Volume 22, Issue 1 (Spring 2021)                   jrehab 2021, 22(1): 2-9 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Gharib M, Rahmani N. Telerehabilitation During the COVID-19 Pandemic. jrehab 2021; 22 (1) :2-9
URL: http://rehabilitationj.uswr.ac.ir/article-1-2837-en.html
1- Orthopedic Reshearch Center, Mazandaran University of Medical Sciences, Sari, Iran. , gharib_masoud@yahoo.com
2- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Full-Text [PDF 1910 kb]   (1309 Downloads)    
Full-Text:   (2386 Views)
n March 11, 2020, the World Health Organization (WHO) declared the acute respiratory syndrome caused by the novel Coronavirus leading to the COVID-19 pandemic [1].
 This global crisis has led to the challenge of the rehabilitation system worldwide to maintain its clinical and professional activities for providing primary and secondary care in private clinics and public health systems [2, 3]. However, the WHO stated that the necessary clinical care for patients and the community should be continued safely, which can be challenging for the rehabilitation staff [1].
Discontinuation of rehabilitation activities, especially physiotherapy, can have a significant negative impact on the patient’s health. Telerehabilitation provides the possibility of continuing rehabilitation services to patients.
Digital rehabilitation
In 2019, the World Confederation of Physiotherapy described digital activity as describing health care services, support, and information provided remotely through digital communications and devices. However, this measure started in 2017 with the development of regulations related to digital physical therapy exercises [4]. The purpose of this measure was to facilitate the effective provision of rehabilitation services, especially physiotherapy by improving access to rehabilitation services and health care management.
There is still no comprehensive definition for telerehabilitation in the literature and industry and also in the policymakers and stakeholders’ view. However, various terms, such as tele_education, telemedicine, tele_monitoring, tele_assistance, mobile health, and digital rehabilitation are used in this field [5].
Barriers to digital rehabilitation
 Although there is no law and infrastructure in the field of telerehabilitation in Iran, some people conducted training, counseling, and treatment remotely through webinars or the use of various software. Lack of a law approved by the Ministry of Health or even scientific associations regarding the presenting person, the topics, the audience, and how to monitor and evaluate the system can lead to the holding and production of non-functional and even incorrect content. It was expected that with the outbreak of the COVID-19, scientific associations of physiotherapy, occupational therapy, speech therapy, etc. would issue permits to rehabilitation colleagues by issuing short statements in the form of guidance and how to use remote health care.
Some countries now use specially-designed and safe technologies to help rehabilitate and monitor patients’ rehabilitation. However, many therapists in Iran use free video conferencing software, such as Google Hangouts, Zoom, and Skype. Although the use of such software is desirable due to the existing infrastructure, these tools do not have the necessary security in virtual and digital activities. 
Countries, such as Australia, the United Kingdom, and the United States began using digital activities in health care systems several years ago, and recently, their specialist and rehabilitation associations have issued guidelines to assist professionals and rehabilitators in the event of COVID-19 outbreak [5]. The creation of digital methods in these countries was possible only because these countries already had the necessary infrastructure to support these technologies. In our country, following the COVID-19 pandemic, there has been an opportunity to start a discussion in the field of digital rehabilitation methods and design and approve regulations and laws in this regard.
Undoubtedly, there are several obstacles to the implementation of a digital system in Iran, including infrastructure, legal and social issues, and economic aspects. Important issues, such as legal liability, ethical issues, such as confidentiality, equipment, patient’s age and level of education, computer literacy of the parties, bandwidth, and internet speed should also be considered.
Prospects and opportunities
The use of digital rehabilitation will provide opportunities for users and services to the community and target groups, such as expanding access to health care providers, self-management, increasing flexibility in providing health care, and reducing the number of patients who leave without treatment.
The effectiveness of treatment and evaluation of patients using digital practice, especially for physiotherapy, occupational therapy, and speech therapy for some acute and chronic musculoskeletal disorders, cardiac rehabilitation, stuttering disorders, neurological problems, stroke, postoperative rehabilitation, pain control, cognitive disorders, pelvic disorders, aphasia, and respiratory disorders has been studied [18171615141312 ,11 ,10 ,9  ,8  ,76]. In these studies, in addition to the level of client satisfaction, the evaluation process, the effectiveness of treatment, and follow-up after treatment were measured and evaluated.
The need for innovation in the technology market in terms of reducing costs and increasing benefits to customers is quite evident. In Iran, it is recommended to design and market the software with the approval of specialized scientific and rehabilitation associations to preserve the personal information of local people.
Another important issue for digital rehabilitation that needs support is the integration of medical data and rehabilitation. Because patients are remotely evaluated or treated, medical and rehabilitation specialists are needed to provide the best service according to their medical and rehabilitation information. In our country, hospitals and clinics have different electronic file systems. However, whether or not they have an electronic recording system at all is a big challenge.
In Iran, special laws and guidelines should be written on the implementation of remote rehabilitation in the fields of evaluation, treatment, and follow-up to express the obligations and rights of all parties involved. Based on the experience of other countries, all data obtained through information technology will be transferred to the medical care department; thus, the medical staff can regularly monitor and evaluate the information provided by the patient through tele_monitoring.
Considering the experiences of other countries, it is necessary to first consider the laws that include the services as the definition of telerehabilitation, the methods of providing the services (telephone, websites, online or offline software, and video conferencing), the conditions to provide services, the people who provide the services (physiotherapist, occupational therapist, speech therapist, etc.), the group of patients who use these services (type of disorder), general expectations (issues related to the therapist’s characteristics, such as having a medical system), issues related to the personal satisfaction of the service provider, the privacy of information and the observance of safety issues [1920]. Then, the approved and registered people will start their activities by providing internet addresses, valid contact numbers, or approved software from related organizations.
The COVID-19 epidemic should be an opportunity to empower health care systems in Iran, including the provision of various rehabilitation services. The digital approach can be an appropriate solution to the challenges that our health care system, especially rehabilitation, may face. Therefore, the provision of telerehabilitation services during the COVID_19 epidemic is an issue that policymakers and various rehabilitation associations should move towards as soon as possible by developing approved regulations and guidelines.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles are considered in this article. 

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
 Both authors contributed equally in preparing this article.

Conflict of interest
The authors declared no conflict of interest.

  1. PAHO and OWH. WHO characterizes COVID-19 as a pandemic [Internet]. 2020 [Updated 2020]. Available from: https://www3.paho.org/hq/index.php?option=com_content&view=article&id=15756:who-characterizes-covid-19-as-a-pandemic&Itemid=1926&lang=en
  2. Pelicioni PHS, Lord SR. COVID-19 will severely impact older people’s lives, and in many more ways than you think! Brazilian Journal of Physical Therapy. 2020; 24(4):293–94. [DOI:10.1016/j.bjpt.2020.04.005] [PMID] [PMCID]
  3. Pinto TF, de Carvalho CR. SARS CoV-2 (COVID-19): Lessons to be learned by Brazilian Physical Therapists. Brazilian Journal of Physical Therapy. 2020; 24(3):185-6. [DOI:10.1016/j.bjpt.2020.04.004] [PMID] [PMCID]
  4. Dantas LO, Barreto RPG, Ferreira CHJ. Digital physical therapy in the COVID-19 pandemic. Brazilian Journal of Physical Therapy. 2020; 24(5):381-3. [DOI:10.1016/j.bjpt.2020.04.006] [PMID] [PMCID]
  5. Pegorari MS, Ohara DG, Matos AP, CR Iosimuta N, TK Ferreira V, Carolina PN Pinto A. Barriers and challenges faced by Brazilian physiotherapists during the COVID-19 pandemic and innovative solutions: Lessons learned and to be shared with other countries. Physiotherapy Theory and Practice. 2020; 36(10):1069-76. [DOI:10.1080/09593985.2020.1818486] [PMID]
  6. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare. 2018; 24(1):4-12. [DOI:10.1177/1357633X16674087] [PMID] [PMCID]
  7. Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: A randomised controlled study with focus on pelvic floor muscle training. BJU International. 2013; 112(3):362-72. [DOI:10.1111/j.1464-410X.2012.11713.x] [PMID] [PMCID]
  8. Eslami Jahromi M, Ahmadian L, Bahaadinbeigy K. The effect of tele-speech therapy on treatment of stuttering. Disability and Rehabilitation: Assistive Technology. 2020; 1-6. [DOI:10.1080/17483107.2020.1754475] [PMID]
  9. Weiss PL, Kizony R, Elion O, Harel S, Baum-Cohen I, Krasovsky T, et al. Development and validation of tele-health system for stroke rehabilitation. Paper presented at: Proceedings of the International Conference on Disability, Virtual Reality and Associated Technologies. 10-12 September 2015; Laval, France. https://www.reabilityonline.com/wp/wp-content/uploads/2015/02/ICDVRAT_2012_Weiss-et-al-tele.pdf
  10. Bennell K, Nelligan R, Dobson F, Rini CM, Keefe F, Kasza J, et al. Internet-delivered exercise and pain-coping skills training for chronic knee pain. Annals of Internal Medicine. 2017; 166(7):I13. [DOI:10.7326/P17-9031] [PMID]
  11. Agostini M, Moja L, Banzi R, Pistotti V, Tonin P, Venneri A, et al. Telerehabilitation and recovery of motor function: A systematic review and meta-analysis. Journal of Telemedicine and Telecare. 2015; 21(4):202-13. [DOI:10.1177/1357633X15572201] [PMID]
  12. Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clinical Rehabilitation. 2017; 31(5):625-38. [DOI:10.1177/0269215516645148] [PMID]
  13. Tam SF, Man WK, Hui-Chan CW, Lau A, Yip B, Cheung W. Evaluating the efficacy of tele-cognitive rehabilitation for functional performance in three case studies. Occupational Therapy International. 2003; 10(1):20-38. [DOI:10.1002/oti.175] [PMID]
  14. Kitsiou S, Paré G, Jaana M. Effects of home telemonitoring interventions on patients with chronic heart failure: An overview of systematic reviews. Journal of Medical Internet Research. 2015; 17(3):e63. [DOI:10.2196/jmir.4174] [PMID] [PMCID]
  15. Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T. Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: A randomised trial. Journal of Physiotherapy. 2017; 63(2):101-7. [DOI:10.1016/j.jphys.2017.02.017] [PMID]
  16. Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth interventions to support self-management of long-term conditions: A systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. Journal of Medical Internet Research. 2017; 19(5):e172. [DOI:10.2196/jmir.6688] [PMID] [PMCID]
  17. Fridler N, Rosen K, Herzberg O, Lev A, Kaplan D, Hildesheimer M, et al. editors. Tele-rehabilitation therapy vs. face-to-face therapy for aphasic patients. Paperpresented at: eTELEMED 2012: The 4th International Conference on eHealth, Telemedicine, and Social Medicine. 30 January - 4 February 2012; Spain, Valencia. https://www.reabilityonline.com/wp/wp-content/uploads/2015/02/etelemed_2012_1_40_40106.pdf
  18. Galiano-Castillo N, Cantarero-Villanueva I, Fernández-Lao C, Ariza-García A, Díaz-Rodríguez L, Del-Moral-Ávila R, et al. Telehealth system: A randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors. Cancer. 2016; 122(20):3166-74. [DOI:10.1002/cncr.30172] [PMID]
  19. Greenhalgh S, Finucane LM, Mercer C, Selfe J. Safety netting; best practice in the face of uncertainty. Musculoskeletal Science and Practice. 2020; 48:102179. [DOI:10.1016/j.msksp.2020.102179] [PMID] [PMCID]
  20. Canadian Physiotherapy Association. Tele-Rehabilitation [Internet]. 2020 [Updated 2020 March 29]. Available from: https://physiotherapy.ca/tele-rehabilitation
Type of Study: Editorial | Subject: Physical Therapy
Received: 27/09/2020 | Accepted: 21/12/2020 | Published: 1/04/2021

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Archives of Rehabilitation

Designed & Developed by : Yektaweb