Browsing by Subject "Middle-income countries"

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    The use of telerehabilitation in physiotherapy inlower-middle income countries: a scoping review
    (2025) Muula, Thumbe; Talberg, Heather; Burgess, Theresa
    Introduction: Health systems in lower- and middle-income countries (LMICs) often have limited access to rehabilitation services. Telerehabilitation (TR) has the potential to be an alternative or adjunct to rehabilitation services in underserved communities in LMICs and can also assist with continuation of care to patients with chronic conditions or injuries requiring ongoing rehabilitation. The aim of this scoping review was to explore the use of TR in physiotherapy in LMICs. Objectives: The specific objectives of the scoping review were to: describe the range of impairments, activity limitations, participation restrictions, and disease or health conditions that are being addressed using TR by physiotherapists in LMICs, describe the nature, mode of delivery, and outcomes of TR interventions used by physiotherapists for patient care in LMICs, and explore the perceived benefits, facilitators, and barriers associated with the implementation and use of TR by physiotherapists in LMICs. Methods: The PRISMA-ScR guideline for reporting was used in the scoping review. Literature focussing on the use of TR in LMICs were extracted from EBSCOhost, Web of Science, Scopus, and PubMed. Full-text articles included in the review were published in English between 2000 to 2024. Literature reviews, editorials, systematic reviews, meta-analyses, and single case studies were excluded from the study. Results: Twenty-six articles were included in the review. Most of these studies focused on musculoskeletal or neurological conditions, with a smaller number of studies involving COVID-19, cardiorespiratory conditions, and diseases of lifestyle. Telerehabilitation was mostly used to address impairments including pain, muscle weakness, anxiety, depression, and fatigue, with little reporting on the impact on activity levels and participation restrictions. The mode of TR varied and primarily involved videoconferences followed by phone calls, with some studies also reporting recorded videos of exercises and messaging. The nature of TR only included treatment in most studies, with three studies including both treatment and assessment. Conclusion: Telerehabilitation is a potentially viable alternative or adjunct to expand access to rehabilitation in LMICs to help address the burden of disease where access to rehabilitation services is limited. The results from the scoping review show that TR is feasible and effective in physiotherapy to provide rehabilitation in LMICs. While most literature has considered the impact on impairments, successful implementation of TR would need to investigate the impact on activity levels and participation restrictions in these populations. The barriers to the use of TR in LMICs should be addressed by promoting technology literacy through training and installing modern TR infrastructure or using low bandwidth technologies to reduce slow internet connections during TR sessions. Future research should be conducted that includes a larger pool of data to investigate the value and feasibility of the use of TR in physiotherapy in LMICs. The adoption of TR use in the field of physiotherapy should be encouraged with the findings from this review supporting its feasibility and value in promoting access to rehabilitation.