Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Sep 1;9(3):e36028.
doi: 10.2196/36028.

Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis

Nathaphon Jirasakulsuk #  1 , Pattaridaporn Saengpromma #  1 , Santhanee Khruakhorn  1
Affiliations
Review

Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis

Nathaphon Jirasakulsuk et al. JMIR Rehabil Assist Technol. .

Abstract

Background: Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers.

Objective: We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness.

Methods: A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane's risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR's effectiveness based on different treatments, controls, and outcome measures.

Results: The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI -0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment.

Conclusions: We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care.

Trial registration: PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289.

Keywords: internet-based intervention; older adults; physical performance; physical therapy; telerehabilitation.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow of studies through the review.
Figure 2
Figure 2
Summary of the the risk-of-bias assessment. A red circle with a minus sign indicates a high risk of bias, a yellow circle with a question mark indicates there are some concerns, and a green circle with a plus sign indicates a low risk of bias.
Figure 3
Figure 3
Meta-analysis comparing the effect of real-time telerehabilitation on range of motion of knee flexion following interventions for all conditions. SMD: standardized mean difference; TR: telerehabilitation.
Figure 4
Figure 4
Meta-analysis comparing the effect of real-time telerehabilitation on balance following interventions for all conditions. SMD: standardized mean difference; TR: telerehabilitation.
See this image and copyright information in PMC

References

    1. Emmerson KB, Harding KE, Taylor NF. Providing exercise instructions using multimedia may improve adherence but not patient outcomes: A systematic review and meta-analysis. Clin Rehabil. 2019 Apr;33(4):607–618. doi: 10.1177/0269215518819706. - DOI - PubMed
    1. Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil. 2009;31(6):427–447. doi: 10.1080/09638280802062553.901523878 - DOI - PubMed
    1. Bae J, Woo S, Lee J, Park S, Kwon SW, Choi SH, Yoon G, Kim M, Hwang S, Lee WK. mHealth interventions for lifestyle and risk factor modification in coronary heart disease: Randomized controlled trial. JMIR Mhealth Uhealth. 2021 Sep 24;9(9):e29928. doi: 10.2196/29928. https://mhealth.jmir.org/2021/9/e29928/ v9i9e29928 - DOI - PMC - PubMed
    1. Bentley CL, Powell L, Potter S, Parker J, Mountain GA, Bartlett YK, Farwer J, O'Connor C, Burns J, Cresswell RL, Dunn HD, Hawley MS. The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease: Randomized controlled feasibility study. JMIR Mhealth Uhealth. 2020 Jun 03;8(6):e16203. doi: 10.2196/16203. https://mhealth.jmir.org/2020/6/e16203/ v8i6e16203 - DOI - PMC - PubMed
    1. Block VAJ, Pitsch E, Tahir P, Cree BAC, Allen DD, Gelfand JM. Remote physical activity monitoring in neurological disease: A systematic review. PLoS One. 2016;11(4):e0154335. doi: 10.1371/journal.pone.0154335. https://dx.plos.org/10.1371/journal.pone.0154335 PONE-D-15-55629 - DOI - DOI - PMC - PubMed