Features of Telerehabilitation and Considerations for Resource-Limited Settings: A Scoping Review

Emily Kelly; Jamie Tingey; Jessica Ott; Helena Hahn; Jacob  Bentley; Stephen Wegener; Zehra Zaidi; Nukhba Zia; Abdulgafoor Bachani

doi:10.20372/dcidj.716

Emily R. Kelly ⁽¹⁾, Jamie L. Tingey ⁽²⁾, Jessica Ott ⁽³⁾, Helena Hahn ⁽⁴⁾, Jacob A. Bentley ⁽⁵⁾, Stephen T. Wegener ⁽⁶⁾, Zehra Zaidi ⁽⁷⁾, Nukhba Zia ⁽⁸⁾, Abdulgafoor M. Bachani ⁽⁹⁾

(1) Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States,

(2) Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, CA, United States,

(3) AAAS Science & Technology Policy Fellow, United States,

(4) Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States,

(5) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA, United States,

(6) Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, MD, United States,

(7) , United States,

(8) Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States,

(9) Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States

https://doi.org/10.20372/dcidj.716

Issue
Vol. 35 No. 1 (2024): Spring Issue

Submitted
September 9, 2023

Published
October 15, 2024

Keywords:

Rehabilitation, Low- and middle-income countries, Telehealth, Disability, Health systems integration

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Abstract

Aim: The global need for rehabilitation is extensive yet remains significantly unmet. Health systems, especially in low- and middle-income countries (LMICs), lack structures and resources to address the rapidly growing need for rehabilitation services. Telerehabilitation offers an innovative approach to narrow health systems gaps and facilitate rehabilitation services. Few studies have investigated features and functionalities used in telerehabilitation, especially regarding implications for resource-limited settings and LMICs. This scoping review aims to identify technological features and functionalities used to deliver telerehabilitation, map them onto clinical care processes, and outline gaps and directions for future research. Methods: This study utilized the PRISMA- checklist. Six databases were searched (PubMed, Embase, Scopus, CINAHL, Compendex, NARIC) to identify articles that described the remote delivery of rehabilitation services. Three reviewers screened and selected relevant publications. Descriptive statistics and qualitative content analysis were used to analyze full-text articles. Results: 135 articles were included in the full-text review. The publication year ranged from 1997 to 2021. The most frequently identified telerehabilitation feature was “data collection,” followed by “videoconferencing,” and “messaging.” Features mapped onto six clinical categories, with “implementation” accounting for 41% of all features, Only 18% of articles focused on LMICs. Few papers included a comprehensive platform of features, discussed integration into health systems, or included financial analyses. Conclusions: Diverse technological features exist for the remote delivery of rehabilitation services, but few cohesive platforms offer features across multiple clinical categories. Additionally, high income countries are overwhelmingly represented in the literature. Future directions for research include expanded focus on resource-limited settings and LMICS, discussion about financial considerations, and attention to health systems integration. Limitations: The generalizability of our findings are limited given the rapid growth of literature on telerehabilitation and continued development of apps and platforms since the time of review.

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Authors

Emily R. Kelly

Department of Clinical Psychology, Seattle Pacific University, Seattle, WA

kellye@spu.edu (Primary Contact)

Jamie L. Tingey

Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, CA

Jessica Ott

AAAS Science & Technology Policy Fellow

Helena Hahn

Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD

Jacob A. Bentley

Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA

Stephen T. Wegener

Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, MD

Zehra Zaidi

Nukhba Zia

Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Abdulgafoor M. Bachani

Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Author Biographies

Emily R. Kelly, Department of Clinical Psychology, Seattle Pacific University, Seattle, WA

Emily R. Kelly is a clinical psychology Ph.D. student and a Registered Nurse, who has a master’s degree in nursing education and specialty certification as a healthcare simulation educator. She has worked as a nurse in diverse healthcare settings across the continuum of care, including acute care, primary care, community health, and baccalaureate nursing education. Emily’s research focuses on the intersection of healthcare and clinical psychology, with a specific interest in healthcare clinician wellbeing and burnout reduction.

Jamie L. Tingey, Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, CA

Jamie L. Tingey, PhD, is a Clinical Assistant Professor and Clinical Psychologist in the Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine. She provides nonpharmacological interventions to individuals with various sleep-related difficulties and disorders, including people with disabilities. Her research broadly focuses on factors that promote positive outcomes in patients with complex and/or chronic conditions (e.g., MS, TBI, ICU survivors) and improving the delivery of evidence-based interventions to individuals with chronic conditions.

Jessica Ott, AAAS Science & Technology Policy Fellow

Dr. Jessica Ott is an anthropologist with research interests in civil society, gender, human rights, health systems, and caregiving. She is currently a AAAS Science & Technology Policy Fellow in Washington, DC.

Helena Hahn, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD

Helena Hahn is a Ph.D. student and has an interest in the intersection of health and technology. She is passionate about developing tools that can promote greater accessibility and provide improved care.

Jacob A. Bentley, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA

Dr. Jacob A. Bentley is a Rehabilitation Psychologist and Acting Associated Professor in the Department of Rehabilitation Medication at the University of Washington School of Medicine. His clinical interests include coping with trauma, injury, and disability. His research interests include evaluation of outcomes associated with exposure to physical and psychological trauma in marginalized populations and the development of sustainable community-based health interventions. His research is often located in low-income community settings, locally and internationally.

Stephen T. Wegener, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, MD

Dr. Stephen T. Wegener is a Rehabilitation Psychologist, professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine, and the current director of the Division of Rehabilitation Psychology and Neuropsychology in the Department of Physical Medicine and Rehabilitation at Johns Hopkins Medicine. He is also a professor of health policy and management at the Bloomberg School of Public Health. His clinical activity is focused on providing psychological services to persons with chronic illness or traumatic injuries including chronic pain, amputation, and traumatic injury.

Zehra Zaidi

Zehra Zaidi is a Senior Research Associate in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. She completed her B.S. in Information Systems and her M.S. in Computer Systems Management. Before joining Johns Hopkins, Zehra served as the Director of Product Management at Qlarant. She helped develop the company’s flagship product – RIViR ™ - a high-powered, artificially intelligent, data analytics solution. She has an extensive background in software product development and building new, innovative technologies. Before Qlarant, Zehra spent 15+ years working for Lockheed Martin. Zehra also has been an adjunct faculty member in the Information Systems Department at University of Maryland Baltimore County (UMBC) for over 10 years.

Nukhba Zia, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Dr. Nukhba Zia is an Assistant Scientist in the Johns Hopkins Bloomberg School of Public Health. She is a health systems researcher with a focus on understanding how healthcare systems can provide care to vulnerable populations. Her focus is on conducting disability assessments and strengthening rehabilitation service delivery with focus at the primary care level. She also works to understand the burden of various types of injuries and how well-prepared trauma care systems are in developing countries. She is interested in developing innovative technological methods to enhance capacity of researchers to generate evidence for utilization by a broader audience, including policymakers and local community members.

Abdulgafoor M. Bachani, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Dr. Abdulgafoor M. Bachani is Associate Professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, and Director for the Johns Hopkins International Injury Research Unit (JH-IIRU). Dr. Bachani’s research focuses on health systems, as well as developing and implementing innovative approaches to measuring the burden of and preventing injury and disabilities. He holds a particular interest in developing approaches for the measurement of disability and understanding the long-term health, economic, and societal consequences of injuries; strengthening health systems to enhance access to rehabilitation services in low-resource settings; applying novel information and communication technology approaches to injury prevention, disability, and rehabilitation; and, developing sustainable capacity for research and practice in the field of injury prevention, disability, and rehabilitation.

1.

Kelly E, Tingey J, Ott J, Hahn H, Bentley J, Wegener S, Zaidi Z, Zia N, Bachani A. Features of Telerehabilitation and Considerations for Resource-Limited Settings: A Scoping Review. DCIDJ [Internet]. 2024 Oct. 15 [cited 2025 Feb. 3];35(1):6-33. Available from: https://dcidj.uog.edu.et/index.php/up-j-dcbrid/article/view/716

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