# New Remote Care Models in Patients with Spinal Cord Injury: A Systematic Review of the Literature
## 4 Discussion  
This literature review, as declared in the published protocol, was conducted in accordance with the PRISMA Statement [22]. The research aim was to analyze the best current scientific evidence regarding the use of teleassistance in the multidisciplinary home management of SCI patients. The focus was on alternative nursing models to in-person care, reconstructing the nurse's role in these settings and their interactions with the multidisciplinary team. Regarding the first RQ, the literature, although limited in number, reveals alternative care models to in-person care. In all four examined RCTs [34; 35; 36; 37], the authors compared home assistance for SCI patients supported by innovative technology (apps, onlineplatforms, and electronic devices) with standard in-person care. Different teleassistance approaches were found:  
* In one case, a real-time video conference service based on an encrypted software was used [34]. * Two RCTs [35; 36; 37] used a patient-managed application. * In one RCT [36], teleassistance was managed through a freely accessible platform for patients and teams. These three modalities to build the model show profound differences in terms of usability, accessibility, and adherence. Mobile apps offer interactive and customizable features that support self-monitoring and engagement, particularly among younger or tech-savvy users; their disadvantage is that patients' digital literacy and motivation could interfere with the results [38]. Video consultations replicate a traditional in-person appointment, and generally are perceived as more personal, improving therapeutic relationship and adherence, especially in chronic care settings [39]. Yet, they require stable internet connections and audio-video devices, so this may limit accessibility in low-resource settings. Finally, messaging platforms are simple, low-cost, and widely accessible--even among older adults--and have shown good results in supporting medication reminders or checks. However, they may be less effective for complex interventions that require real-time feedback or clinical nuance [40]. Deepening nurse's position among multidisciplinary team members, in one study [34], home nurses interfaced with the multidisciplinary team through a real-time videoconferencing, while in [PERSON] et al. 's [37] study, the nurse led the team as the direct manager of the app-based care. This last model enhanced the role of the follow-up nurse as coordinator of a multidisciplinary teamwork where a physical medicine and rehabilitation specialist, a physiotherapist and an occupational therapist were involved. The nurse had the responsibility to perform regular in-person assessments in order to ensure via the app that the patient was stable (the input was then converted accordingly to ICF taxonomy), or, in the case of complications, send messages to the competent team member, who had three days to answer the alert. In addition, the nurse ensured regular scanning of patients' messages every Monday. In the remaining studies [35; 36], it was not detailed how the nurse interfaced with the rest of the team, but the nurse was present as an equal member. In three RCTs [35; 36; 37], the patient remotely interfaced with the team by uploading data, photos, and videos into the applications used, allowing professionals to quickly assess the patient's condition and identify early signs of complications. This communication model between patient and team was in line with previous studies about telenursing for lung cancer patients [41; 42] and for chronic obstructive pulmonary disease (COPD) patients [43]. Regarding our second RQ, we investigated the reported effects of the remote care model compared to a traditional in-patient approach for SCI, even from a psychosocial point of view and for the clinical dimension.