Table 3.
Overall studies characteristics.
| References | Clinical condition [total sample size] | Patients characteristiscs | Case vs. control group [size] | Control group [type] | Case group [type of engagement] | Engagement assessment | Main results |
|---|---|---|---|---|---|---|---|
| Yeh et al. (69) | Stroke, TBI, SCI [N = 14] | Unspecified | [14 vs. –] | No | Emotional engagement (secondary outcome of the study) | The mood was measured with the POMS questionnaire; experience of “presence” in the telerehabilitation environment, willingness to persist with therapy, and a telerehabilitation usability questionnaire | Patients felt less efficacious in continuing therapy after participating in the telerehabilitation game compared to their reported perseverance self-efficacy before the game and showed a decreased willingness to persist in therapy regardless of fatigue after the gameplay.Telerehabilitation significantly enhanced stroke patients' psychological states |
| Lloréns et al. (70) | ABI [N = 10] | Chronic phase (> 6 months) | [10 vs. –] | No | Self-awareness game, that consist in answering questions related to knowdledge (anatomical and pathological matters), reasoning (situational exercises), action (role-playing), or cohesion (jokes and sayings), in a competitive context | Self-Awareness Deficits Interview (SADI) Social Skills Scale (SSS) | The VR game improved self-awareness and the social cognition deficits in patients with ABI after the 8 months training period |
| White et al. (71) | Stroke [N = 12] | Unspecified | [12 vs. –] | No | Face-to-face sessions aimed to provide orientation to the iPad, educate toward therapist recommended rehabilitation Apps and access to other tablet technology features | Telephonic semi-structured interviews | Stroke survivors experienced increased participation in therapeutic activities, increased socialization, and less inactivity and boredom |
| Ferreira et al. (72) | PD [N = 33] | Mild-to-moderate stage (Hoehn and Yahr score 1–2.5) | [22 vs. 11] | Usual care | Biofeedback from the system and weekly telephonic interviews | Semi-structured interviews to assess willingness to continue in the study, satisfaction with the SENSE-PARK System, changes in health status or medical condition, adverse events, feedback messages, and doubts about the system | Motivation to wear such a system can be increased by providing direct feedback about the individual health condition |
| Nijenhuis et al. (73) | Stroke [N = 24] | Chronic phase (> 6 months) | [24 vs. –] | No | Video-game and remote supervision of the clinicians | Intrinsic Motivation Inventory (IMI) | Participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention |
| Lloréns et al. (74) | Stroke [N = 45] | Chronic phase (> 6 months) | [30 vs. 15] | Training at the hospital. | Engagement as a secondary outcome | Usability Scale (SUS) Intrinsic Motivation Inventory (IMI) | Both groups considered the VR system similarly usable and motivating |
| Palacios-Ceña et al. (75) | MS [N = 24] | Unspecified | [24 vs. –] | No | Video-game and tracked movement feedback | Unstructured interviews | Four main themes emerged from the data: 1) regaining previous capacity and abilities. 2) Sharing the disease, 3) adapting to the new treatment. This refers to the appearance of factors that motivate the patient during KVHEP |
| Houlihan et al. (76) | SCI [N = 126] | Traumatic SCI, chronic phase (≥1year postinjury) | [84 vs. 42] | Usual care | Peer health coach (PHC), who acts as a supporter, role model, and advisor | Patient Activation Measure (PAM) | Intervention participants reported a significantly greater change in PAM scores compared with controls. Participants reported a significantly greater decrease in social/role activity limitations, greater services/resources awareness, greater overall service use, and a greater number of services used |
| Engelhard et al. (77) | MS [N = 31] | MS with Expanded Disability Status Scale ≤ 6.5 | [31 vs. –] | No | A dedicated “Symptom Tracker” page allowed subjects to compare severity between symptoms and view recent trends | Completion of the web-exercises | 52% of the subjects reported improved understanding of their disease, and approximately 16% wanted individualized wbPRO content. Over half of perceived well-being variance was explained by MS symptoms, notably depression, fatigue, and pain |
| Lai et al. (78) | PD [N = 30] | Mild-to-moderate stage (Hoehn and Yahr score 1–3) | [20 vs. 10] | Self-regulated exercises | To instruct participants on proper exercise techniques to increase mastery, discuss barriers or issues with the participants' ability to attend the exercise sessions, help participants set achievable goals to complete the exercise prescription, provide verbal encouragement to achieve the desired exercise workload | Measures of adherence included four variables: number of sessions performed, time of exercise, and attendance | Internet supervised training at home could promote stronger program adherence than self-managed home-exercise training. The telehealth system, telecoaches provided a sense of companionship and accountability and bolstered participants' confidence to overcome several impediments to participation |
| Skolasky et al. (79) | LSS [N = 182] | post-surgery phase | [122 vs. 60] | Usual care | Telephone-based intervention engagement | Engagement is a secondary outcome | Health behavior change counseling improved health outcomes after the surgical procedure through changes in rehabilitation engagement |
| Pitt et al. (80) | Aphasia [N = 19] | Unspecified | [19 vs. –] | No | Video-conferences to create opportunities for communicative success, to share personal life history, and to provide support for living successfully with aphasia through networking with others | Quality of Communication Life Scale. Communicative Activities Checklist Engagement a secondary outcome | Improvements in communication-related quality of life increased engagement in communicative activities and decreased aphasia severity |
| D'hooghe et al. (81) | MS [N = 57] | Relapsing-remitting MS with Expanded Disability Status Scale ≤ 4 | [57 vs. –] | No | A combination of self-management and motivational messages, to enhance self-energy management and physical activity to improve the level of fatigue in pwMS | Modified Fatigue Impact Scale (MFIS) Short Form-36 (SF-36) Hospital Anxiety Depression Scale (HADS) | MS TeleCoach is a potential self-management tool to increase activity and reduce fatigue |
| Dennett et al. (82) | MS [N = 135] | Unspecified | [90 vs. 45] | Conventional home (paper format) | Web-based exercises with personal conversational support through the weekly interviews | Interviews | The web-based physio is important for building in conversations with people with MS about expectations of exercise and its potential benefits, particularly for those whose condition is deteriorating |
| Vries et al. (83) | PD [N = 16] | Unspecified | [16 vs. –] | No | Video recorded movement observation. | Semi-structured interviews after the software exposure | The following conditions were identified to foster patients' engagement: Camera recording (e.g. being able to turn off the camera), privacy protection (e.g. patients' behavior, patients' consent, camera location) and perceived motivation (e.g. contributing to science or clinical practice) |
| Thomas et al. (84) | MS [N = 15] | Unspecified | [15 vs. –] | No | Telephonic interviews | Interviews | Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management |
| Chemtob et al. (85) | SCI [N = 33] | SCI with paraplegia, chronic phase (≥1year postinjury) | [22 vs. 11] | Usual care | The counseling sessions focused on fostering the basic psychological needs and autonomous motivation, teaching behavior change techniques, and self-regulatory strategies | Conversation analyses | The intervention group reported greater autonomous motivation post-intervention. Large to moderate effects supporting the intervention group were found for health participation, and meaningful life experiences and social cognitive predictors. A trained physical activity counselor can increase physical activity motivation |
| Ellis et al. (86) | PD [N = 61] | Mild-to-moderate stage (Hoehn and Yahr score 1–3) | [44 vs. 21] | Active control group | Cognitive-behavioral elements to enhance the basic behavioral change component of the individualized exercise and walking program and to emphasize participants' engagement in managing their health condition | Daily records of steps taken and exercises performed, using either the mobile health application (mHealth group) or paper calendars (active control group) | Adherence to the exercise program was similar between groups. The addition of enhanced, remotely monitored, mobile technology-based, behavioral change elements to the exercise prescription appeared to benefit participants who were less active differentially |
TBI, Traumatic Brain Injury; ABI, Acquired Brain Injury; SCI, Spinal Cord Injury; MS, Multiple Sclerosis; PD, Parkinson disease; LSS, Lumbar spinal stenosis.