Technologies used to facilitate remote rehabilitation of adults with deconditioning, musculoskeletal conditions, stroke, or traumatic brain injury: an umbrella review

Abstract

Objective: To provide an overview of technologies (devices, tools, or software applications) used to facilitate remote rehabilitation of adults with deconditioning, musculoskeletal conditions, stroke, or traumatic brain injury and to summarise the quantitative evidence of their efficacy.Introduction: Healthcare providers are considering how to meet longer-term rehabilitation needs of people whose health or level of activity and participation has been impacted directly or indirectly by the COVID-19 pandemic. Demands on rehabilitation services are increasing, driving a need for more services to be delivered in homes and communities. This review will identify the effectiveness of healthcare technologies that can facilitate remote rehabilitation.Inclusion criteria: This review included quantitative systematic reviews where participants were adults requiring rehabilitation for musculoskeletal conditions, stroke, traumatic brain injury or older adults requiring rehabilitation for deconditioning. Interventions included a technology and focused on recovery or rehabilitation with one of the following primary outcomes: physical activity levels, balance and/or gait, physical performance (mobility), or functional performance. Secondary outcomes included levels of pain, cognitive function, health-related quality of life and adverse effects.Methods: Five databases were searched from January 2016 to December 2020 to identify English-language publications. Critical appraisal of five systematic reviews was conducted independently by two reviewers, using the JBI critical appraisal checklist for systematic reviews and research syntheses. Data extraction was performed independently by two reviewers using a standard JBI data extraction tool. Data were summarized using a tabular format with supporting text.Results: Despite the large number of systematic reviews found in the initial search, only five met the inclusion criteria. Of these, each explored a different technology which included: wearable activity trackers, computer-based activities, non-immersive virtual reality, mobile apps, web-based rehabilitation interventions, electronic-health-based interventions (web-based or app-based with a wearable activity tracker). Computer-based activities were beneficial for improving cognitive function but showed no benefit on quality of life in post-stroke rehabilitation. Interventions that included wearable activity trackers showed mixed findings for increasing levels of physical activity for community dwelling older adults with deconditioning. Mobile apps were beneficial for increasing levels of physical activity and physical or functional performance for post-stroke rehabilitation. Web-based rehabilitation that contained a variety of components to support home exercise was not effective in improving physical performance or quality of life, reducing pain, or increasing levels of physical activity among individuals with rheumatoid arthritis. Electronic-health-based interventions (web-or app-based with a wearable activity tracker) were effect...

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