JMIR Publications

ABSTRACT

Background:

Telerehabilitation involves the delivery of rehabilitation services through communication technologies. In contrast to traditional in-person rehabilitation, telerehabilitation can help overcome barriers including geographic distance and facility use. There is evidence to suggest that telerehabilitation can lead to increased patient engagement and adherence to treatment plans. However, limited research exists on the association of telerehabilitation with adverse events, potentially hindering its broader adoption and utilization in healthcare.

Objective:

This systematic review of randomized controlled trials aims to summarize existing research on adverse events related to telerehabilitation delivery.

Methods:

This review was conducted according to the methodological framework outlined by the Joanna Briggs Institute. Studies were identified from MEDLINE ALL, EMBASE, APA PsycINFO, CENTRAL, and CINAHL. Included studies were randomized controlled trials published between 2013 and 2023, written in English, and had no geographic or delivery mode restrictions. Data extraction utilized the Template for Intervention Description and Replication (TIDieR) framework, along with authors, publication year, sample size, specific telerehabilitation modes, and the incidence, type, severity, and relatedness of reported adverse events. Methodological quality was assessed using the Cochrane risk of bias tool.

Results:

Search results identified 9,022 references, of which 37 randomized controlled trials met the criteria for inclusion. There were a total of 3,166 participants, with a mean age of 57.4 years, and 32.3% being female. Various delivery modes were utilized, with videoconferencing emerging as the most frequently employed method. A total of 201 adverse events were recorded during 65,352 sessions (0.31% or 3.1/1000 sessions). These events were predominantly physical (e.g., falls, palpitations), non-serious/mild, and not directly attributed to the telerehabilitation intervention. Additionally, 92.2% of included studies implemented various safety practices including vital signs monitoring, safety checklists, and scheduled check-ins with study personnel.

Conclusions:

This review demonstrates that telerehabilitation exhibits a generally safe profile as an alternative to in-person rehabilitation, with most reported adverse events being rare, non-serious/mild, and unrelated to telerehabilitation protocols. However, more extensive research with detailed reporting on adverse events characteristics is needed. Moreover, future research should evaluate the effectiveness of different safety practices and their association with adverse events. An enhanced understanding of potential risks in telerehabilitation can foster broader adoption while ensuring its safe implementation among healthcare providers and patients.