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. 2023 Aug 1;25:e46715. doi: 10.2196/46715

Table 3.

Details of each category and subcategory and the corresponding references.

Categories and subcategories References
Technology issues

Lack of technology access

Lack of reliability and usability of technology

Network issues

Lack of technology skills

Technological barriers
Practice issues

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]


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]


Lack of training, guidelines, or protocols

Lack of hands-on methods
Patient issues

Inappropriate target group
  • 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]


Patient behavior
  • 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]


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]

Environmental issues

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]


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]

Attributions

Negative attitudes
  • Negative attitudes or reluctance of health care providers [49,50,53,86]

  • Negative attitudes or reluctance of patients, clients, or caregivers [44,45,50,54,59,62,66,68,71,87,91,92,94]

    • Causation of nocebo effects [59]

  • 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]


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]

Policy and regulation issues

Privacy and security issues

Billing and reimbursement issues
  • Funding, reimbursement, and payment for telehealth services [46,62,64,67,70,72,79,91]


Policies
  • Workplace policies or missing workplace policies [70,72,77,95]

  • Licensure issues when providing telehealth across state borders [47,72]

  • Health policies [67]

Interpersonal issues

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]


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]

Administration issues

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]


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]

HHS Vulnerability Disclosure