Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review

Abstract

Background Physical therapists are key players in the management of musculoskeletal conditions, which are common in rural and remote communities. There are few physical therapists in rural regions compared to potential need, so care is either not provided or must be sought in urban centers, requiring travel and time away from work and family to access services. Telerehabilitation strategies, such as real-time videoconferencing, are emerging as possible solutions to address shortages in rural physical therapy services. Objectives This review will: (1) determine the validity and the reliability of secure videoconferencing for physical therapy management of musculoskeletal conditions; (2) determine the health, system, and process outcomes when using secure videoconferencing for physical therapy management of musculoskeletal conditions. Methods A protocol-driven systematic review of four databases was carried out by two independent reviewers. Study criteria included English language articles from January 2003 to December 2016, on physical therapy management using secure videoconferencing, pertaining to adults 18-80 years with chronic musculoskeletal disorders. Randomized controlled trials, pre-experimental studies, and case-control studies were included. Quality analysis was performed utilizing standardized tools specific for the study designs. Results and conclusions Validity and reliability studies were identified as having high risk of bias. Intervention studies were of moderate quality, and found positive impact on health outcomes and satisfaction. Two studies evaluated costs, with evidence of cost savings in one study. More robust research is required to evaluate long-term effects of telerehabilitation for physical therapy management of musculoskeletal disorders, including cost-benefit analyses.

Development and implementation of technologies for physical telerehabilitation in Latin America:

“…The outcomes are comparable to those obtained by the well-known face-to-face physiotherapy [14]- [17]. Since telerehabilitation systems are used in real clinical scenarios, several assistive technologies have been implemented using basic communication tools, e.g., healthcare assistance by videoconference [18]. Because of technological advances, more sophisticated methods were introduced into rehabilitation processes [19].…”

Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer?

“…reliability in the assessment of peripheral joints and the spine, with good to excellent psychometric properties for the different clinical outcomes (eg, pain, swelling, muscle strength, balance, gait, active and passive range of motion). [19][20] Lower validity and reliability have been identified in the assessment of the shoulder and elbow joints, for the examination of the nerve functioning around the elbow, the scar assessment of the knee, and the evaluation of lumbar spine posture. [19][20] Furthermore, the absence of reporting of standard error of measurement and coefficient of variation, and the involvement of assessors with different clinical expertise and training (eg, naïve, expert) may limit the generalization of findings.…”

“…[19][20] Lower validity and reliability have been identified in the assessment of the shoulder and elbow joints, for the examination of the nerve functioning around the elbow, the scar assessment of the knee, and the evaluation of lumbar spine posture. [19][20] Furthermore, the absence of reporting of standard error of measurement and coefficient of variation, and the involvement of assessors with different clinical expertise and training (eg, naïve, expert) may limit the generalization of findings. [19][20] On the other hand, one strength of qualitative studies investigating both patients' and physical therapists' perspectives is the good acceptability of telerehabilitation in terms of overall user experience, adherence, and satisfaction, both in MSK disorders and after elective orthopedic surgical conditions.…”

“…[19][20] Furthermore, the absence of reporting of standard error of measurement and coefficient of variation, and the involvement of assessors with different clinical expertise and training (eg, naïve, expert) may limit the generalization of findings. [19][20] On the other hand, one strength of qualitative studies investigating both patients' and physical therapists' perspectives is the good acceptability of telerehabilitation in terms of overall user experience, adherence, and satisfaction, both in MSK disorders and after elective orthopedic surgical conditions. 17,20-21 Furthermore, preliminary economic analyses have revealed that telerehabilitation enhances the quality of MSK care, which in turn impacts the total cost savings for national health care systems.…”

“…17,20-21 Furthermore, preliminary economic analyses have revealed that telerehabilitation enhances the quality of MSK care, which in turn impacts the total cost savings for national health care systems. 20 Nevertheless, satisfaction and economic outcomes are often poorly reported and not standardized, thus limiting usefulness of data. 20…”