53). The number of participants reporting adverse events was similar between groups (40 [21%] for in-person care and 35 [19%] for telerehabilitation) and none were serious. INTERPRETATION: Telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain. FUNDING: National Health and Medical Research Council.

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.

Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study.

BACKGROUND: Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. OBJECTIVE: This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. METHODS: Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. RESULTS: Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. CONCLUSIONS: Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required.

Co-designing resources for rehabilitation via telehealth for people with moderate to severe disability post stroke.

OBJECTIVES: The COVID-19 pandemic necessitated rapid transition to telehealth. Telehealth presents challenges for rehabilitation of stroke survivors with moderate-to-severe physical disability, which traditionally relies on physical interactions. The objective was to co-design resources to support delivery of rehabilitation via telehealth for this cohort. DESIGN: Four-stage integrated knowledge translation co-design approach. Stage 1: Research team comprising researchers, clinicians and stroke survivors defined the research question and approach. Stage 2: Workshops and interviews were conducted with knowledge users (participants) to identify essential elements of the program. Stage 3: Resources developed by the research team. Stage 4: Resources reviewed by knowledge users and adapted. PARTICIPANTS: Twenty-one knowledge users (clinicians n = 11, stroke survivors n = 7, caregivers n = 3) RESULTS: All stakeholders emphasised the complexities of telehealth rehabilitation for stroke and the need for individualised programs. Shared decision-making was identified as critical. Potential risks and benefits of telehealth were acknowledged and strategies to ameliorate risks and deliver effective rehabilitation were identified. Four freely available online resources were co-designed; three resources to support clinicians with shared decision-making and risk management and a decision-aid to support stroke survivors and caregivers throughout the process. Over six months, 1129 users have viewed the webpage; clinician resources were downloaded 374 times and the decision-aid was downloaded 570 times. CONCLUSIONS: The co-design process identified key elements for delivery of telehealth rehabilitation to stroke survivors with moderate-to-severe physical disability and led to development of resources to support development of an individualised telehealth rehabilitation plan. Future research should evaluate the effectiveness of these resources. CONTRIBUTION OF PAPER.

Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers.

BACKGROUND: Pulmonary rehabilitation (PR) plays an important role in the management of symptomatic patients with chronic respiratory diseases (CRD). While studies have investigated the feasibility and efficacy of virtual PR (VPR), it is important to understand the experiences of patients and healthcare providers (HCPs) during the rapid digital health transformation that occurred in the COVID-19 pandemic. OBJECTIVES: To explore the experiences and perspectives of patients and HCPs who participated in VPR during the pandemic. METHODS: Semi-structured interviews were conducted with CRD patients and HCPs. This study used a qualitative descriptive approach and a team-based inductive thematic analysis. RESULTS: Participants included 11 HCPs (7 female; 29-55 years) and 19 CRD patients (11 male; 62-83 years; 15 COPD, 4 COPD/ILD). Three major themes and 10 subthemes were identified: i) the pandemic response: a 'trial by fire' (navigating uncertainty, emotional impact of change, shifting practice amid complexity); ii) beyond the emergency: navigating a 'new normal' (eligibility and assessment for VPR, virtual exercise, virtual education and resources, clinical supervision and patient safety); and iii) care beyond boundaries: the implications of using technology for PR (benefits and limitations of technology, psychosocial implications, VPR in the future). CONCLUSION: The pivot to VPR was acknowledged as positive by both patients and HCPs although both groups were mindful of the implementation challenges. These findings provide insight into the experience of HCPs and patients in introducing VPR in response to the pandemic and will inform future implementation of VPR for individuals with CRD.

Enhancing automated lower limb rehabilitation exercise task recognition through multi-sensor data fusion in tele-rehabilitation.

BACKGROUND: Tele-rehabilitation is the provision of physiotherapy services to individuals in their own homes. Activity recognition plays a crucial role in the realm of automatic tele-rehabilitation. By assessing patient movements, identifying exercises, and providing feedback, these platforms can offer insightful information to clinicians, thereby facilitating an improved plan of care. This study introduces a novel deep learning approach aimed at identifying lower limb rehabilitation exercises. This is achieved through the integration of depth data and pressure heatmaps. We hypothesized that combining pressure heatmaps and depth data could improve the model's overall performance. METHODS: In this study, depth videos and body pressure data from an accessible online dataset were used. This dataset comprises data from 30 healthy individuals performing 7 lower limb rehabilitation exercises. To accomplish the classification task, three deep learning models were developed, all based on an established 3D-CNN architecture. The models were designed to classify the depth videos, sequences of pressure data frames, and combination of depth videos and pressure frames. The models' performance was assessed through leave-one-subject-out and leave-multiple-subjects-out cross-validation methods. Performance metrics, including accuracy, precision, recall, and F1 score, were reported for each model. RESULTS: Our findings indicated that the model trained on the fusion of depth and pressure data showed the highest and most stable performance when compared with models using individual modality inputs. This model could effectively identify the exercises with an accuracy of 95.71%, precision of 95.83%, recall of 95.71%, and an F1 score of 95.74%. CONCLUSION: Our results highlight the impact of data fusion for accurately classifying lower limb rehabilitation exercises. We showed that our model could capture different aspects of exercise movements using the visual and weight distribution data from the depth camera and pressure mat, respectively. This integration of data provides a better representation of exercise patterns, leading to higher classification performance. Notably, our results indicate the potential application of this model in automatic tele-rehabilitation platforms.

Effectiveness of telerehabilitation intervention to improve pain and physical function in people with patellofemoral pain syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition in young and active adults. Exercise therapy is an essential part of rehabilitation in people with PFPS (PwPFPS). Telerehabilitation is an innovative treatment approach that has been used in several musculoskeletal conditions. This study aims to investigate the non-inferiority of telerehabilitation through a smartphone application, the Vito App, compared to face-to-face physical therapy on reducing pain and improving physical function, quality of life, and psychological factors. METHODS: This randomized controlled trial will include 60 PwPFPS. to a control group (face-to-face physical therapy) or an experimental group (telerehabilitation). The intervention for both groups consists of stretching, strengthening, balance, and functional exercises for 6 weeks and three sessions per week. The primary outcomes are pain intensity by visual analog scale (VAS), physical function by the Kujala questionnaire and functional tests including the bilateral squat, anteromedial lunge, and step down, and quality of life by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire quality of life subscale. Secondary outcomes are psychological factors such as anxiety and depression assessed with the Hospital Anxiety and Depression Scale (HADS) questionnaire, kinesiophobia assessed with the Tampa scale, and pain catastrophizing assessed with the Pain Catastrophizing Scale (PCS). Assessments will be held in 3 phases: pre-test (before the intervention), post-test (after the 6 weeks of intervention), and follow-up (1 month after the end of the intervention). DISCUSSION: We expect that both the control group and experimental group will show similar improvements in clinical and psychological outcome measures. If our hypothesis becomes true, PwPFPS can use telerehabilitation as a practical treatment approach. Telerehabilitation can also enhance accessibility to rehabilitation services for active adults and for people living in remote and rural areas. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20201112049361N1. Registered on 29 October 2022.

Telerehabilitation Following Stroke.

Stroke remains a major cause of disability. Intensive rehabilitation therapy can improve outcomes, but most patients receive limited doses. Telehealth methods can overcome obstacles to delivering intensive therapy and thereby address this unmet need. A specific example is reviewed in detail, focused on a telerehabilitation system that targets upper extremity motor deficits after stroke. Strengths of this system include provision of daily therapy associated with very high patient compliance, safety and feasibility in the inpatient or home setting, comparable efficacy to dose-matched therapy provided in-clinic, and a holistic approach that includes assessment, education, prevention, and activity-based therapy.

Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio / Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture

Introducción: Evaluar si, en pacientes con fractura de extremo distal del radio, los ejercicios domiciliarios realizados en una pantalla táctil de dispositivos tableta reducen el consumo de recursos presenciales y mejoran la recuperación clínica, comparado con el programa convencional de ejercicios domiciliarios prescrito en papel. Material y métodos: Ensayo clínico pragmático, multicéntrico, paralelo, de dos grupos y controlado, con evaluador cegado y análisis por intención de tratar. Reclutados cuarenta y seis pacientes con fractura de extremo distal del radio en dos hospitales del Sistema Sanitario Público de Andalucía (SSPA). Los participantes de los grupos experimental y control recibieron el mismo tratamiento de sesiones presenciales de fisioterapia. El grupo experimental recibió un programa de ejercicios domiciliario utilizando la aplicación para tableta ReHand y el grupo control recibió un programa de ejercicios domiciliario en papel. Variable principal: número de sesiones de fisioterapia registradas en la base de datos electrónica del SSPA. Variables secundarias: número de consultas de rehabilitación presenciales con un médico rehabilitador y variables clínicas como la funcionalidad, la fuerza de prensión, la destreza manual, el dolor y la amplitud de movimiento. Resultados: El grupo experimental necesitó menos sesiones de fisioterapia (DM: −16,94; IC del 95%: −32,5 a −1,38) y consultas de rehabilitación (DM: −1,7; IC del 95%: −3,39 a −0,02) en comparación con el grupo control. Conclusión: En pacientes con fractura de extremo distal del radio, la prescripción de ejercicios realizados en una pantalla táctil de dispositivos tipo tableta a través de ReHand redujo el número de sesiones de fisioterapia y de consultas de rehabilitación.(AU)

Introduction: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methods: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. Results: The experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. Conclusions: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.(AU)

Does an outdoor virtual environment projected in a head-mounted display affect balance in healthy young adults?

BACKGROUND: Virtual reality head-mounted display (VR-HMD) is increasingly used for balance evaluation and rehabilitation. However, more studies must be conducted on virtual environments (VE) effects. This study aimed to assess the impact of an outdoor VE projected in a high-quality VR-HMD and of the VR-HMD mass on postural stability, postural control and leaning. METHODS: This study involved ten healthy young men who performed five 30-s stabilometric trials. Four experimental conditions were randomly performed: eyes open (EO) or eyes closed (EC), with (VR) or without (No VR) VR-HMD. Postural stability (antero-posterior (AP) and medio-lateral (ML) ranges of the center of pressure (CoP), 90% confidence ellipse area), postural control (CoP velocity (global, AP and ML)) and standard deviation of the CoP mean position), and postural leaning (AP/ML CoP mean position) were assessed. The comparisons between EO VR and EO No VR were used to analyze the VE effects and comparisons between EC VR and EC No VR for the VR-HMD mass effects. RESULTS: Spatiotemporal parameters that characterised postural stability and postural control, except ML velocity (p > 0.05), were significantly influenced by the simulated VE with higher values in EO VR than EO No VR (p < 0.05), but not by the VR-HMD mass. The mean position of the CoP showed no significant differences between conditions. SIGNIFICANCE: Postural stability and postural control modification due to the VE used in this study revealed that this VE could be interesting for VR-HMD rehabilitation and assessment. VR-HMD is not a factor to be considered for stabilometric analysis.

Towards a Patient-Centered Design of a Cancer Telerehabilitation System.

Successful implementation of telehealth platforms requires a detailed understanding of patient's needs, preferences, and attitudes toward a home-based platform. The goal of this study was to identify patient-centered characteristics of a cancer rehabilitation system based on cognitive evaluation of user interface and semi-structured qualitative interviews. Quantitative and qualitative feedback from 29 patients with metastatic urogenital cancer was collected after using a cancer telerehabilitation system. Heuristic evaluation, cognitive walkthrough, and analysis of qualitative interviews demonstrated a high level of support for the concept of home-based cancer telerehabilitation by cancer patients. Post-task surveys demonstrated sufficient usability and satisfaction scores from the participants. The patients provided valuable and insightful comments on how to further improve the functionality and interface of the platform. Further improvement of the system usability, consistency, and accessibility based on the patient-centered design principles will significantly facilitate the implementation of cancer telerehabilitation in clinical practice.

Role of telerehabilitation in the rehabilitation of children with cerebral palsy during COVID-19: A review.

Individuals with cerebral palsy (CP) have limited mobility and are unable to actively participate in tasks that are part of their daily living. Thus, continuous therapeutic sessions are required to keep such individuals active and engaged in the environment. Due to the coronavirus disease of 2019 (COVID-19) lockdowns, rehabilitation for children with CP was inhibited which consequently put them at risk of losing their functional gains which were obtained through previous in-person therapies. In order to avoid this, an alternate to conventional therapy was required and this rendered it necessary to review the role of telerehabilitation (TR) and its various modes for the rehabilitation of children with CP. This study aimed to explore the effectiveness of TR for children with CP during COVID-19 through the present literature and to determine if TR is an alternate to conventional physical therapy in children with CP during the coronavirus outbreak. This scoping review was conducted by searching different databases such as PubMed, Cochrane Collaboration, Medline, and Google Scholar on the basis of inclusion criteria. Screening was performed from January 2019 to June 2022 and the initial screening attempt returned 469 studies. After applying the aforementioned criteria, all impertinent studies were excluded which resulted in 28 studies being included for this review as they contained information about the effectiveness of TR on children with CP during COVID-19. These 28 articles included randomised controlled trials, surveys, reviews, clinical trials, case reports, prospective studies, editorials, and longitudinal studies. Three out of the 7 randomised controlled trial studies revealed that action observation treatment can be a useful approach for TR in child with CP during similar pandemics. The other 3 studies supported the use of computer-based games, robots, nonimmersive virtual reality, and wearable haptic devices as a significant means of TR in child with CP as an alternate to routine therapy during COVID-19. TR is an affable mode of rehabilitation specifically for the pediatric population. In the future, it can be an alternate to routine therapy for those who are unlikely to get daily access to in-person therapeutic sessions due to various reasons or circumstances.

Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study.

INTRODUCTION: Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. PURPOSE: To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. METHODS: In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. RESULTS: The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. CONCLUSIONS: In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.

Opinions, satisfaction and expectations of individuals with multiple sclerosis about telerehabilitation services.

OBJECTIVE: The opinions, satisfaction, and expectations of telemedicine can provide essential data for remote health services in individuals with Multiple Sclerosis (MS). The study aimed to demonstrate the views (barriers-benefits), satisfaction, and expectations of individuals with MS about telerehabilitation services. METHODS: A prospective cross-sectional was conducted with 82 individuals with MS who received telerehabilitation services for at least one year. The participants have completed SymptoMScreen, Beck Depression Inventory (BDI), Telehealth Usability Questionnaire (TUQ), Telemedicine Satisfaction Questionnaire (TSQ), Telehealth Barriers Questionnaire (TBaQ and Telehealth Benefits Questionnaire (TBeQ). RESULTS: As the age of individuals with MS increased, TUQ (r: -0.517, p < 0.001) and TBeQ (r: -0.383, p < 0.001) decreased, while TSQ (r: 0.405, p < 0.001) and TBaQ (r: 0.390, p < 0.001) increased. SymptoMScreen score (r: -0.288, p < 0.05) was weakly associated with TUQ. In addition, TUQ, TSQ, TBeQ, and TBaQ were strongly correlated (p < 0.001). CONCLUSION: In order to improve usability and satisfaction in telerehabilitation services, the age, symptom severity, and education levels of individuals with MS should be considered. Telehealth methods with high usability should be preferred to increase patient satisfaction.