| Summary of review finding |
Studies contributing to the review finding |
GRADE‐CERQual assessment of confidence in the evidence |
Explanation of GRADE‐CERQual assessment |
| Perceptions about rehabilitation services delivered at patients´ homes through in‐person encounters or via telerehabilitation |
| Finding 1. Patients and caregivers receiving and healthcare providers delivering telerehabilitation services perceived at least some in‐person home encounters as necessary. They felt that telerehabilitation services alone lost the rapport of social interaction and the opportunity to make meaningful connections. They also pointed out that some types of services provided with the hands could not be delivered using telerehabilitation (moderate confidence finding). |
Brouns 2018; Damhus 2018; Dennett 2020; Gélinas‐Bronsard 2019; Hale Gallardo 2020; Hoaas 2016; Lawson 2020; O'Shea 2020; Ownsworth 2020; Palazzo 2016; Pekmezaris 2020; Saywell 2015; Shulver 2016; Van der Meer 2020
|
Moderate confidence |
Downgraded because we had minor concerns regarding methodological limitations and relevance; no/very minor concerns regarding coherence and adequacy |
| Finding 2. Patients and healthcare providers described how in‐person home‐based rehabilitation and telerehabilitation encouraged patients' self‐management and made them feel empowered about the rehabilitation process. Patients become active contributors and shaped the process and its pace according to their needs. This was seen to facilitate the achievement of final results, whatever the goal that rehabilitation aimed to achieve (high confidence finding). |
Argent 2018; Bodker 2015; Dennett 2020; Dinesen 2019; Dubouloz 2004; Edbrooke 2020; Emmerson 2018; Folan 2015; Gélinas‐Bronsard 2019; Hoaas 2016; Mohd Nordin 2014; Ng 2013; Nordin 2017; O'Shea 2020; Ownsworth 2020; Pekmezaris 2020; Pinto 2014; Ranaldi 2018; Randström 2012; Shulver 2016; Sureshkumar 2016; Tsai 2016; Turner 2011; Van der Meer 2020. |
High confidence |
We had minor concerns regarding methodological limitations, and no/very minor concerns regarding coherence, adequacy, and relevance |
| Finding 3. Patients and healthcare providers appreciated how in‐person home‐based rehabilitation or telerehabilitation improved patient outcomes related to independence, overall functioning at home, and everyday use of assistive devices, which are facilitated by the interaction with the home environment implicit in these types of services (low confidence finding). |
Bodker 2015; Borade 2019; Dennett 2020; Dubouloz 2004; Govender 2019; O'Shea 2020; Pinto 2014; Randstrom 2013
|
Low confidence |
Downgraded because we had no/very minor concerns regarding methodological limitations, serious concerns regarding coherence, and moderate concerns regarding adequacy and relevance |
| Finding 4. Patients, caregivers and healthcare providers regarded the transition from the hospital to home as a challenging process given the lack of human and infrastructure resources available in the home setting. This may have an impact on the implementation of in‐person home‐based rehabilitation. |
Govender 2019; HeydariKhayat 2020; Mohd Nordin 2014; Turner 2011; VanderVeen 2019
|
Moderate confidence |
Downgraded because we had moderate concerns regarding methodological limitations, minor concerns regarding coherence, and relevance, and no/very minor concerns regarding adequacy |
| Finding 5. Patients and healthcare providers described several factors that might affect patients’ motivation and engagement with telerehabilitation services, including support from healthcare providers or family members and other caregivers during sessions, good communication with the healthcare provider, what the exercise required from the patient and their surroundings, and the presence of comorbidities. |
Bodker 2015; Brouns 2018; Dennett 2020; Dinesen 2019; Edbrooke 2020; Folan 2015; Hoaas 2016; Lawson 2020; O'Doherty 2013; O'Shea 2020; Palazzo 2016; Ranaldi 2018; Randström 2014; Saywell 2015; Stark 2019; Stuifbergen 2011; Teriö 2019; Van der Meer 2020; Vik 2009
|
Moderate confidence |
Downgraded because we had no/very minor concerns regarding methodological limitations and adequacy, moderate concerns regarding coherence, and minor concerns regarding relevance |
| Finding 6. Patients, caregivers, and providers described a number of privacy and confidentiality issues when services were provided at home. These included the increased privacy of being able to exercise at home but also the loss of privacy when elements of one’s home life were visible to others. |
Bodker 2015; Brouns 2018; Dennett 2020; Gélinas‐Bronsard 2019; Hoaas 2016; Lawson 2020; Ng 2013; Ownsworth 2020; Oyesanya 2019; Palazzo 2016; Pekmezaris 2020; Randström 2012; Randstrom 2013; Randström 2014;Rietdijk 2020
|
High confidence |
We had no/very minor concerns regarding methodological limitations and coherence, and minor concerns regarding adequacy and relevance |
| Finding 7. Patients regarded in‐person home‐based rehabilitation and telerehabilitation services as convenient and less disruptive of everyday activities. |
Govender 2019; Hale Gallardo 2020; HeydariKhayat 2020; Lawson 2020; Ownsworth 2020; Palmcrantz 2017; Pekmezaris 2020; Pinto 2014; Randström 2012; Randstrom 2013; Shulver 2017; Silveira 2019; Stark 2019; Tsai 2016; Tyagi 2018; Van der Meer 2020
|
High confidence |
We had no/very minor concerns regarding methodological limitations, coherence, adequacy,and relevance |
| Finding 8. Patients, caregivers, and healthcare providers called for more training in the context of in‐person home‐based rehabilitation. |
Govender 2019; O'Doherty 2013; Randström 2014; Schopfer 2020; Umb Carlsson 2019; VanderVeen 2019
|
Low confidence |
Downgraded because we had no/very minor concerns regarding methodological limitations, minor concerns regarding coherence, serious concerns regarding adequacy, and moderate concerns regarding relevance |
| Perceptions about rehabilitation services delivered at home through telerehabilitation |
| Finding 9. Healthcare providers highlighted the importance of personalising the service to each patient’s needs and resources at home. |
Bodker 2015; Damhus 2018; Dennett 2020; Edbrooke 2020; Lawson 2020; Ownsworth 2020; Shulver 2017; Silveira 2019; Tsai 2016
|
High confidence |
We had no/very minor concerns regarding methodological limitations, coherence and adequacy, and minor concerns regarding relevance |
| Finding 10. Patients, caregivers, healthcare providers and other stakeholders described how telerehabilitation changed the nature of the patient‐provider relationship. This included overcoming physical barriers to communication and enabling quick responses to questions, creating a more relaxed environment for communication, and supporting shared decision making. Some patients described how telerehabilitation services allowed them to keep connected with their healthcare provider after being discharged from the hospital. However, other patients felt abandoned when receiving telerehabilitation services. |
Argent 2018; Bodker 2015; Brouns 2018; Dennett 2020; Dinesen 2019; Emmerson 2018; Gélinas‐Bronsard 2019; Hale Gallardo 2020; Kamwesiga 2017; Lawson 2020; Malmberg 2018; Nordin 2017; Ownsworth 2020; Palazzo 2016; Palmcrantz 2017; Shulver 2017; Stuifbergen 2011; Tsai 2016; Van der Meer 2020
|
High confidence |
We had minor concerns regarding methodological limitations and relevance, and no/very minor concerns regarding coherence and adequacy |
| Finding 11. Healthcare providers and patients described some aspects of telerehabilitation services at home as challenging. Healthcare providers described problems in assessing patients, their environment, and whether they were performing exercises correctly. Providers and patients also emphasised the need for a quiet place during telerehabilitation sessions and described challenges tied to interruptions from family members. |
Argent 2018; Bodker 2015; Damhus 2018; Lawson 2020; Mendell 2019; Ownsworth 2020; Palazzo 2016; Rietdijk 2020; Shulver 2017; Silveira 2019; Sureshkumar 2016; Tsai 2016; Tyagi 2018
|
High confidence |
We had no/very minor concerns regarding methodological limitations, coherence and adequacy, and minor concerns regarding relevance |
| Finding 12. Patients, caregivers, healthcare providers and other stakeholders regarded telerehabilitation as an opportunity to make rehabilitation services more accessible. |
Argent 2018; Brouns 2018; Damhus 2018; Dennett 2020; Emmerson 2018; Folan 2015; Gélinas‐Bronsard 2019; Hale Gallardo 2020; Hoaas 2016; Lawson 2020; Malmberg 2018; O'Shea 2020; Ownsworth 2020; Oyesanya 2019; Palmcrantz 2017; Rietdijk 2020; Saywell 2015; Shulver 2017; Tyagi 2018; Van der Meer 2020
|
High confidence |
We had no/very minor concerns regarding methodological limitations, coherence, adequacy and relevance |
| Finding 13. Healthcare providers and policymakers highlighted the need for adequate equipment, infrastructure and maintenance both on the provider side and the patient side but described how these needs were not always met. They described challenges including a lack of resources and investment, a lack of awareness around the resources needed, and rapid advances in technology that make technology rapidly obsolete. |
Bodker 2015; Brouns 2018; Gélinas‐Bronsard 2019; Hale Gallardo 2020; Lawson 2020; Mendell 2019; Ownsworth 2020; Oyesanya 2019; Palmcrantz 2017; Shulver 2016; Teriö 2019; Tyagi 2018; Van der Meer 2020
|
Moderate confidence |
Downgraded because we had no/very minor concerns regarding methodological limitations, coherence, and adequacy, and moderate concerns regarding relevance |
| Finding 14. Patients and caregivers described many usability issues related to the device, the program or the application; they also emphasised the need for easy‐to‐use technologies that could be adapted to the patient’s individual needs. Patients and caregivers reported a lack of familiarity with, fear of or frustration with digital technology. Patients, caregivers, and healthcare providers called for more training and support in the use of these technologies. |
Argent 2018; Bodker 2015; Brouns 2018; Damhus 2018; Emmerson 2018; Folan 2015; Gélinas‐Bronsard 2019; Hale Gallardo 2020; Hoaas 2016; Lawson 2020; Malmberg 2018; Mendell 2019; O'Shea 2020; Ownsworth 2020; Palazzo 2016; Palmcrantz 2017; Rietdijk 2020; Shulver 2016; Shulver 2017; Silveira 2019; Stuifbergen 2011; Sureshkumar 2016; Teriö 2019; Tsai 2016; Tyagi 2018; Van der Meer 2020
|
Moderate confidence |
Downgraded because we had minor concerns regarding methodological limitations and coherence, no/very minor concerns regarding adequacy, and moderate concerns regarding relevance |
| Finding 15. Healthcare providers differed in their views about whether telerehabilitation was cost‐efficient for them, but many patients encountered it as affordable and cost‐saving when the equipment and infrastructure have been provided. |
Bodker 2015; Brouns 2018; Damhus 2018; Gélinas‐Bronsard 2019; Lawson 2020; Ownsworth 2020; Van der Meer 2020
|
High confidence |
We had no/very minor concerns regarding methodological limitations, coherence and adequacy, and moderate concerns regarding relevance |
