JMIR Publications

ABSTRACT

Background:

Telerehabilitation using information and communication technologies becomes increasingly important. This also applies to physiotherapy with home-based exercises for patients with musculoskeletal shoulder disorders. Information and communication technologies (ICT) that assist patients in prevention or rehabilitation and thus promote their health and well-being are also referred to as health-enabling technologies (HETs). Currently, no overview of HETs that assist patients with musculoskeletal shoulder disorders exercising at home exists.

Objective:

This scoping review provides a broad overview of HETs assisting patients with musculoskeletal shoulder disorders exercising at home. It focuses on approaches used by HETs, development phases and reported outcomes.

Methods:

The search strategy adheres to the PICO-framework using medical subject headings and text words related to the terms ‘upper extremity’, ‘exercises’ and ‘information and communication technologies’. The databases MEDLINE, EMBASE, IEEE Xplore, CINAHL, and PEDro were searched. Two reviewers independently screened titles and abstracts, and subsequently full texts against pre-defined inclusion and exclusion criteria. A systematic narrative synthesis was done. Categories were built deductively-inductively. Overall, 8,988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included for qualitative and quantitative analysis.

Results:

HETs range from simple videoconferencing systems through mobile applications with video instructions to complex sensor-based technologies. Various sensor hardware, hardware for output, and software are used, with PC displays, the Microsoft Kinect camera and related software being the most common. The identified HETs provide direct or indirect instruction, control, correction, assessment, provision of additional information, and/or a reminder of exercises in descending order of frequency. Range of motion, starting and final position, and exercise intensity are the most common criteria for instructing and correcting exercises. Most often visual instructions for exercising are provided. About half of all HETs report on telerehabilitation aspects. More than half of all technologies report only on prototypes. About a quarter are evaluated for technical feasibility, acceptance, and/or usability, using different assessment instruments. Efficacy or effectiveness has been demonstrated only for eight HETs. An interdisciplinary contribution to the development of technologies as well as an evaluation by patients is mentioned in approximately one third of all articles.

Conclusions:

This review provides a first overview of various technologies that serves for future research and development. Currently, comparability and sound selection of HETs proves to be difficult in the light of varying prototype status, partially small sample sizes, different study designs, different measurement instruments, missing telerehabilitation aspects, and missing efficacy studies. In the future more interdisciplinary research and development of HETs seems advisable to consider all relevant aspects.