Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods

Abstract

Background Upper limb (UL) disabilities have attracted worldwide attention due to the high economic costs of health care and the negative effects on the quality of life of patients with these disabilities. Telerehabilitation technologies are one of the most important ways to reduce rehabilitation costs and increase the quality of life of patients. Therefore, the aim of this study was to investigate the role of telerehabilitation in improving the health status of patients with upper limb disabilities. Methods This scoping review was conducted by searching the Web of Science, PubMed, and Scopus until July 30, 2021. We used a data extraction form with 18 fields to extract data from primary studies. The selection of articles and data extraction was made by four researchers using a data collection form based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth and sixth researchers.Inclusion criteria were studies published in English, studies on upper limb disability, and telerehabilitation based on any technology (synchronous telerehabilitation, asynchronous, or both). Exclusion criteria were articles that did not focus on telerehabilitation and upper limb disabilities. Also, books, book chapters, letters to the editor, and conference abstracts were also removed. Results A total of 458 articles were retrieved, and after removing irrelevant and duplicate articles, 29 articles were finally included in this review. Most telerehabilitation was performed for patients with stroke (65%). Among the 15 different services provided with telerehabilitation technologies, "Evaluation of exercises and also a musculoskeletal function of patients by the therapist","Recording of patients' rehabilitation exercises and sending them to the therapist” and "Prescribing new rehabilitation exercises by the therapist" were the most widely used services, respectively. Virtual reality technologies, smart wearables, and robots were used to provide telerehabilitation services. Among the 13 types of evaluation used for telerehabilitation systems, “Evaluation and measurement of upper limb function” was the most used evaluation in the studies. "Improvement in musculoskeletal functions”, "Increasing patients' interest and motivation to perform rehabilitation exercises", and "Increasing adherence to rehabilitation exercises and greater participation in treatment processes" were the most important outcomes, respectively. Conclusion Our findings indicate that telerehabilitation provides individuals with equitable access to rehabilitation services, improves musculoskeletal function, and empowers individuals by providing a variety of rehabilitation capabilities.

Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review

“…As discussed above, telerehabilitation and virtual reality were two types of technology used along with rehabilitation robots. Some studies [ 3 , 82 , 83 ] showed that if special interventions such as game-based virtual reality, and telerehabilitation with rehabilitation robots are used, upper limb function, mental health and patients’ participation in rehabilitation exercises can be improved. Moulaei et al [ 3 ], showed in a scoping review that telerehabilitation could lead to “improving in musculoskeletal functions”, “increasing patients’ interest and motivation to perform rehabilitation exercises”, “increasing adherence to rehabilitation exercises and more participation in treatment processes”, “remote monitoring and control of patients”, “reducing or relieved pain” and “improving quality of life”.…”

“…Some studies [ 3 , 82 , 83 ] showed that if special interventions such as game-based virtual reality, and telerehabilitation with rehabilitation robots are used, upper limb function, mental health and patients’ participation in rehabilitation exercises can be improved. Moulaei et al [ 3 ], showed in a scoping review that telerehabilitation could lead to “improving in musculoskeletal functions”, “increasing patients’ interest and motivation to perform rehabilitation exercises”, “increasing adherence to rehabilitation exercises and more participation in treatment processes”, “remote monitoring and control of patients”, “reducing or relieved pain” and “improving quality of life”. Fernández-Vázquez et al [ 84 ], also pointed out that virtual reality as a very interesting tool in treating upper limb disorders along with rehabilitation robots can improve the motor function of the upper limb, increase users’ motivation and enjoyment, a large number of repetitions or high intensity rehabilitation.…”

“…Impaired upper limb (UL) functions to restrict the performance of activities of daily living, limit social participation [ 1 ], specifically decrease the independence of affected individuals and reduce patients’ quality of life [ 2 , 3 ]. In upper limb disabilities, patients develop musculoskeletal problems such as paresis, pain, loss of sensation, and spasticity in different parts of the upper limb and so these problems can have manifold consequences in the daily lives of those impacted.…”

An analysis of clinical outcomes and essential parameters for designing effective games for upper limb rehabilitation: A scoping review

“…64,65 Likewise, if the games are combined with telerehabilitation technologies, robots and/or smart wearables, they can increase the motivation and tendency of patients to perform therapeutic exercises, easily perform repetitive, boring and longterm exercises, increase the patient's independence in performing therapeutic exercises, increasing adherence to rehabilitation exercises and ultimately improving the quality of life of patients with upper limb disability. 2 Other outcomes identified in this review were "High user satisfaction with the system," and "Increasing patients' autonomy in daily life activities." Some studies [66][67][68] have shown that rehabilitation games are useful and effective for people with upper limb disabilities, and these individuals and therapists have also reported a high level of satisfaction and acceptance of these games.…”

Editorial: How can wearable robotic and sensor technology advance neurorehabilitation?

“…In particular, the technology allows more intensive and tailored patient rehabilitation activities and services (increasing the amount and quality of therapy that can be administered and supervised) and enable all the involved actors in the team (e.g., physicians, therapists, bioengineers and others) to design patient-centered and custom intervention collaboratively. Moreover, technology can transform rehabilitation from a one-on-one human resource intensive treatment that can only be provided in specialized centers to a technology-driven, remotely-supervised and widely accessible enterprise (Moulaei et al, 2022 ). Given the increased costs associated with long-term rehabilitation and the difficulty in providing appropriate duration and intensity of rehabilitation services required to manage disability, cost-effective development of robotic rehabilitation is greatly warranted.…”