JMIR Publications

ABSTRACT

Background:

Nurses are widely recognized as one of the competent healthcare providers who offer comprehensive care to patients with chronic diseases during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance, however, it remains unclear which chronic disease patients are benefited the most from this innovative delivery mode.

Objective:

This study aims to 1) summarize current components of community-based nurse-led telerehabilitation programs using the Chronic Care Model, 2) evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs, and 3) compare the effects of telerehabilitation on patients with different chronic diseases.

Methods:

This was a systematic review with meta-analysis. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health resources use. A meta-analysis was conducted using a random-effect model.

Results:

A total of 26 studies were included in the meta-analysis. Telephone follow-ups are the most commonly used telerehabilitation delivery approach. Chronic Care Model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (Cardiac diseases: SMD=0.45; 95% CI: 0.09 to 0.81; p=0.01; X2=1.93; I2=48%; p=0.16) (Chronic respiratory diseases: SMD=0.18; 95% CI: 0.05 to 0.31; p=0.007; X2=1.68; I2=0%; p=0.43) and self-care (Cardiac diseases: MD=5.49; 95% CI: 2.95 to 8.03; p<0.0001; X2=6.52; I2=23%; p=0.26) (Diabetes: SMD=1.20; 95% CI: 0.55 to 1.84; p=0.0003; X2=46.29; I2=91%; p<0.00001) were observed in the groups that used telerehabilitation. For patients with any of the six targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (SBP: MD=10.48; 95% CI: 2.68 to 18.28; p=0.008; X2=2.17; I2=54%; p=0.14) (DBP: MD=1.52; 95% CI: -10.08 to 13.11; p=0.80; X2=11.47; I2=91%; p=0.0007) and HbA1c (MD=0.19; 95% CI: -0.19 to 0.57; p=0.32; X2=12.35; I2=68%; p=0.01) levels, respectively.

Conclusions:

Better designed nurse-led rehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. Future research could be conducted to integrate the Chronic Care Model with telerehabilitation to maximize the benefits for community-dwelling patients with multimorbidity. Clinical Trial: This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42022324676.