Abstract
Background: Global demand for rehabilitation services is increasing, yet access remains constrained, with low- to middle-income countries facing disproportionate barriers. Telerehabilitation offers a promising solution, but successful implementation depends on understanding user perspectives and acceptance.
Aim: This scoping review aims to synthesise patient, caregiver and family member perceptions and experiences regarding technology-delivered rehabilitation services and identify implications for improving service delivery through this modality.
Setting: Studies examining telerehabilitation interventions across various healthcare contexts published between 2000 and 2024.
Method: A complete search of the literature will be conducted across four databases (PubMed, Web of Science, Scopus and EBSCOhost) supplemented by grey literature sources including theses, opinion pieces, scholarly articles and organisational reports. Two reviewers will independently examine titles, abstracts and full texts of English and Afrikaans publications reporting qualitative information on perspectives and experiences of patients who received telerehabilitation or their family members/caregivers.
Results: The scoping review will summarise current evidence on user experiences with telerehabilitation, identifying key themes, barriers, facilitators and recommendations.
Conclusion: This review will provide valuable insights into stakeholder experiences with telerehabilitation to inform future implementation.
Contribution: Findings will guide the development of patient-centred telerehabilitation programmes and identify research gaps to enhance technology-enabled rehabilitation service delivery worldwide.
Keywords: caregivers; experiences; family members; patients; perspectives; qualitative; scoping review; telerehabilitation.
Introduction
Rehabilitation services are experiencing an increased demand globally (World Health Organization [WHO] 2017b). The rising demand for rehabilitation strains healthcare systems, especially vulnerable health systems of low- and middle-income countries (LMICs) (WHO 2017a). The epidemiological transitioning of disease profiles towards non-communicable diseases and trauma contributes to the increasing need for rehabilitation (Cieza et al. 2020). Furthermore, increased survival rates also imply that many people now live with impairments or limitations in functioning that can be improved through rehabilitation (Krug & Cieza 2017). Approximately one-third of the population needs rehabilitation services (Cieza et al. 2020). Unfortunately, the growing need is not met by a similar rate of resource availability and allocation towards healthcare (Krug & Cieza 2017; WHO 2017a). Rehabilitation is often perceived as a complex health strategy, requiring coordination within multidisciplinary teams (Gutenbrunner & Nugraha 2019).
Rehabilitation is traditionally delivered using a face-to-face model. This mode of delivery is seen to be beneficial as it provides direct patient-therapist interaction with hands-on manual techniques, hands-on assessment and immediate feedback (Muñoz-Tomás et al. 2023). Face-to-face delivery modes are costly for the healthcare providers and users with regard to travelling costs, physical infrastructure and resources (Martinez-Martin & Cazorla 2019; Muñoz-Tomás et al. 2023). Therefore, innovation is needed to meet the growing need for rehabilitation (Amatya & Khan 2022). The WHO acknowledges rehabilitation as an essential healthcare strategy to facilitate physical, cognitive, mental and functional capacity after injury, illness or impairment (Cieza 2019). Innovative rehabilitation care models to enhance function and promote participation can potentially increase access to care and strengthen rehabilitation in health systems (Amatya & Khan 2022).
The application of technology in healthcare is increasing (Srivastava et al. 2015). Providers, policymakers, and patients increasingly recognise technology’s potential as a cost-effective approach to close the gap between need and supply of care (Cardoso 2021; Hinman et al. 2017; Skolasky et al. 2022). Technology has advanced diagnostics, management, administration, patient support and self-care, consequently increasing outcomes of care (Haleem et al. 2021). Innovative service delivery models are also applicable for rehabilitation to enhance access to quality care (Amatya & Khan 2022). The coronavirus disease 2019 (COVID-19) pandemic has sparked and pushed rehabilitation towards greater technology use (Alghamdi & Alghamdi 2022). Telerehabilitation (TR) offers untapped potential and, if fully embedded in the health system, can potentially make a meaningful contribution to facilitate optimal functioning and participation.
Telerehabilitation offers numerous person-centred benefits (Cranen et al. 2017). It offers convenience by allowing home-based care, reducing travel burden and costs (Cranen et al. 2017). Published reports also show that telerehabilitation can improve patient support and adherence through continuous monitoring, provider communication and timely interventions (Cranen et al. 2017; Saaei & Klappa 2021). By leveraging technology for remote rehabilitation delivery, healthcare providers can reach more patients without the need for additional resource investment in physical infrastructure or on-site staff (Bradford, Caffery & Smith 2015; Sidelil et al. 2023). These benefits could potentially save costs, thereby reducing the strain on health systems. However, the benefits can only be fully realised if this mode of service delivery is positively perceived and accepted by users as a feasible and effective rehabilitation service delivery mode.
User perspectives about the use of technology in healthcare are mixed. Published reports, mostly biased towards high-income settings, suggest that some patients may be sceptical about the use of technology for rehabilitation delivery (Ariza-Vega et al. 2021; Lawford et al. 2018; Stark, Krayter & Dockweiler 2023). This perception is often related to the lack of experience and understanding of the use of technology to deliver rehabilitation (Stark et al. 2023). In addition, patients expressed concern about the potential impact on effectiveness because of the lack of personal interaction if technology is used (Eriksson, Lindstrom & Ekenberg 2010; Fernandes et al. 2022). In lower-income settings, much scepticism relates to data availability and costs (Cardoso 2021). To efficiently embed technology as a delivery mode for rehabilitation, understanding user perspectives is paramount to enhancing acceptance.
To our knowledge, there are no qualitative systematic syntheses to explore patient and caregiver perspectives, preferences and concerns about telerehabilitation as a mode of delivery. Understanding the patient perspective is crucial for optimal health system and patient outcomes. Therefore, this study aims to systematically synthesise patient, caregiver and family members’ perceptions and experiences with telerehabilitation. A specific focus will be on identifying barriers and facilitators to adopting telerehabilitation, describing perceived outcomes related to telerehabilitation, including patient satisfaction, experience, adherence and engagement and identifying research gaps and practice implications for telerehabilitation based on insights from these groups. Through this patient-focused lens, the research seeks to inform the development of optimised, tailored telerehabilitation programmes and identify implications for improving accessibility and quality of rehabilitation care.
Methods
Review question
What is the status of the literature on the perspectives and experiences of patients, caregivers and family members of patients on the use of technology in rehabilitation?
Inclusion criteria
Participants
Studies will be included that explore all patients attending or attended rehabilitation services at healthcare settings. Rehabilitation services will consist of the following services: physiotherapy, occupational therapy, speech, language and hearing therapy, orthotists, prosthetists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses (WHO 2017a). Caregivers and family members of these patients will also form part of the population of this study.
Concept
Studies will be considered for this scoping review that focus on the experiences and perspectives of telerehabilitation use (information on technology use in rehabilitation) during rehabilitation services by patients and their caregivers. The studies will also include the implementation of telerehabilitation in healthcare services at all levels of care where rehabilitation services are provided.
Context
Publications will be included in this scoping review that are based at any healthcare facilities where rehabilitation services are provided, including, but not limited to, hospitals, primary care facilities, residential care homes and rehabilitation facilities.
Types of sources
This review will include original studies that use qualitative methodologies. Studies must be in English and Afrikaans and in the date range of 2000 to 2024. This review omitted studies published before 2000. Telerehabilitation is a relatively modern field, and technology, along with methodologies, has advanced rapidly in recent years. Including studies before 2000 may not accurately represent the current state of telerehabilitation or reflect the latest technological and methodological advancements. Moreover, excluding pre-2000 studies allows the review to concentrate on the most recent and relevant literature, thereby enhancing the review’s quality and relevance.
Reporting and registration
The methodology draws on the JBI framework for scoping reviews (Aromataris & Munn 2020) and follows the reporting standards established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-ScR guidelines (Tricco et al. 2018). The scoping review protocol registration is accessible on Open Science Framework at (https://doi.org/10.17605/OSF.IO/67J4N).
Search strategy
PubMed (MEDLINE) was searched initially to check for existing reviews (Appendix 1: preliminary PubMed search). No current systematic reviews or scoping reviews were identified on this topic. Eligible studies will be located using a comprehensive search approach. A full search strategy was developed for PubMed, Scopus, Web of Science and EBSCOhost (Academic Search Premier, Africa Wide Information, CINAHL [Cumulative Index to Nursing and Allied Health Literature], E-Journals, ERIC [Education Resources Information Center], Health Source – Consumer edition, Health Source – Nursing/Academic Edition, MasterFile Premier, MEDLINE and Military & Government Collection). The search approach will be tailored to the specific database, incorporating relevant keywords and indexing terms specific to that source. Publications from 2000 to the present will be part of the review, as telerehabilitation is a relatively new field, and technology and methodology have evolved rapidly in recent years (Peretti et al. 2017). If studies before 2000 were included, data may not provide an accurate representation of the current state of TR and may not reflect the latest advances in technology and methodology. Additionally, excluding studies before 2000 can help to ensure that the review focuses on the most recent and relevant literature, which ensures the review remains current and applicable. To enhance the scope of the review, manual screening of reference lists from included articles will identify studies not captured by the initial search. Grey literature and unpublished sources – such as expert commentaries, academic theses, opinion articles, peer-reviewed papers and institutional reports – will also be explored to ensure comprehensive coverage of the topic.
Source of evidence selection
All identified records will be compiled and transferred to Rayyan (systematic review and meta-analysis software tool) following the search (Ouzzani et al. 2016). This software will be used to screen for duplicates and identify eligible titles and abstracts. A dual-reviewer process will be employed throughout the study selection phase. Two researchers will independently screen titles and abstracts against predefined inclusion criteria. Studies that meet initial criteria will undergo full article review by the same reviewers. All excluded full-text studies will be systematically recorded, with specific reasons for exclusion documented. These details will be included in the final report of the findings to ensure transparency. Any disagreements between reviewers during extraction and analysis will be settled through discussion. If no agreement is reached, a third researcher will provide an independent decision. The full search results and selection process will be thoroughly reported in the published review. A PRISMA flow diagram will document the visual presentation of the selection pathway, from initial search results to final included studies (Page et al. 2021).
Data extraction
A Microsoft® Excel form developed by the research team will be used for independent data extraction by two reviewers. This form will be based on the JBI-QARI (qualitative data extraction tool for qualitative research) (Munn, Tufanaru & Aromataris 2014). The following information will be labelled on an Excel document: author information, year of publication, methodology, geographical location, setting, populations (type, age and condition), phenomena of interest and findings (extracting quotes from participants, themes and sub-themes). The data collection form will be updated during the extraction process if new relevant information is discovered. Changes to the form will be recorded and included in the final review. Inter-reviewer discrepancies regarding data extraction will be resolved through collaborative discussion between the primary reviewers. In cases where consensus cannot be achieved, a third independent reviewer will be asked to determine the outcome. Study authors will be contacted when important information is missing from their papers or when clarification is needed. To address the variability in qualitative reporting among included studies, this review will employ a thematic analysis approach to identify common concepts across differing formats. A descriptive synthesis will be used to combine findings from studies with different reporting styles. Variations in how results are presented will be documented and examined to understand their potential implications for the overall analysis.
Data analysis and presentation
Thematic analysis will help identify main themes and sub-themes from the included articles (Creswell 2007). Themes and sub-themes will be independently reviewed following the extraction of quotations and the identification of core concepts by two reviewers for quality assurance. Following this process, the two independent reviewers will meet to review the final themes and sub-themes. The final themes and sub-themes will be used to summarise the data from each study. The extracted data will be added to ATLAS.ti version 25 according to predetermined themes and sub-themes such as perspectives, experiences, satisfaction, communication, expectations, technology and barriers and facilitators. Descriptive data such as bibliographic details, study design, sample characteristics (age, condition, stage of condition and care provided), years of publication, country, setting (area and care setting), data collection methods, outcomes and type of TR will be included in a table format.
Review findings
As of September 2024, the current review is at the data extraction phase. Following the above analysis, results from included studies will be reported narratively. The collated results will be incorporated into a manuscript. The complete article will be submitted to a peer-reviewed open-access journal for publication. The outcomes of this scoping review are anticipated to be ready for submission by July 2025. The data gathered through this scoping review will be made accessible upon reasonable request.
Implications and recommendations
The proposed protocol will provide a guide on conducting the scoping review to map existing studies on the perspectives and experiences of patients, carers and family members on the use of technology in rehabilitation. The growing demand for rehabilitation services, especially for LMICs (WHO 2017a), requires better methods and solutions to improve accessibility and quality of care. Telerehabilitation was found to be successful in providing a promising alternative method (Cardoso 2021; Skolasky et al. 2022), although the success of TR is determined by the acceptance and satisfaction of the users. Understanding the perceptions of the users can help identify the barriers and facilitators to adopting technology and ensure that the patient’s needs are met more effectively. Additionally, this research will highlight the design of user-centred TR programmes, promoting better engagement and adherence outcomes.
Limitations
A limitation of our scoping review is the exclusion of studies published before 2000, which may omit relevant historical perspectives on the evolution of telerehabilitation. A scoping review was selected for this study as the aim of the study is to provide a broad overview of the perspectives of the patients and their caregivers using TR. Therefore, this fits the methodology of a scoping review better. A systematic review will limit the data available for inclusion. Additionally, the review scope includes English and Afrikaans publications only, potentially overlooking valuable insights from non-English and Afrikaans-speaking populations. The full search of all databases was conducted with no limitation on languages. Languages were only limited by the final search. Approximately 650 searches were found before the limitation was added. Only 2 of the overall searches were in another language, namely Spanish (Coronel et al. 2023) and German (Kordel, Schulte & Karstens 2023) were excluded. These limitations may affect the generalisability of our findings.
Conclusion
This scoping review will examine patient, caregiver, and family member perspectives on TR services. The review will analyse qualitative studies published from 2000 to 2024 to identify barriers, facilitators, and user experiences with TR. The findings will contribute to the development of patient-centred TR programmes and provide evidence to guide implementation strategies for improving access to rehabilitation care. Understanding user perspectives is essential for the successful adoption of TR services in healthcare systems.
Acknowledgements
The authors would like to thank Dr Marisa Coetzee, Ms Thandi Conradie, Dr Maria Charumbira and Dr Eugene Nizeyimana for their assistance and guidance in this research.
Competing interests
The author reported that they received funding from the National Research Foundation Chair Initiative, which may be affected by the research reported in the enclosed publication. The author has disclosed those interests fully and has implemented an approved plan for managing any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university under its policy on objectivity in research.
The authors, Quinette Louw (Editor-in-Chief) and Dawn Ernstzen (Editorial Board), serves as editorial board members of this journal. The peer review process for this submission was handled independently, and the authors had no involvement in the editorial decision-making process for this manuscript. The authors have no other competing interests to declare.
Authors’ contributions
Q.L. conceptualised the study and obtained funding. G.B.P. drafted the initial article, while Q.L. and D.E. reviewed and revised it for intellectual content. All authors participated in designing the work, read through it thoroughly and endorsed its final version.
Ethical considerations
Ethical clearance to conduct this study was obtained from Stellenbosch University, Health Research Ethics Committee (Ref: S22/22/253).
Funding information
The authors have disclosed that financial support was obtained for the research, authorship and/or publication of this article by the National Research Foundation Chair Initiative (Grant number UID 115461).
Data availability
Derived data supporting the findings of this study will be available from the corresponding author, G.B.P. on reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.
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Appendix 1: PubMed (MEDLINE)
Search conducted on 22 March 2023.
Limiters: Publication date: 01 January 2000 to 31 December 2024.
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