Telerehabilitation in Musculoskeletal Disorders: Effectiveness, Adherence, and Equity Issues – Evidence

Abstract

Telerehabilitation has been a new method of providing musculoskeletal rehabilitation by use of remote monitoring, automation and technology assisted interventions but its mechanistic nature and translational characteristics can be well explained by use of controlled research on humans. This review is a metaanalysis of evidence of human models that examine the effectiveness, adherence, and equity-related implications of the telerehabilitation in musculoskeletal disorders. Experiments with rodent, rabbit and canine models in which musculoskeletal injuries are inflicted experimentally, as well as those that use automated treadmills, resistance devices, robotic limb-loading systems and sensor-guided activity platforms all reveal that remotely monitored rehabilitation leads to muscle regeneration, connective tissue remodeling, joint mobility and functional recovery when mechanical loading is precisely controlled. Telerehabilitation based on human models also demonstrates high compliance, which is regular attendance, a decrease in the level of stress during handling, and objective control of the exposure to rehabilitation, thus improving internal validity and reliability of outcomes. Moreover, technology-based rehabilitation delivery impairs variability caused by the operator, and provides indirect though valuable information about the potential of telerehabilitation to facilitate equitable access to uniform rehabilitation. Although these are the strengths, constraints of an ecological validity, technological constraints and species-specific differences indicate unresolved challenges in translation. All in all, human evidence can support the effectiveness, the benefits of adherence, and the potential of equity of telerehabilitation in musculoskeletal rehabilitation, and the need to incorporate adaptive technologies and integrative outcome measures in order to improve future translation applications.