Exploring Barriers to Implementing Telerehabilitation from experiences of managers, policymakers, and providers of rehabilitation services in Iran: A Qualitative Study

Abstract

Background: Telerehabilitation is an emerging technology that uses digital technologies to perform evaluation, counseling, treatment, and telemonitoring to provide rehabilitative care to patients in various locations such as homes, communities, health centers, and workplaces. This approach has advantages such as reducing costs and overcoming barriers of distance and time. Reducing patient-rehabilitator interaction, and being hard to teamwork and express thoughts and feelings are some disadvantages of this approach. TR services are provided by a variety of rehabilitation specialists. The aim of the study was to identify barriers in the way of implementing TR in Iran Methods: This study was conducted using a conventional content analysis method based on a qualitative approach. 26 people were selected as participants based on purposive sampling with maximum diversity. Data were collected through semi-structured interviews and managed using MAXQDA 10 software. Results: 765 codes were extracted by conducting interviews and coding. The findings of this study are classified into seven main categories and 32 sub-categories. The main categories are insufficient infrastructure, legal, physical, and moral hazards, lack of priority and insufficient determination, insufficient support of the public and non-governmental organizations, poor knowledge in using equipment, Lack of knowledge and negative attitude, and low capacity in comparison with face-to-face rehabilitation. Conclusion: This study shows that based on the insights from the experiences of participants, inadequate infrastructure and poor knowledge of the use of equipment are the most important obstacles in the way of TR. This study reveals that the implementation of TR in Iran encounters several obstacles and eliminating them requires serious effort.

Factors Facilitating and Inhibiting the Implementation of Telerehabilitation—A Scoping Review

“…All 28 included studies were published between 2014 and 2023, and all but three studies [ 25 , 26 , 27 ] were conducted in high- or upper-middle-income countries [ 28 ]. Most of these ( n = 10) were undertaken in Canada [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], followed by 5 studies in Australia [ 39 , 40 , 41 , 42 , 43 ] and 4 studies in the USA [ 44 , 45 , 46 , 47 ].…”

“…Most of these ( n = 10) were undertaken in Canada [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], followed by 5 studies in Australia [ 39 , 40 , 41 , 42 , 43 ] and 4 studies in the USA [ 44 , 45 , 46 , 47 ]. The three studies conducted in lower-middle-income countries were from India [ 25 ], Iran [ 26 ] and Uganda [ 27 ].…”

“…Of the 28 included publications, 17 addressed the research question using a qualitative design [ 26 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], while 5 studies worked with a quantitative design [ 25 , 40 , 50 , 51 , 52 ] and 5 studies were based on a mixed methods approach [ 27 , 30 , 38 , 41 , 53 ]. One of the included articles was a synthesis of six qualitative and quantitative studies with different study designs, which were mentioned, but not explained in detail (pre-post, pilot studies, RCTs, observational designs) [ 31 ].…”

“…One of the mixed-methods studies was a combination of a survey and focus groups [ 53 ]. The majority of studies ( n = 16) were cross-sectional in design [ 25 , 26 , 29 , 32 , 36 , 37 , 39 , 42 , 43 , 44 , 46 , 48 , 50 , 51 , 52 , 53 ], followed by pre-and post-design [ 30 , 38 , 40 , 47 , 49 ]. In qualitative studies, the sample sizes ranged from n = 3 to n = 26, and in quantitative studies, they ranged from n = 26 to n = 513.…”

“…Other complementary digital offers were exercise videos [ 32 , 41 , 45 ], e-learning modules [ 34 , 35 ], emails [ 46 ], SMS [ 27 ] and phone calls [ 27 , 33 ]. In four studies TR was not described in more detail [ 26 , 36 , 39 , 43 ].…”