Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature

Solomon, Rosie M; Dhakal, Roshan; Halpin, Stephen; Hariharan, Ram; O’Connor, Rory J; Allsop, Matthew J; Sivan, Manoj

doi:10.1038/s41393-022-00797-8

Cited by 20 publications

(28 citation statements)

References 49 publications

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“…Specifically, telerehabilitation encompasses diagnosing, evaluating, and managing health care for persons with physical, cognitive, or social impairment and disability [ 7 ]. Telerehabilitation has been shown to be both feasible and effective in chronic heart failure and coronary artery disease [ 8 ], stroke [ 9 ], multiple sclerosis [ 10 ], and spinal cord injuries [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study

Munce¹,

Andreoli²,

Bayley³

et al. 2023

JMIR Rehabil Assist Technol

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Background Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented. Objective The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally. Methods The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis. Results A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of “infrastructure, equipment, and space” and “leadership and organizational support”; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit. Conclusions Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future.

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Section: Introductionmentioning

confidence: 99%

Clinicians’ Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study

Munce¹,

Andreoli²,

Bayley³

et al. 2023

JMIR Rehabil Assist Technol

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“…In the systematic review (2021), the effect of online transfer techniques and wheelchair mobility training on changing COPM scores was not studied [18]. In another systematic review conducted in 2022 in low-and middle-income countries, only 5 studies used the remote rehabilitation approaches in PwSCI [39]. None of them investigated the level of occupational performance and satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of online wheelchair mobility and transfer training on the occupational performance in people with spinal cord injuries

Parvaneh,

Motaharinezhad,

Mohajer

et al. 2023

Preprint

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Background Online training for the rehabilitation of People with Spinal Cord injuries (PwSCI) is necessary. Various environmental barriers create challenges in transferring and transporting these individuals out of the home to participate in face-to-face interventions. Furthermore, these challenges were exacerbated by the COVID-19 pandemic in the past.Study Design: A single-blind randomized controlled trial.Objectives This research aims to investigate the effectiveness of online wheelchair mobility and transfer training, on the level of performance and satisfaction in PwSCI.Setting: SCI associations and hospitals and clinical centers.Methods The PwSCI were randomly divided into an online training group (OTG) and a control group (CG). The OTG received online training during 5 group sessions for five weeks. The results were analyzed to compare changes in occupational performance level and satisfaction after the intervention, and one month later.Results 37 (CG = 18 and OTG = 19) out of 49 participants completed the 5-week intervention and follow-up assessments. The average age of participants in the CG was 35.0 years, and the OTG was 33.7 years. We found a significant increase in performance (p < 0.001) and satisfaction (p < 0.001) within the OTG during the pre-post assessment. There were also significant differences in performance (p < 0.026) and satisfaction (p < 0.015) between groups.Conclusion The results showed that online wheelchair mobility and transfer training can be a suitable method for telerehabilitation and training PwSCI.

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“…As well as experiencing barriers to rehabilitation, LMICs are experiencing an increase in life expectancy and greater numbers of people with noncommunicable diseases including neurological conditions [ 2 , 6 , 7 ]. Although in its early stages, telemedicine is increasingly being explored in LMICs to deliver care to challenging or remote areas.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence of the clinical effectiveness of telerehabilitation for people with neurological conditions is mixed, but overall it is reported to be at least equivalent to standard care [ 12 , 13 ]. There is, however, limited evidence on the cost-effectiveness of telerehabilitation [ 6 , 9 ]. Much of the research in telerehabilitation has been undertaken in high-income countries, with notably fewer studies in LMICs [ 6 , 14 , 15 ], where the rehabilitation context, as well as the barriers and facilitators to the feasibility, adoption, scalability, and sustainability of telerehabilitation, may be quite different.…”

Section: Introductionmentioning

confidence: 99%

Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study

Paul,

Thomson,

Asibey

et al. 2024

JMIR Mhealth Uhealth

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Background Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required.

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Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature

Cited by 20 publications

References 49 publications

Clinicians’ Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study

Clinicians’ Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study

Effectiveness of online wheelchair mobility and transfer training on the occupational performance in people with spinal cord injuries

Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study

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