Technologies used to facilitate remote rehabilitation of adults with deconditioning, musculoskeletal conditions, stroke, or traumatic brain injury: an umbrella review
Authors: Edwards Deborah , Williams Jenny , Carrier Judith , Davies Jennifer 
Published: August 2022

ABSTRACT

Objective:
The objective of this review was to provide an overview of technologies (devices, tools, or software applications) used to facilitate remote rehabilitation of adults with deconditioning, musculoskeletal conditions, stroke, or traumatic brain injury, and to summarize the quantitative evidence of their efficacy.

Introduction:
Health care providers are considering how to meet longer-term rehabilitation needs of people whose health or level of activity and participation has been impacted directly or indirectly by the COVID-19 pandemic. Demands on rehabilitation services are increasing, driving a need for more services to be delivered in homes and communities. This review will identify the effectiveness of health care technologies to facilitate remote rehabilitation.

Inclusion criteria:
This review included quantitative systematic reviews where participants were adults requiring rehabilitation for musculoskeletal conditions, stroke, or traumatic brain injury, or older adults requiring rehabilitation for deconditioning. Interventions included a technology and focused on recovery or rehabilitation with one of the following primary outcomes: physical activity levels, balance and/or gait, physical performance (mobility), or functional performance. Secondary outcomes included levels of pain, cognitive function, health-related quality of life, and adverse effects.

Methods:
Five databases were searched from 2016 to 2020 to identify English-language publications. Critical appraisal of five systematic reviews was conducted independently by two reviewers. Data extraction was performed independently by two reviewers. Data were summarized using a tabular format with supporting text.

Results:
Despite the large number of systematic reviews found in the initial search, only five met the inclusion criteria. Of these, each explored a different technology, including wearable activity trackers, computer-based activities, non-immersive virtual reality, mobile apps, web-based rehabilitation interventions, and electronic health-based interventions (web-based or app-based with a wearable activity tracker). Computer-based activities were beneficial for improving cognitive function but showed no benefit on quality of life in post-stroke rehabilitation. Interventions that included wearable activity trackers showed mixed findings for increasing levels of physical activity for community-dwelling older adults with deconditioning. Mobile apps were beneficial for increasing levels of physical activity and physical or functional performance for post-stroke rehabilitation. Web-based rehabilitation that contained a variety of components to support home exercise was not effective in improving physical performance or QoL, reducing pain, or increasing levels of physical activity among individuals with rheumatoid arthritis. Electronic health-based interventions (web-based or app-based with a wearable activity tracker) were effective in improving physical performance and reducing pain in individuals with osteoarthritis of the knee or hip. Therapy in the form of screen-based, non-immersive virtual reality could be successfully transferred to the home environment for improving the balance/gait of individuals with stroke.

Conclusions:
The small number of heterogeneous systematic reviews included in this umbrella review and the very low quality of evidence, mostly from single small primary studies, make it difficult to draw overall conclusions that differ from the original review findings. This highlights a paucity of strong, high-quality evidence underpinning technologies that can be used to facilitate remote rehabilitation in the wake of the COVID-19 pandemic.