[REVIEW] Telerehabilitation: Review of the State-of-the-Art and Areas of Application – Full Text  

ABSTRACT

Background: Telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Various types of telerehabilitation treatments and their relative intensities and duration have been reported.

Objective: The objective of this review is to provide a detailed overview of the rehabilitation techniques for remote sites (telerehabilitation) and their fields of application, with analysis of the benefits and the drawbacks related to use. We discuss future applications of telerehabilitation techniques with an emphasis on the development of high-tech devices, and on which new tools and applications can be used in the future.

Methods: We retrieved relevant information and data on telerehabilitation from books, articles and online materials using the Medical Subject Headings (MeSH) “telerehabilitation,” “telemedicine,” and “rehabilitation,” as well as “disabling pathologies.”

Results: Telerehabilitation can be considered as a branch of telemedicine. Although this field is considerably new, its use has rapidly grown in developed countries. In general, telerehabilitation reduces the costs of both health care providers and patients compared with traditional inpatient or person-to-person rehabilitation. Furthermore, patients who live in remote places, where traditional rehabilitation services may not be easily accessible, can benefit from this technology. However, certain disadvantages of telerehabilitation, including skepticism on the part of patients due to remote interaction with their physicians or rehabilitators, should not be underestimated.

Conclusions: This review evaluated different application fields of telerehabilitation, highlighting its benefits and drawbacks. This study may be a starting point for improving approaches and devices for telerehabilitation. In this context, patients’ feedback may be important to adapt rehabilitation techniques and approaches to their needs, which would subsequently help to improve the quality of rehabilitation in the future. The need for proper training and education of people involved in this new and emerging form of intervention for more effective treatment can’t be overstated.

Introduction

In the last few years, telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Long-distance communication can be easily achieved by videoconferencing, email, and texting, to name a few. Today there is the possibility of controlling robots, robotic arms, or drones at a distance. Thanks to these advancements, the course of human action has been considerably transformed [1]. During the last 20 years, demographic changes and increased budget allocation in public health have improved new rehabilitative practices [2]. Rehabilitation is an old branch of medicine, but in the last few years, new telecommunication-based practices have been developed all over the world. These particular approaches in the field of rehabilitation are commonly defined as telerehabilitation, which should be considered as a telemedicine subfield consisting of a system to control rehabilitation at a distance [3].

Telerehabilitation has been developed to take care of inpatients, transferring them home after the acute phase of a disease to reduce patient hospitalization times and costs to both patients and health care providers. Telerehabilitation allows for treatment of the acute phase of diseases by substituting the traditional face-to-face approach in the patient-rehabilitator interaction [4]. Finally, it can cover situations in which it is complicated for patients to reach traditional rehabilitation infrastructures located far away from where they live.

Controlled studies on rehabilitation have demonstrated that quick management of an injury or a disease is critical to achieve satisfactory results in terms of increasing a patient’s self-efficacy. Hence, a rehabilitation program should start as soon as possible, be as intensive as possible, be prolonged, and continue during the recovery phase. A major factor is the initiation time, which, in general, should begin as soon as possible. In most cases, the initial stages of rehabilitation, after the occurrence of a disease or injury, could be performed by patients at home even if they need accurate and intensive treatment. For these reasons, telerehabilitation was developed to achieve the same results as would be achieved by the normal rehabilitation process at a hospital or face to face with a physiotherapist. Various types of telerehabilitation treatments and their relative intensities and duration have been reported [5].

The first scientific publication on telerehabilitation is dated 1998 and, in the last few years, the number of articles on the topic has increased, probably because of the emerging needs of people and due to the development of exciting new communication and computer technologies. Figure 1 shows the number of patients treated through telerehabilitation from 1998 to 2008 according to studies published in the international literature [2].

A remarkable increase in the number of patients treated by telerehabilitation is noticeable from 2002 to 2004. After a subsequent decrease, the number of patients assisted by telerehabilitation increased starting from 2007, probably due to the support of new technologies and the overcoming of the initial skepticism to which every new technology is subjected.

Telerehabilitation is primarily applied to physiotherapy [6,7], and neural rehabilitation is used for monitoring the rehabilitative progress of stroke patients [8]. Telerehabilitation techniques mimic virtual reality [912] and rehabilitation for neurological conditions by using robotics and gaming techniques [13]. Quite often, telerehabilitation has been associated with other nonrehabilitative technologies such as remote monitoring of cardiovascular parameters, including electrocardiogram (ECG), blood pressure, and oxygen saturation in patients with chronic diseases [14]. These technologies belong to another telemedicine branch called telemonitoring, which has been widely developed and used in recent years. A few studies were also centered on the economic aspects of the use of telerehabilitation to reduce the costs of hospitalization [15]. We reviewed the status and future perspectives of telerehabilitation by analyzing their impact on patients’ everyday life. The main topics taken into account were (1) the status of telerehabilitation and analysis of the main medical specialties where it is being applied, (2) quality-of-life improvement due to telerehabilitation, and (3) the future of telerehabilitation.

Figure 1. Number of patients treated from 1998 to 2008 through telerehabilitation techniques.

 

Continue —> JRAT-Telerehabilitation: Review of the State-of-the-Art and Areas of Application | Peretti | JMIR Rehabilitation and Assistive Technologies

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