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Advances in Telerehabilitation for Optimising Recovery
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Advances in Telerehabilitation for Optimising Recovery

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "TeleHealth and Digital Healthcare".

Deadline for manuscript submissions: 30 September 2024 | Viewed by 7309

Special Issue Editors

Dr. Jade Kettlewell

E-Mail Website
Guest Editor
Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
Interests: rehabilitation; stroke; telerehabilitation; clinical trials; implementation science; complex interventions; behavior change; remote delivery; intervention scaleability
Prof. Dr. Natasha Lannin

E-Mail Website
Guest Editor
Department of Neuroscience, Monash University, Melbourne, Australia
Interests: rehabilitation; stroke; telerehabilitation; clinical trials; implementation science; complex interventions; behavior change; remote delivery; intervention scaleability
Dr. Lauren Christie

E-Mail Website
Guest Editor
St. Vincents Health Network Sydney, Australian Catholic University, Sydney, Australia
Interests: telerehabilitation; smart technologies; implementation science; behavior change; rehabilitation; clinical translation

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic has fundamentally changed how the world approaches everyday life and service delivery, including healthcare. Telerehabilitation has been used for decades to facilitate access to services, especially in countries where healthcare teams cover large geographical areas or have limited access to specialist services. However, it was the COVID-19 pandemic that highlighted the potential of telerehabilitation, providing a leap forwards in its use and the rapid advancement of our understanding of its role in optimising clinical outcomes.  

This Special Issue, dedicated to telerehabilitation, will focus on the provision of rehabilitation using telehealth technologies as its central theme, with a specific focus on optimising recovery from a range of clinical conditions. Telerehabilitation is the delivery of rehabilitation services at a distance, using information and communication technology (telephone, internet-based videoconferencing, sensors and apps and virtual reality programs with clinical monitoring).

For this Special Issue of Healthcare, we seek commentaries, original research, short reports, and reviews on advances and challenges in telerehabilitation for patient recovery. Telerehabilitation consultations may include assessment, diagnosis, goal-setting, therapy delivery, education and monitoring, and we welcome original research across this range. This Special Issue aims to inform improvements in the way telerehabilitation is delivered, advances in technologies, approaches to delivering telerehabilitation, changes in healthcare systems and environments, and cost-benefits of telerehabilitation.

It is envisioned that healthcare providers, researchers, technology developers and policymakers will use this Special Issue as a resource for advancing the field of telerehabilitation, improving remote service delivery, and ultimately improve patient outcomes.

Dr. Jade Kettlewell
Prof. Dr. Natasha Lannin
Dr. Lauren J. Christie
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • telerehabilitation
  • telehealth
  • remote intervention
  • telemedicine
  • eHealth
  • rehabilitation

Published Papers (7 papers)

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12 pages, 2384 KiB  
Article
Insights into Digital MedicRehApp Maintenance Model for Pulmonary Telerehabilitation: Observational Study
by Michele Vitacca, Mara Paneroni, Manuela Saleri and Chiara Giuseppina Beccaluva
Healthcare 2024, 12(14), 1372; https://doi.org/10.3390/healthcare12141372 - 9 Jul 2024
Viewed by 491
Abstract
Maintenance strategies after center-based pulmonary rehabilitation (CBPR) are currently needed. This study aimed to evaluate the feasibility and effect on the quality of life of a home-based pulmonary rehabilitation (HBPR) program delivered by a digital app. As secondary objectives, the patients’ adherence, symptoms, [...] Read more.
Maintenance strategies after center-based pulmonary rehabilitation (CBPR) are currently needed. This study aimed to evaluate the feasibility and effect on the quality of life of a home-based pulmonary rehabilitation (HBPR) program delivered by a digital app. As secondary objectives, the patients’ adherence, symptoms, effort tolerance changes, and safety were evaluated. This was a single-arm prospective observational monocentric study on 30 patients referred for chronic respiratory diseases. The prescription and evaluations of the HBPR programs performed at the pulmonary facility and delivery of structured exercise and counselling by the digital health tool were achieved under the supervision of a respiratory therapist. Digital capabilities included aerobic, strength, and respiratory exercises, which were monitored with a fitness tracker. The engagement rate of the HBPR after the CBPR was 1:10. The EuroQoL VAS score increased from 66.2 ± 16.28 to 75.60 ± 16.07 (p < 0.001), mainly in younger subjects. No patient was lost during the HBPR program. The global adherence session rate was 94%. The Medical Research Council dyspnea scale (MRC), COPD Assessment Test (CAT) score, and six-minute walking test (6MWT) improved from admission into the pulmonary unit to the end of the HBPR program. Between the beginning and end of the CBPR, the CAT score decreased from 14.4 ± 6.39 to 8.50 ± 5.39 (p < 0.001), the MRC decreased from 1.87 ± 0.9 to 1.17 ± 0.83 (p < 0.001), and the 6MWT increased from 451 ± 93 to 473 ± 115 m (p < 0.05). The average Technology Acceptance Model score for usability was high (145 ± 12.1) and no adverse events occurred during the HBPR program. This HBPR model seemed to be feasible and well-accepted by patients, leading to improvements in quality of life, symptoms, and functional capacity. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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14 pages, 570 KiB  
Article
Factors Associated with Device, Internet and Videoconferencing Use Amongst Individuals with Moderate-to-Severe Traumatic Brain Injury
by Sarah L. Chuah, Diane L. Whiting, Thomas M. Gates and Grahame K. Simpson
Healthcare 2024, 12(14), 1371; https://doi.org/10.3390/healthcare12141371 - 9 Jul 2024
Viewed by 435
Abstract
Videoconferencing (VC) has the potential to improve access to quality healthcare for individuals with traumatic brain injury (TBI) who require intensive and ongoing rehabilitation post-injury. Gaps in information and communication technology (ICT) use, access, and skills, however, may undermine equitable participation in remotely [...] Read more.
Videoconferencing (VC) has the potential to improve access to quality healthcare for individuals with traumatic brain injury (TBI) who require intensive and ongoing rehabilitation post-injury. Gaps in information and communication technology (ICT) use, access, and skills, however, may undermine equitable participation in remotely delivered healthcare and rehabilitation. This cross-sectional study sought to identify which demographic, injury-related, and psychological factors are associated with gaps in digital inclusion amongst individuals with a TBI. Between March 2020 and December 2023, 186 adults with a moderate-to-severe TBI who were aged 18–65 years and were within five years post-injury completed a range of self-report measures. The results demonstrated that most individuals with a moderate-to-severe TBI reported high levels of technology skills and access and used the internet from multiple devices daily. While injury severity was unrelated to technology use, this finding may reflect an overestimation of technology use amongst individuals with the most severe injuries, who were excluded from the study. Several demographic and psychological factors were found to predict VC readiness and are presented within a model to guide clinicians considering client suitability for VC rehabilitation. The current findings indicate that the use of VC in clinical settings following a moderate-to-severe TBI is feasible and suggest that individuals with a TBI may benefit from the greater provision of remotely delivered healthcare than is currently offered. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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12 pages, 249 KiB  
Article
Access, Readiness and Willingness to Engage in Allied Health Telerehabilitation Services for Adults: Does Cultural and Linguistic Diversity Make a Difference?
by Clarice Y. Tang, Andisheh Bastani, Balwinder Sidhu, Golsa Saberi and Elise Baker
Healthcare 2024, 12(11), 1141; https://doi.org/10.3390/healthcare12111141 - 4 Jun 2024
Viewed by 454
Abstract
Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients [...] Read more.
Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients receiving allied health services from a large tertiary health service located in Sydney, Australia, to use telerehabilitation for adults. Overall, 72% patients reported having access to technology, 38% met our readiness criteria and 53% reported willingness to engage in telerehabilitation. There were no differences in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access (OR = 0.94, 95% CI 0.90 to 0.97), readiness (OR = 0.95, 95% CI 0.92 to 0.98) and willingness (OR = 0.97, 95% CI 0.95 to 1.00) to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness (OR = 2.73, 95% CI 1.55–4.79) but not access (OR = 1.79, 95% CI 0.87 to 3.68) or readiness (OR = 1.90, 95% CI 0.93 to 3.87). Our findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients’ digital health literacy, especially patients from older age groups, to ensure equitable engagement in telerehabilitation services. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
11 pages, 856 KiB  
Article
Designing an Informative App for Neurorehabilitation: A Feasibility and Satisfaction Study by Physiotherapists
by María Teresa Sánchez-Rodríguez, Mónica Yamile Pinzón-Bernal, Carmen Jiménez-Antona, Sofía Laguarta-Val, Patricia Sánchez-Herrera-Baeza, Pilar Fernández-González and Roberto Cano-de-la-Cuerda
Healthcare 2023, 11(18), 2549; https://doi.org/10.3390/healthcare11182549 - 14 Sep 2023
Cited by 2 | Viewed by 1069
Abstract
Background: New technologies have gained popularity, especially the use of mobile phone applications, in neurorehabilitation. The aim of this paper was (1) to develop a free mobile application (NeurorehAPP) that provides information about and helps to select the appropriate mobile application [...] Read more.
Background: New technologies have gained popularity, especially the use of mobile phone applications, in neurorehabilitation. The aim of this paper was (1) to develop a free mobile application (NeurorehAPP) that provides information about and helps to select the appropriate mobile application related to a list of neurological disorders (cognitive impairment, Alzheimer’s disease, Parkinson‘s disease, multiple sclerosis, traumatic brain injury, stroke, cerebral palsy, muscular dystrophy, spina bifida, and facial paralysis), based on different objectives such as healthy habits, information, assessment, and treatment; and (2) to assess the feasibility, acceptability, and degree of satisfaction by physiotherapists after using NeurorehAPP for a minimum of three months. Methods: A free application was created to work with the Android® operating system. The degree of satisfaction and acceptance with the application was assessed with an adaptation of the Customer Satisfaction Questionnaire through a survey via email applied to physiotherapists from hospitals and neurological rehabilitation centers in Spain after using the application. Results: NeurorehAPP includes a total of 131 apps. A total of 121 physiotherapists completed a satisfaction survey. The total sample showed 85.41% satisfaction with the service provided by the app and 86.41% overall satisfaction with NeurorehAPP. Conclusions: NeurorehAPP is a free, intuitive, and friendly app used with the Android® operating system that allows the selection of the most appropriate app according to the type of user, neurological disorder, objective, and FDA criteria. Physiotherapists showed a high degree of satisfaction and acceptance with NeurorehAPP. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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37 pages, 2843 KiB  
Systematic Review
Delivery of Allied Health Interventions Using Telehealth Modalities: A Rapid Systematic Review of Randomized Controlled Trials
by Melissa J. Raymond, Lauren J. Christie, Sharon Kramer, Carla Malaguti, Zaneta Mok, Betina Gardner, Melita J. Giummarra, Serena Alves-Stein, Claire Hudson, Jill Featherston, Anne E. Holland and Natasha A. Lannin
Healthcare 2024, 12(12), 1217; https://doi.org/10.3390/healthcare12121217 - 18 Jun 2024
Viewed by 858
Abstract
Objectives: To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. Study design: A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Eligible trials: Trials were eligible [...] Read more.
Objectives: To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. Study design: A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Eligible trials: Trials were eligible for inclusion if they compared a comparable dose of face-to-face to telehealth interventions delivered by a neuropsychologist, occupational therapist, physiotherapist, podiatrist, psychologist, and/or speech pathologist; reported patient-level outcomes; and included adult participants. Data sources: MEDLINE, CENTRAL, CINAHL, and EMBASE databases were first searched from inception for systematic reviews and eligible trials were extracted from these systematic reviews. These databases were then searched for randomized clinical trials published after the date of the most recent systematic review search in each discipline (2017). The reference lists of included trials were also hand-searched to identify potentially missed trials. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 1. Data Synthesis: Fifty-two trials (62 reports, n = 4470) met the inclusion criteria. Populations included adults with musculoskeletal conditions, stroke, post-traumatic stress disorder, depression, and/or pain. Synchronous and asynchronous telehealth approaches were used with varied modalities that included telephone, videoconferencing, apps, web portals, and remote monitoring, Overall, telehealth delivered similar improvements to face-to-face interventions for knee range, Health-Related Quality of Life, pain, language function, depression, anxiety, and Post-Traumatic Stress Disorder. This meta-analysis was limited for some outcomes and disciplines such as occupational therapy and speech pathology. Telehealth was safe and similar levels of satisfaction and adherence were found across modes of delivery and disciplines compared to face-to-face interventions. Conclusions: Many allied health interventions are equally as effective as face-to-face when delivered via telehealth. Incorporating telehealth into models of care may afford greater access to allied health professionals, however further comparative research is still required. In particular, significant gaps exist in our understanding of the efficacy of telehealth from podiatrists, occupational therapists, speech pathologists, and neuropsychologists. Protocol Registration Number: PROSPERO (CRD42020203128). Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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14 pages, 633 KiB  
Protocol
Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol
by Niki Chouliara, Trudi Cameron, Scott Ballard-Ridley, Rebecca J. Fisher, Jade Kettlewell, Lisa Kidd, Leanna Luxton, Valerie Pomeroy, Rachel C. Stockley, Shirley Thomas and Adam L. Gordon
Healthcare 2024, 12(10), 1027; https://doi.org/10.3390/healthcare12101027 - 15 May 2024
Viewed by 960
Abstract
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate [...] Read more.
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient–family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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18 pages, 479 KiB  
Systematic Review
Digital Apps to Improve Mobility in Adults with Neurological Conditions: A Health App-Focused Systematic Review
by Reem Rendell, Marina Pinheiro, Belinda Wang, Fiona McKay, Ashleigh Ewen, Catherine Carnegie, Erin Tikomaidelana, Zino Fattah and Leanne Hassett
Healthcare 2024, 12(9), 929; https://doi.org/10.3390/healthcare12090929 - 30 Apr 2024
Viewed by 1269
Abstract
The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps [...] Read more.
The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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