Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta–Meta-Analysis

Abstract

Objective Telerehabilitation is an option that should be adapted as soon as possible in order to face the crisis caused by COVID-19. An umbrella and mapping review with meta–meta-analysis (MMA) of the available scientific evidence was performed to determine if telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. Methods A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta-meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews (CDSR), MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. Results Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference [SMD] = 0.18; 95% CI = 0.03–0.34). Conclusion The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. Impact The advantages of lower cost and less interference by the rehabilitation processes in patients’ daily life could justify implementing telerehabilitation in clinical settings in the COVID-19 era.

Barriers and Challenges of Implementing Telerehabilitation: A Systematic Review

“…Furthermore, those studies have found conflicting results for this variable. Further studies are required to evaluate the cost-effectiveness of this rehabilitation model, the barriers encountered by patients when performing TR, and the patients' acceptance of the model [21]. According to studies, numerous factors can help TR to develop at a slower pace and require further time to be able to convince the patient of its effectiveness as conventional approaches.…”

“…Despite these barriers, TR could be a better treatment option for some patients. Furthermore, it has considerable advantages, although further study is required to investigate its effectiveness in other conditions [21,22]. With the development of technology, and in some conditions that individuals with a disability cannot travel for face-to-face interventions, for example in the COVID-19 pandemic, the need for TR has increased and simultaneously has sped up the adop-tion of digital culture, worldwide.…”

A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): a randomised controlled trial

“…12 Telerehabilitation provides a viable alternative that could be superior to no rehabilitation and as effective as conventional rehabilitation. 13 14 We investigated possible superiority of a telerehabilitation programme for COVID-19 (TERECO) over no rehabilitation with regard to functional exercise capacity, lower limb muscle strength…”

Telerehabilitation in neurorehabilitation: has it passed the COVID test?

“…Telerehabilitation was an invaluable tool in providing continuity of care during very risky and uncertain times. Although it has been an emerging technological innovation in the field of rehabilitation for some years, 7 the absolute need for telerehabilitation presented itself during this public health crisis. 8 This was the first time we implemented institution-wide telerehabilitation, and we did so at a rapid pace, for a large number of patients and clinicians.…”