Rehabilitation Technologies for Chronic Conditions: Will We Sink or Swim?

Abstract

Introduction: Chronic conditions such as stroke, Parkinson’s disease, spinal cord injury, multiple sclerosis, vestibular disorders, chronic pain, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease are leading causes of disability among middle-aged and older adults. While evidence-based treatment can optimize clinical outcomes, few people with chronic conditions engage in the recommended levels of exercise for clinical improvement and successful management of their condition. Rehabilitation technologies that can augment therapeutic care—i.e., exoskeletons, virtual/augmented reality, and remote monitoring—offer the opportunity to bring evidence-based rehabilitation into homes. Successful integration of rehabilitation techniques at home could help recovery and access and foster long term self-management. However, widespread uptake of technology in rehabilitation is still limited, leaving many technologies developed but not adopted. Methods: In this narrative review, clinical need, efficacy, and obstacles and suggestions for implementation are discussed. The use of three technologies is reviewed in the management of the most prevalent chronic diseases that utilize rehabilitation services, including common neurological, musculoskeletal, metabolic, pulmonary, and cardiac conditions. The technologies are (i) exoskeletons, (ii) virtual and augmented reality, and (iii) remote monitoring. Results: Effectiveness evidence backing the use of technology in rehabilitation is growing but remains limited by high heterogeneity, lack of long-term outcomes, and lack of adoption outcomes. Conclusion: While rehabilitation technologies bring opportunities to bridge the gap between clinics and homes, there are many challenges with adoption. Hybrid effectiveness and implementation trials are a possible path to successful technology development and adoption.

The evolution of augmented reality to augment physical therapy: A scoping review

“…Using technologies to facilitate home based treatment in conjunction with clinical care could enable greater practice of therapeutic skills and movement and perhaps integration of therapeutic strategies into daily activities and improved long-term outcomes. 54 In this context, AR technology could bridge the clinic to the home. 54 …”

“…With the explosion of technology development and potential to augment physical therapy, it would be fruitful to align research inquiries with the field of implementation science. 54 Implementation science, as applied to healthcare, is the field of study that examines how novel approaches are adopted and implemented by consumers (e.g., healthcare providers, patients, and insurance regulators). Usability of systems is paramount and perspectives of end-users of technology provide valuable direction as to how the technology should be used.…”