Technology issues
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Lack of technology access |
Availability of adequate equipment [45,46,49,54,55,59,62,64,68,70,71,73,77,78,83-87,90,92-95]
Access of older adults [59,68]
Patient groups in rural areas [55,84]
Technology costs [45,49,53,54,62,64,71,72,89,93]
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Lack of reliability and usability of technology |
Insufficient quality of technology [62,70,94]
Unreliability of technology [42,46,48,51,52,57,62,65-67,72,86,89,91]
Lack of user-friendly software [49,53,59,70,95]
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Network issues |
Connection failure or limited bandwidth [44,47-49,51-53,55-57,59,62,64-66,70,71,76-79,84,85,87-90,93-95]
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Lack of technology skills |
Limited technology skills or confidence in use [51,59] of patients [44,49,51,56,57,59,62,64,67,70-74,79,83,86,90,95,96] of health professionals [29,62,70,72,81-84,90,95]
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Technological barriers |
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Practice issues
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Diminished fidelity of observations and poor conditions for visual instructions |
Observations or assessment options decreased [43,47,50,51,56,57,61-63,65,66,70,71,78,81,82,84,85,87,90,94,96]
Fear to oversee red flags [49,59,62,78]
Small screen size or pixilation [78]
Video lag [65]
Single-camera angle [56,57,62,66]
Assessment that required walking [56]
Lightning glare in glasses during eye exam [56]
Sound quality [66]
Loss of perception of smell [60]
Lack of experience to “fill the blanks” [63]
Lack of perception of the strengths of the patient [59,90]
Lack of ability to read body language [70,90]
Demonstration of exercises [59,62]
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Lack of knowledge, skills, or experience |
Patients lack knowledge about the role of technology in rehabilitation [49]
Therapist skills [55]
Lack of knowledge and experience [29,47,55,59,63,64,67,71,85,90,92,94,95]
Lack of confidence [43,67,79,80,91]
Lack of activity options for telehealth [47,64,72,91]
Hard to engage clients [76]
Missing evidence base [67,75,90]
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Lack of training, guidelines, or protocols |
Lack of appropriate telehealth training [49,53,54,64,76,83-85,90,92,95]
Learning curve required [76,95]
Missing guidelines or standard protocols [77,83,84,88,90,91]
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Lack of hands-on methods |
Lack of direct hands-on methods [42,43,45,47-51,53-56,58-62,64,66,67,70,73,76,77,80-84,88,90,92,94-96]
Inability of physical examinations [50,51,58,61,62,64,66,70,81,84,88,94,95]
Inability to demonstrate, intervene, or provide assistance with hands [47,48,51,62,73,76,81,82,84,92,94,95]
Inability to program or adjust hearing aids remotely [83,90]
Inability to perform swallowing assessments [48]
Inability to take anthropometric measurements [70]
Hands-on absence in terms of presence in a broader sense [42,88]
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Patient issues
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Inappropriate target group |
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Not appropriate for all groups of patients [54,73,81,91,92]
Age [55,73,74,85,90]
Diagnosis [50,55,64,85,90]
Vision and hearing abilities [73,74,88]
Cognitive abilities [73,96]
Language skills [85,88]
Personal preference [81]
Technology experience [88]
Inappropriate referrals [47]
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Patient behavior |
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Maintenance of patient attention [91,94]
Children’s negative behavior increased [55] or harder to manage [66,91]
Children’s engagement reduced [66,97]
Inferior patient compliance [53,94]
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Safety issues |
Safety risks [43,62,64,67,73,80,81,94,96]
High fall risk [51]
Missing safeguard measures [56,62,73,86,96]
Increased need for multitasking in telehealth could increase the risk of fall [59]
Unsupervised exercise execution might lead to incorrect technique [51]
Perception of safety risks might be harder [59,64]
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Environmental issues
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Physical and sensory environment |
Limit telehealth experience for patients and health care professionals [58,85]
Noise distractions [61,62,70,73,85,93]
Poor camera angles [48]
Limited space [62,73,84,86,95]
Lack of privacy [46,64,73,85,95]
Lack of material needed [48,52,72,73,81]
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Social environment |
Absence of people to support with technology or other tasks [45,47,56,70,72,86,87,95]
Missing language interpreters [46,52,70]
Struggling, overwhelmed, or reluctant relatives [55,73,76,82,94,96]
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Attributions
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Negative attitudes |
Negative attitudes or reluctance of health care providers [49,50,53,86]
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Negative attitudes or reluctance of patients, clients, or caregivers [44,45,50,54,59,62,66,68,71,87,91,92,94]
Lack of understanding of telehealth [45,71]
Fear of scams by especially older clients [68]
Worsened public perception of the profession [83]
Fear of job automatization [90]
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Perceived drawbacks |
Quality concerns [87,89]
Lack of perceived clinical usefulness [43,49,53]
Lack of clinical effectiveness [43,49,50,54,62,64,66,67,77,78,80,84,91,92,94]
Slower progress of treatment [78]
Reduced patient satisfaction [67]
Diminished capability to meet urgent cases [83]
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Policy and regulation issues
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Privacy and security issues |
Patient privacy at risk [43,45,46,49,50,59,72,80,84,95]
Security, confidentiality, and data protection concerns [43,45,46,49,50,53,59,66,67,71,72,83,84,89-92,95]
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Billing and reimbursement issues |
Funding, reimbursement, and payment for telehealth services [46,62,64,67,70,72,79,91]
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Policies |
Workplace policies or missing workplace policies [70,72,77,95]
Licensure issues when providing telehealth across state borders [47,72]
Health policies [67]
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Interpersonal issues
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Diminished client-practitioner interaction and communication |
Limited interaction between the client and the practitioner [83,94]
Harder to establish relationship or rapport [47,57,62,63,69,70,73,83-85,88,90,91,93]
Harder to establish trust [50,73]
Risk of impersonal care [54,67,83,90,93]
Lack of human warmth [73]
Impaired perception of client personality traits [59]
Nuances get lost over the screen [73]
Diminished communication quality in general [50,58,62,84,90,94]
Language barriers [62,66,70,94]
Increased possibility of misunderstandings [81,88,94]
Risk of social isolation for patients [86]
Risk of social isolation for providers [62,86]
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Ethical and cultural issues |
Web-based sessions of female providers in the presence of male caregivers [49]
Cultural reasons for not accepting video calls [74]
Discussion of private or embarrassing topics [83]
Reacting to worrisome activities, seen in the home of patients [46]
Examinations involving disrobing [64]
Lack of comfort and support for difficult or emotional conversations [88]
Ethical concerns, not specified [54]
Spiritual or religious barriers, not specified [59,70]
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Administration issues
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Lack of support |
Lack of administrative and technical support [29,49,53,54,70,77,78,83,84,90]
Inefficiencies in organization, scheduling, or visit preparation [70,78,90]
Lack of knowledge of using the system or troubleshooting [29]
Not enough referrals and promotions for telehealth [64]
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Workload increase |
Increased workload, pressure, or stress [49,53,55,66,82,86]
Increased time need to organize and use telehealth [29,44,46,62,70,78,82,84,89-91,94,95]
Increased level of fatigue [66,84-86,91,95]
Worsening of appointment-related travel [83]
Change in working hours [90]
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