International Journal of Telerehabilitation最新文献

Telerehabilitation adoption in low-middle income countries (LMICs) accelerated during COVID-19 pandemic, promoting a surge in telehealth initiatives, many of which remain unexplored. This scoping review aims to assess the current state of telerehabilitation services in LMICs across Asia and Africa using Arksey and O'Malley's five-stage framework with PRISMA-ScR guidelines. Two reviews were conducted: one covering from 2012 to 2022 and another from 2023 to January 2025, yielding a total of 87 relevant articles. The key themes that emerged from the collected literature include current telerehabilitation status, pandemic utilization, implementation challenges, user understanding of telerehabilitation along with their perceptions and practices, and feasibility together with legal-ethical aspects and acceptability. Despite limited ICT skills and infrastructure challenges, users reported positive experiences, primarily using mobile phones and video conferences. However, privacy concerns along with digital literacy issues remain. Although many nations adopted WHO guidelines and donor support, formal policies and sustainable implementation strategies are still lacking. The findings underscore the need for context specific and sustainable frameworks to strengthen telerehabilitation in LMICs.

This multimethod process evaluation aimed to explore the implementation of a telehealth coaching intervention for parents of children with motor difficulties. Four therapists and 59 parents participated. The dosage of 525 sessions was compared to the study protocol. Thirty-three external rater assessments, 62 therapists' self-adherence and 59 parent satisfaction surveys were analyzed descriptively for adherence, parent responsiveness and intervention quality. Therapists' interviews were analyzed thematically for implementation experience. A median of nine sessions per family was provided; only 58% were received within the prescribed timeframe. Adherence (83%), participant responsiveness (91%), and intervention quality (85%) were high, along with therapists' self-adherence (84%) and parent satisfaction (87%). Therapists reported partnering effectively with parents in the intervention and maintaining a family-oriented approach. Regular feedback and mentorship were the most effective implementation strategies identified by therapists. Telehealth coaching interventions can be implemented with high fidelity when therapists receive proper training and support.

Objective: This pilot randomized controlled trial explored feasibility, and preliminary effects from remotely delivered high- versus low-intensity exercise prior to balance training for people with Spinocerebellar Ataxia (SCA).

Methods: Twenty participants with SCA (types 1, 2, 3, or 6) were randomized to high- or low-intensity exercise (30 min), followed by balance training (30 min), delivered via telehealth twice-weekly for 8-weeks. Exercises were progressive and individualized based on ataxia severity, mobility, and home equipment. Outcomes included disease-specific measures (Scale for Assessment and Rating of Ataxia at home, Cerebellar Cognitive Affective Syndrome Scale), and fatigue (Fatigue Severity Scale) assessed at baseline, mid- and post-intervention.

Results: Eighteen participants completed the intervention with high adherence. Both groups improved on disease-specific measures, with greater gains in cognition and reduced fatigue in the low-intensity group.

Conclusions: Remote delivery of exercise and balance training is feasible in SCA. Fatigue may limit tolerability of higher exercise intensities. National Institutes of Health Clinical Trials Registration Number: NCT05826171.

Background: Persons with Parkinson's disease (PwPD) require ongoing rehabilitation to maintain independence, but traditional center-based and unsupervised home programs have limitations in accessibility and adherence. Home-based telerehabilitation (TR) offers a promising alternative by enabling remote delivery of exercise interventions.

Objective: To evaluate the effect of home-based TR on balance, functional mobility, and quality of life in PwPD.

Methods: A comprehensive electronic search was conducted across PubMed, CINAHL, Embase, OvidSP, ProQuest, Scopus, Web of Science, Cochrane CENTRAL, and PEDro databases. Interventional studies on exercise-centric home-based TR for PwPD with either balance, functional mobility, or quality of life as outcomes were included.

Results: A total of 37 studies were included in this systematic review, of which 13 were eligible for meta-analysis. The meta-analysis revealed small but significant improvements in balance (SMD = 0.25; 95% CI: 0.04 to 0.45; p = 0.02). and functional mobility (SMD = -0.28; 95% CI: -0.52 to -0.05; p = 0.02). However, no significant effect was observed for quality of life (SMD = -0.08; 95% CI: -0.25 to 0.09; p = 0.35).

Conclusion: Home-based TR is effective for improving balance and functional mobility in PwPD, although, its effect on quality of life is unclear which warrants further research.

Objective: Compare the effects of physiotherapist-supervised synchronous telerehabilitation (TR) with unsupervised asynchronous TR in adults diagnosed with post-COVID syndrome (PCS).

Methods: In this single-blind randomized controlled trial conducted with 31 participants with PCS were randomized into a synchronous telerehabilitation (STR) group, which underwent two-hour sessions per week for eight weeks, and an asynchronous telerehabilitation (ATR) group, which performed unsupervised exercises. Lower limb functional strength (Five Times Sit-to-Stand Functional Test) as the primary outcome, and the dyspnea (Modified Medical Research Council), fatigue (Fatigue Assessment Scale), stress, anxiety, depression (Depression, Anxiety, and Stress Scale-21), and quality of life (World Health Organization Quality of Life-BREF Questionnaire) were assessed remotely at the baseline, after 8 weeks of intervention, and at a 20-week follow-up. Data were analyzed using a mixed-model analysis of variance.

Intervention: Participants were randomized into a synchronous telerehabilitation (TRS) group, which performed two-hour sessions per week for eight weeks, and an asynchronous telerehabilitation (TRA) group, which performed the same exercise protocol but without the supervision of a physiotherapist. Instructional videos were made available via social media (WhatsApp and YouTube). Participants were also instructed to perform the protocol twice a week for eight weeks.

Results: A statistically significant difference was only observed in lower limb functionality between both groups (p = 0.02). The STR group demonstrated significant improvements in lower limb functional strength (p = 0.03), dyspnea (p = 0.02), fatigue (p = 0.00), stress (p = 0.03), and quality of life (p = 0.00), without any adverse events. Conversely, the ATR group experienced significant improvements in fatigue (p = 0.00) and anxiety (p = 0.02).

Conclusion: The present findings show that both modalities demonstrated positive effects over an 8-week TR program in adults with PCS. However, the synchronous approach achieved greater improvements in lower limb functionality, dyspnea, fatigue, stress, and quality of life. Our findings revealed that asynchronous model was associated with higher dropout rates and suggest synchronous TR may offer advantages regarding treatment adherence.

Although there is more evidence in neuropsychological rehabilitation for transfer of treatment effects to daily life when using compensatory strategy training, computerized programs for patients with acquired brain injury still focus on function training. Therefore, we developed Karman Line Plan, a digitalized version of an evidence-based compensatory Goal Management Training intervention for individuals with brain injury and executive function problems. Karman Line Plan consists of a digital environment (Plan Game) and a mobile application (Plan Tool). This study aims to describe the design process and evaluate the usability and acceptance of Karman Line Plan. The program was developed using a three-phase standardized user-centred design approach. Results indicate that Karman Line Plan is perceived as user-friendly and valuable by both patients and therapists. The findings emphasize the importance of involving the target patient population early in the development process to allow for early adjustments and meet end-user needs.

Despite the growing use of telehealth in stroke rehabilitation, it remains unclear whether online assessments (i.e., tele-assessment) can match the accuracy of in-person evaluations. Given the high prevalence of stroke and its significant impact on mobility, precise assessment is essential. This study evaluated the reliability and safety of a tele-assessment protocol for mobility and balance in individuals with chronic stroke, using the OMPEPE guideline. Twenty-five participants underwent in-person and synchronous tele-assessment (Timed Up and Go, Five Times Sit-to-Stand, and Functional Reach tests) within 24 to 48 hours. One month later, the same physiotherapist and a second investigator independently scored asynchronous video recordings. Results showed strong agreement between online and in-person assessments, with excellent intra- and inter-rater reliability (ICC > 0.90). Most participants had moderate to severe motor impairment. These findings suggest that tele-assessment is a reliable and safe approach when systematically planned, providing an effective solution for monitoring individuals with chronic stroke conditions when in-person healthcare is not feasible.

Multi-Modality Aphasia Therapy (M-MAT) is a cost-effective group intervention for post stroke aphasia. M-MAT was recently adapted for telerehabilitation but has not yet been tested. This pilot study aimed to investigate the feasibility, acceptability, and preliminary signs of efficacy, providing 30 hours of M-MAT Tele to three groups of three people with chronic aphasia. Participants were grouped according to aphasia severity. Clinical outcomes were assessed at three timepoints. Feasibility and acceptability were assessed through a range of trial measures including recruitment, adherence, treatment fidelity and overall participant ratings. Recruitment targets were achieved, with nine participants receiving a median 24.4h of the prescribed dose. Therapy integrity and adherence were high (94%), effect sizes favoured positive clinical change, and acceptability was strong based on participant and therapist feedback. Minor protocol/software changes were recommended. This pilot study showed that M-MAT Tele was acceptable and feasible to participants and therapists, with positive preliminary outcomes.

Ukraine's current rehabilitation and healthcare challenges have catalyzed a national push toward scalable, AI-enabled digital health solutions. This Letter reports on a joint initiative of I.Ya. Horbachevsky Ternopil National Medical University, and the V.M. Glushkov Institute of Cybernetics of the National Academy of Sciences of Ukraine to operationalize the human digital twin (HDT) concept within a tele-diagnostic (TD) & artificial intelligence (AI) platform for telerehabilitation and digital education. The Letter delineates how HDTs, understood as continuously updated virtual representations of individual patients, are coupled with AI agents to support remote patient monitoring, decision-support, and personalized rehabilitation trajectories. Beyond clinical care, these HDTs function as virtual patients for simulation-based training and in-silico experimentation, enabling students, residents, and multidisciplinary teams to rehearse diagnostic and therapeutic strategies without risk to real patients. By integrating sensor-derived data, AI-driven expert systems, and web-based learning environments, the TD+AI platform exemplifies how resource-constrained settings can effectively employ HDT technologies to converge digital health and digital education. The Letter concludes by highlighting opportunities for international collaboration to co-develop, validate, and scale such HDT-centered telerehabilitation ecosystems.