Using Telehealth to Guarantee the Continuity of Rehabilitation during the COVID-19 Pandemic: A Systematic Review

Abstract

COVID-19 has abruptly disrupted healthcare services; however, the continuity of rehabilitation could be guaranteed using mobile technologies. This review aims to analyze the feasibility and effectiveness of telehealth solutions proposed to guarantee the continuity of rehabilitation during the COVID-19 pandemic. The PubMed, Cochrane Library, Web of Science and PEDro databases were searched; the search was limited to randomized controlled trials, observational and explorative studies published up to 31 May 2022, assessing the feasibility and effectiveness of telerehabilitation during the COVID-19 pandemic. Twenty studies were included, for a total of 224,806 subjects: 93.1% with orthopedic complaints and 6.9% with non-orthopedic ones. The main strategies used were video and audio calls via commonly available technologies and free videoconferencing tools. Based on the current evidence, it is suggested that telerehabilitation is a feasible and effective solution, allowing the continuity of rehabilitation while reducing the risk of infection and the burden of travel. However, it is not widely used in clinical settings, and definitive conclusions cannot be currently drawn. Telerehabilitation seems a feasible and safe option to remotely deliver rehabilitation using commonly available mobile technologies, guaranteeing the continuity of care while respecting social distancing. Further research is, however, needed to strengthen and confirm these findings.

Do patients with and survivors of COVID-19 benefit from telerehabilitation? A meta-analysis of randomized controlled trials

“…Therefore, further generalization of the efficacy of telerehabilitation to older patients with COVID-19 needs further high-quality study with well-designed and easy-to-use devices. Apart from that, attention must be paid to educating healthcare workers to thoroughly understand the available telerehabilitation technologies and better encourage and instruct patients from all kinds of backgrounds to use the devices for telerehabilitation ( 59 ).…”

“…Another limitation lay in the small sample sizes (three of seven trials have very small sample sizes), which might have affected the statistical power of this meta-analysis. The reason why the demographics of some studies are not addressed at the scale one would expect can be explained by the fact that COVID-19 is a relatively novel and unprecedented disease and therefore the implementation of telerehabilitation with patients with COVID-19 is a new and understandably scarcely diffused approach ( 34 , 59 ). When evaluating the overall evidence quality of key outcomes using the GRADE tool, the evidence was downgraded one level if the total sample size was < 400 (as a rule of thumb for implementing GRADE 'optimal information size' criteria) ( 66 ).…”

“…COVID-19 calls for heavy demand for rehabilitation services and thus induces a heavy economic burden. If telerehabilitation, however, could have comparable effectiveness to face-to-face rehabilitation but in a more cost-effective manner (such as significantly reducing the burden of travel), this strategy could be further promoted as a viable alternative to deliver rehabilitation services during and even after the COVID-19 pandemic ( 59 ). Apart from that, we strongly recommend future studies be conducted per the CONSORT guideline and accurately report all relevant outcomes (including but not limited to physical, psychological, and social functioning, activities of daily living, and quality of life) in the forms of absolute values and change scores and if possible, provide stratified results in terms of the severity of disease, age, gender, and comorbidities, which may facilitate future systematic reviews and thus allow more robust and precise findings.…”

Validity and Reliability of a Novel Smartphone Tele-Assessment Solution for Quantifying Hip Range of Motion

“…The COVID-19 pandemic led to an exponential increase in digital health services delivered via information and communication technologies [ 1 ]. Tele-rehabilitation via online video communication is an emerging area that is attracting increasing attention as a potential alternative to conventional, face-to-face rehabilitation; it is suggested to be an option for people located remotely to reduce the need for frequent travel [ 2 ].…”

Virtual reality for neurorehabilitation: A bibliometric analysis of knowledge structure and theme trends

“…Since 2020, the annual publication has grown dramatically to over 200 publications in 2021. This is undoubtedly due to the explosion of COVID-19 facilitating the development of telerehabilitation techniques, such as VR therapy ( 33 , 34 ). It is foreseeable that this research area will maintain its popularity in the near future.…”