Effects of spinal stabilization exercises delivered using telerehabilitation on outcomes in patients with chronic neck pain: a randomized controlled trial

Exploring participant satisfaction with an eHealth intervention for low back pain and knee osteoarthritis: Enhancing physiotherapy access in rural Australia

INTRODUCTION

Accessing health services in rural Australia is challenging and innovative solutions to meet residents' needs are required. Research into eHealth is crucial as it offers potential solutions to these challenges. The study aimed to assess participants' satisfaction and experience with an eHealth physiotherapy intervention at improving physical function for low back pain and knee osteoarthritis in rural Australia.

METHODS

Telephone surveys collected data on participant satisfaction and experiences. Satisfaction was rated on a scale of 0-10, and the data was presented descriptively and compared between groups (eHealth and usual care) using Mann-Whitney U tests. Participant experiences with the pilot trial were gathered using open-ended questions, categorised and presented descriptively.

RESULTS

75/156 (48%) participants responded to the satisfaction survey. Overall satisfaction was significantly higher for the eHealth group, median = 9 [IQR: 8-10] compared with the usual care group, median = 8 [IQR: 5-9] (p = 0.025). Satisfaction was also significantly higher in the eHealth group for all secondary measures in the study, including accessibility to healthcare practitioner (p = 0.001), time to contact physiotherapist (p = 0.011), cost of intervention (p < 0.001) and distance travelled (p < 0.001). For the pilot experiences, inconvenient aspects such as completing forms/administration and travel were significantly higher in the usual care group, while difficulties with exercises, were significantly higher in the eHealth group (p = 0.005).

CONCLUSIONS

An eHealth intervention for physiotherapy is acceptable to patients with knee osteoarthritis and low back pain in rural Australia. Future telehealth interventions should pay special attention to participant's exercise workload and motivation.

Efficacy of mHealth in Patients With Chronic Neck Pain: A Systematic Review and Meta-Analysis

OBJECTIVES

To assess the efficacy of mobile health-based interventions for alleviating symptoms of chronic neck pain in patients.

METHODS

A systematic search was conducted in databases, including the China National Knowledge Infrastructure, VIP, Wanfang, Chinese Biomedical Databases, PubMed, Embase, Web of Science, and Cochrane Library, for randomized controlled trials (RCTs) regarding support provided to patients with chronic neck pain using mobile health interventions from database inception to March 2024. Two researchers independently screened the literature and evaluated the quality using the Cochrane Handbook 5.1 risk of bias assessment tool. Statistical analyses were performed using RevMan 5.2, and the quality of evidence was assessed according to the GRADE criteria.

RESULTS

Ten RCTs comprising 825 participants were included. A meta-analysis indicated that mobile health interventions were more effective than other physical therapies for reducing pain (short-term: SMD = -0.76, [95% CI -1.50, -0.02], p = .04; mid-term: SMD = -0.48, [95% CI -0.78, -0.18], p < .01), although there was no significant difference for improving neck disability status (short-term: MD = -6.74, [95% CI -13.65, 0.17], p = .06; mid-term: SMD = -2.26 [95% CI -6.71, 2.20], p = .32). Compared to minimal intervention, mobile health interventions were more effective in reducing pain (short-term: SMD = -1.16, [95% CI -1.70, -0.63], p < .001) and improving neck disability status (short-term: MD = -7.88, [95% CI -12.27, -3.13], p < .001).

CONCLUSIONS

Mobile health-based interventions positively affected the predictive outcomes for patients with chronic neck pain, reduced pain levels, and improved neck disability. Further research is needed to demonstrate their benefits for reducing fear of pain and improving quality of life.

Effectiveness of telerehabilitation on the International Classification of Functioning, Disability, and Health framework outcomes during the COVID-19 pandemic: A systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to synthesize and analyze the evidence on the effectiveness of telerehabilitation categorized according to the International Classification of Functioning, Disability, and Health (ICF) outcomes for physical therapy (PT) during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Studies were identified using the Physiotherapy Evidence Database (PEDro), Scopus, PubMed, EMBASE, and other sources of data. Randomized controlled trials comparing telerehabilitation with the control group (i.e., no treatment/usual care) were included. Standard meta-analysis techniques were applied to assess the effectiveness of telerehabilitation. Outcome measures were categorized according to the domains of the ICF.

Results

Among the 134 studies that met the eligibility criteria, the majority of findings demonstrated significant improvements across all domains of the ICF following telerehabilitation as compared to the control group, regardless of participant groups. Only 9 of 134 studies were included in the meta-analysis. Six studies enrolled individuals with COVID-19 and the remaining three enrolled individuals with knee osteoarthritis (OA) who were unable to access services at the clinic. Compared with the control group, the Borg-Rating-of-Perceived-Exertion scale, as reflected in an impairment domain, was significantly lower in individuals with COVID-19 who received telerehabilitation (3 studies, n = 135; standardized mean difference (SMD) -1.82, 95% CI -2.77 to -0.86). Compared with that in the control group, 30-second sit-to-stand test (3 studies, n = 122; SMD 0.88, 95% CI 0.52-1.25) and 6-minute-walking test (4 studies, n = 221; SMD 0.83, 95% CI 0.42-1.24), as reflected to an activity domain, showed significant improvement in the telerehabilitation group. Conversely, there was no effectiveness of telerehabilitation on an activity domain as measured by the timed up and go test in people with knee OA (3 studies, n = 111; SMD -0.45, 95% CI -1.19 to 0.30).

Conclusion

This study provides evidence supporting the effectiveness of telerehabilitation across all domains of the ICF, with significant improvements observed in the impairment and activity domains for individuals with COVID-19. These improvements are particularly evident in the meta-analysis findings such as perceived exertion, leg strength, and functional capacity.

Real-time video telerehabilitation shows comparable satisfaction and similar or better attendance and adherence compared with in-person physiotherapy: a systematic review

QUESTION

How does physiotherapy delivered by real-time, video-based telerehabilitation compare with in-person delivery for the outcomes of attendance, adherence and satisfaction?

DESIGN

Systematic review of randomised control trials indexed in PubMed, CINAHL, Embase, Cochrane and PEDro on 12 March 2024.

PARTICIPANTS

Adults aged > 18 years.

INTERVENTION

Physiotherapy delivered via real-time video telerehabilitation.

OUTCOME MEASURES

Attendance, adherence and satisfaction.

RESULTS

Eight studies were included for attendance (n = 1,110), nine studies for adherence (n = 1,190) and 12 studies for satisfaction (n = 1,247). Telerehabilitation resulted in attendance at treatment sessions that was 8% higher (95% CI -1 to 18) and adherence to exercise programs that was 9% higher (95% CI 2 to 16) when compared with in-person physiotherapy. Satisfaction was similar with both modes of delivery (SMD 0.03 in favour of telerehabilitation, 95% CI -0.23 to 0.28). The level of certainty assessed by GRADE ranged from very low to low, primarily due to inconsistency and high risk of bias.

DISCUSSION

Attendance at appointments among participants assigned to telerehabilitation was somewhere between similar to and considerably higher than among control participants. Adherence to self-management with telerehabilitation was better than with in-person delivery, although with some uncertainty about the magnitude of the effect. Reported satisfaction levels were similar between the two modes of treatment delivery. Given the significance of attendance, adherence and satisfaction for successful outcomes, telerehabilitation offers a valuable alternative mode for physiotherapy delivery.

CONCLUSION

Real-time telerehabilitation has potentially favourable effects on attendance at treatment appointments and adherence to exercise programs, with similar satisfaction when compared with traditional in-person physiotherapy.

REGISTRATION

PROSPERO CRD42022329906.

Delivery of Allied Health Interventions Using Telehealth Modalities: A Rapid Systematic Review of Randomized Controlled Trials

Objectives: To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. Study design: A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Eligible trials: Trials were eligible for inclusion if they compared a comparable dose of face-to-face to telehealth interventions delivered by a neuropsychologist, occupational therapist, physiotherapist, podiatrist, psychologist, and/or speech pathologist; reported patient-level outcomes; and included adult participants. Data sources: MEDLINE, CENTRAL, CINAHL, and EMBASE databases were first searched from inception for systematic reviews and eligible trials were extracted from these systematic reviews. These databases were then searched for randomized clinical trials published after the date of the most recent systematic review search in each discipline (2017). The reference lists of included trials were also hand-searched to identify potentially missed trials. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 1. Data Synthesis: Fifty-two trials (62 reports, n = 4470) met the inclusion criteria. Populations included adults with musculoskeletal conditions, stroke, post-traumatic stress disorder, depression, and/or pain. Synchronous and asynchronous telehealth approaches were used with varied modalities that included telephone, videoconferencing, apps, web portals, and remote monitoring, Overall, telehealth delivered similar improvements to face-to-face interventions for knee range, Health-Related Quality of Life, pain, language function, depression, anxiety, and Post-Traumatic Stress Disorder. This meta-analysis was limited for some outcomes and disciplines such as occupational therapy and speech pathology. Telehealth was safe and similar levels of satisfaction and adherence were found across modes of delivery and disciplines compared to face-to-face interventions. Conclusions: Many allied health interventions are equally as effective as face-to-face when delivered via telehealth. Incorporating telehealth into models of care may afford greater access to allied health professionals, however further comparative research is still required. In particular, significant gaps exist in our understanding of the efficacy of telehealth from podiatrists, occupational therapists, speech pathologists, and neuropsychologists. Protocol Registration Number: PROSPERO (CRD42020203128).

Effects of Telerehabilitation on Pain and Disability in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis

(1) Background: This systematic review and meta-analysis explores the effectiveness of telerehabilitation in patients suffering from chronic neck pain, specifically on pain and disability. The research delves into an area of growing significance within the realm of healthcare, aiming to understand the impact of digital interventions on the rehabilitation process for individuals with prolonged neck pain. (2) Methods: The comprehensive review encompasses a wide array of studies evaluating the collective outcomes of numerous trials focused on telerehabilitation strategies. In this systematic review, PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched to identify studies on telerehabilitation's impact on pain. (3) Results: Eight studies met the inclusion criteria. Using the Downs and Black quality assessment, three studies were classified as good and five as fair. The authors identify specific modalities within telerehabilitation, such as remote exercise programs and virtual consultations, that contribute significantly to positive patient outcomes. Meta-analysis indicated a significant overall effect of telerehabilitation on pain reduction (MD = -1.27; 95% CI = -2.06; -0.47; p = 0.002). These findings support telerehabilitation's efficacy in pain management. (4) Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of telerehabilitation as an effective and accessible means of managing chronic neck pain, offering valuable insights for both healthcare practitioners and policymakers in advancing patient-centered care.

Efficacy of telerehabilitation in patients with nonspecific neck pain: A meta-analysis

INTRODUCTION

At a rate of more than 30% annually, neck pain is a very prevalent musculoskeletal ailment that is second only to low back pain as the most common cause of disability. Most occurrences of neck pain are nonspecific. Telerehabilitation is regarded as a potentially effective healthcare approach in this setting. This review aims to evaluate how a telerehabilitation-based intervention affected individuals with nonspecific neck pain (NNP) in terms of pain and disability.

METHODS

PubMed, Web of Science, Scopus, Embase, MEDLINE, Cochrane library, ClinicalTrials.gov, CNKI, and WanFang were consulted from inception to September 2023, with the inclusion of randomized controlled trials only. The experimental data were meta-analyzed using RevMan 5.3.

RESULTS

The meta-analysis contained eight studies; there was no significant difference in pain improvement in patients with NNP by telerehabilitation compared to conventional care (SMD = -0.10, 95% CI: -0.48 to 0.28), but there was a significant effect on disability improvement (SMD = -0.41, 95% CI: -0.78 to -0.03). Telerehabilitation demonstrated more significant improvements in pain (SMD = -1.16, 95% CI: -1.99 to -0.32) and disability (MD = -3.78, 95% CI: -5.29 to -2.27) compared to minimal or no intervention.

DISCUSSION

This study emphasizes the potential benefits of employing telerehabilitation in patients with NNP, especially in reducing pain intensity and improving disability. But additional study is required to fully grasp the potential of telerehabilitation in this field.