Table 1.
Implementation outcomes for telerehabilitation interventions.
| Study author, year, and implementation construct | Implementation outcomes | |
| Chow, 2015 [41,65] |
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Acceptability | SMS intervention acceptability was 90.9% (279/307); request to stop SMS was 2.3% (7/307) |
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Adoption | Focus groups reported high user engagement with saving and sharing SMS messages, receiving support from providers and family, and message personalization |
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Appropriateness | SMS was useful: 90.9% (279/307) SMS was easy to understand: 96.7% (297/307) SMS was motivating for change: 77.2% (237/307); especially for diet (249/307, 81.1%), exercise (223/307, 72.6%), and medication adherence (234/307,76.2%) Appropriateness of language used in SMS: 94.8% (291/307) Appropriateness of SMS frequency (4 times/week): 86.0% (264/307); timing : 89.9% (276/307, random timing was considered ideal); and 6-month duration: 77.2% (237/307) |
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Feasibility | Not assessed |
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Fidelity | 96.0% (338/352) of participants received all scheduled messages (analytic data) and read ≥75% of SMS messages: 95.4% (293/307 self-report survey respondents) |
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Implementation cost | US $0.10/SMS message (<US $10 per capita) |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Dale, 2015 [42] |
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Acceptability | Satisfaction with 24-week program duration was 79% (48/61) and with number of SMS messages was 84% (51/61) Recommend to other people: 90% (55/61) |
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Adoption | 98% (60/61) of participants initiated the SMS intervention ≥1 website login: 75% (46/61); median 3, range 0-100 |
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Appropriateness | 90% (55/61) and 43% (26/61) of participants felt that SMS messages and the website were good cardiac rehabilitation (CR) delivery methods, respectively Appropriate number of SMS messages: 84% (51/61) Intervention useful for learning about (47/61, 77%) and recovering from (51/61, 84%) a heart event and for changing behaviors, such as physical activity (39/61, 64%) and consumption of fruit and vegetables (37/61, 61%), saturated fat (34/61, 56%), and salt (26/61, 43%) |
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Feasibility | Not assessed |
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Fidelity | Read all SMS messages: 85% (52/61) Sent ≥1 SMS step count message: 95% (58/61); mean of 15 submissions (SD 8.7) over 24 weeks |
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Implementation cost | Not assessed |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Kraal, 2013 [60,66] |
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Acceptability | Satisfaction was higher for telerehabilitation than for center-based rehabilitation (8.7/10 vs 8.1/10; P=.02) |
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Adoption | Not assessed |
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Appropriateness | Not assessed |
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Feasibility | Not assessed |
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Fidelity | Exercise adherence was similar in telerehabilitation and center-based rehabilitation (mean 22.0, SD 6.8, vs mean 20.6, SD 4.3, sessions) |
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Implementation cost | Similar per-capita cost to deliver telerehabilitation and center-based rehabilitation (€314 vs €336) Per-capita costs did not differ between telerehabilitation and center-based rehabilitation for total health care use (mean €2419, SD 1968, vs mean €2855, SD 2797; P=.39) or total work absenteeism (mean €3846, SD 8400, vs mean €6569, SD 8170; P=.12) Probability of cost-effectiveness was higher for telerehabilitation than for center-based rehabilitation under several assumptions |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Lear, 2015 [61,67] |
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Acceptability | 22 purposively sampled interviews reported satisfaction, acceptability, and confidence in using virtual CR |
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Adoption | High self-reported engagement and utilization in virtual CR (interview data) Mean website log-ins was 27 per participant (range 0-140) Mean engagement in chat sessions with health care providers was 3.6 |
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Appropriateness | Virtual CR perceived to be accessible and effective |
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Feasibility | Virtual CR perceived to be convenient |
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Fidelity | Not assessed |
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Implementation cost | Not assessed |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Maddison, 2015 [43,68] |
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Acceptability | SMS and website intervention components were liked by 57% (43/75) and 73% (55/75) of participants, respectively Acceptability of 24-week intervention duration: 71% (53/75) Acceptability of message delivery timing: 57% (43/75); exercise ideas SMS content: 77% (58/75); exercise benefits education content: 79% (59/75); and website content: 47% (35/75); 49% (37/75) did not use the website |
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Adoption | Not assessed |
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Appropriateness | Some (number not reported) participants who were already exercising felt the intervention was unnecessary or the exercise prescription was not relevant |
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Feasibility | Difficulties using website: 17% (13/75) Major barriers were lack of high-speed broadband or knowledge about using websites |
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Fidelity | 93% (70/75) read most SMS messages 64% (48/75) used the website (visits per participant: mean 11, SD 16, range 0-82) |
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Implementation cost | NZ $239 per capita (intervention set-up + delivery only; health care utilization and indirect societal costs excluded) Incremental cost-effectiveness ratio: NZ $28,768 per quality-adjusted life year (QALY) Probability of cost-effectiveness: 72% (willingness to pay: NZ $20,000 per QALY) and 90% (willingness to pay: NZ $50,000 per QALY) |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Maddison, 2019 [45,69] |
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Acceptability | 87% (58/67) would choose telerehabilitation instead of center-based rehabilitation if implemented in clinical practice Satisfaction with individualized exercise prescription: 90% (60/67); real-time exercise monitoring: 94% (63/67); encouragement and social support: 87% (58/67); behavior change messages: 85% (57/67); self-monitoring: 96% (64/67); and goal-setting features: 69% (46/67) |
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Adoption | 94% (77/82) of participants initiated telerehabilitation |
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Appropriateness | 97% (65/67) of patients reported that telerehabilitation is a good approach for delivering exercise rehabilitation |
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Feasibility | Wearable sensor is easy to use: 99% (66/67); and is comfortable: 97% (65/67) Smartphone app is easy to use: 79% (53/67); easy to understand: 87% (58/67); and reliable: 66% (44/67) Rare technical difficulties, commonly solved with familiarization |
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Fidelity | Adherence to prescribed exercise was comparable in telerehabilitation (mean 58.34%, SD 36.58, range 0-100) and center-based rehabilitation (mean 63.80%, SD 30.59, range 0-100; P=.31) |
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Implementation cost | Lower per-capita program delivery cost for telerehabilitation than for center-based rehabilitation (NZ $1130 vs NZ $3466) No difference in total (ie, program delivery + health care and medication utilization) per-capita cost (NZ $4920 vs NZ $9535) |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Park, 2014 [62] |
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Acceptability | Strong or moderate agreement about intervention satisfaction: 82% (23/28) for SMS reminders + education; and 88% (22/25) for SMS education alone |
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Adoption | Not assessed |
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Appropriateness | Strong or moderate agreement that the interventions were useful for assisting medication adherence: 71% (20/28) for SMS reminders + education; and 48% (12/25) for SMS education alone |
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Feasibility | Strong or moderate agreement that interventions were easy to use: 88.6% Technical difficulties receiving SMS: 7.6% |
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Fidelity | Not assessed |
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Implementation cost | Not assessed |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Piotrowicz, 2014 [63,70] |
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Acceptability | Not assessed |
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Adoption | Not assessed |
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Appropriateness | Felt safer during exercise with hybrid telerehabilitation than unsupervised: 80.9% Hybrid telerehabilitation was useful for increasing exercise: 95%; daily physical activity: 80%; and mental health: 71% |
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Feasibility | Telemonitoring device was very easy or easy to use: 98.3% No problems self-fitting electrocardiogram (ECG) electrodes: 99.4% No problems transmitting ECG from home: 84% Missed ≥1 exercise session due to technical difficulties: 39.3% Problems communicating with telemonitoring center: 62.8% |
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Fidelity | Not assessed |
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Implementation cost | Not assessed |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Salvi, 2018 [64,71] |
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Acceptability | Guided exercise telerehabilitation ratings (mean [95% CI] rating score, max 5) for ease of use: 3.53 (2.94-4.12); interest: 4.42 (4.11-4.74); stimulation: 3.95 (3.49-4.41); and enjoyment: 3.84 (3.46-4.22) nb: data represent only 35% (19/55) of participants randomized to telerehabilitation |
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Adoption | 73% (40/55) of participants initiated guided exercise telerehabilitation Nonadoption was attributed to unavailability of the clinical team |
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Appropriateness | Guided exercise telerehabilitation ratings (mean [95% CI] rating score, max 5) for usefulness to increase motivation: 4.59 (4.35-4.83); to increase safety: 4.47 (4.13-4.81); and to increase compliance: 4.47 (3.93-5.01) Overall, guided exercise telerehabilitation was considered appropriate for its purpose |
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Feasibility | Exercise sessions affected by technical errors: 18% (ie, poor biosensor signal or connectivity and poor transmission of data to server) Suboptimal internet connectivity prevented 15 participants from recording or completing any exercise sessions 6 dropouts were attributed to technical challenges |
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Fidelity | Participants initiated (mean [95% CI]) 61% (76%-46%) of the prescribed number of exercise sessions (79% [91%-67%] among 17 participants who completed the study) and completed 32% (44%-20%) of the prescribed duration of exercise (45% [59%-31%] among 17 participants who completed the study) |
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Implementation cost | Not assessed |
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Penetration | Not assessed |
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Sustainability | Not assessed |
| Varnfield, 2014 [44] |
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Acceptability | Not assessed |
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Adoption | Program uptake (ie, completion of ≥1 exercise session) was higher in telerehabilitation than center-based rehabilitation: 80% (48/60) vs 62% (37/60); relative risk (RR)=1.30, 95% CI 1.03-1.64; P<.05 |
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Appropriateness | Smartphone-measured step counts increased motivation to reach exercise goals: 84% (38/45) |
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Feasibility | Not assessed |
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Fidelity | Categorical adherence (ie, completing 4/6 weeks of exercise training) was higher in telerehabilitation than center-based rehabilitation: 95% (45/48) vs 68% (25/37); RR=1.40, 95% CI 1.13-1.70; P<.05 |
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Implementation cost | Not assessed |
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Penetration | Not assessed |
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Sustainability | Not assessed |