Your recent systematic review sought to examine how telerehabilitation stacks up against traditional in-person physiotherapy with respect to attendance, adherence and satisfaction. How did you define these three aspects in your review?

We know from existing systematic reviews that telerehabilitation is non-inferior to in-person care for most conditions.

However, despite its proven effectiveness, telerehabilitation is not widely adopted in clinical practice.

We concentrated on attendance, adherence and satisfaction because these factors may influence broader adoption of telerehabilitation.

We defined attendance and adherence based on the definitions provided in the recently published clinical practice guidelines on telerehabilitation developed by the American Physical Therapy Association.

An international group of experts and a consumer created these guidelines by drawing on current scientific literature, clinical information and accepted approaches to telerehabilitation in practice.

By utilising these guidelines, we defined attendance as the proportion of scheduled physiotherapy sessions attended, and adherence as the proportion of prescribed home exercise program that participants completed.

Satisfaction referred to how satisfied participants were with the treatment they received.

How much data did you find?

We included eight studies for attendance (n = 1110), nine studies for adherence (n = 1190), and 12 studies for satisfaction (n = 1247).

The trials were published between 2008 and 2024. Interestingly, the greatest number of studies were conducted here in Australia (n = 6), followed by Canada (n = 3) and the USA (n = 3), with the remainder (n = 6) conducted in other countries.

Did telerehabilitation lead to higher attendance in comparison to in-person physiotherapy?

Yes, telerehabilitation generally led to either similar or higher attendance compared to in-person physiotherapy.

This makes sense given that convenience and lack of transport barriers are both often cited as advantages of telerehabilitation.

Our findings showed a broad 95 per cent confidence interval ranging from –1 to 18 per cent higher attendance, indicating that although most studies found similar or higher attendance rates, not all did.

Interestingly, the only study that reported clearly worse attendance for telerehabilitation exclusively used home visits as the in-person comparator.

Home visits are very convenient and remove barriers such as issues with technology and software; these factors negatively affected attendance in the telerehabilitation arm of some studies.

Overall, most studies showed similar or better attendance for telerehabilitation—particularly when software was adequate and training was provided for physiotherapists.

What about adherence with home exercise or self-management programs?

Adherence to home exercise and self-management programs was higher in telerehabilitation compared to in-person physiotherapy.

Specifically, adherence improved by about nine percentage points, with a 95 per cent confidence interval ranging from two to 16 per cent higher.

To put this in perspective, if participants were adhering to 80 per cent of their exercises in-person, they could potentially adhere to between 82 per cent and 96 per cent of their exercises with telerehabilitation.

We are not entirely sure why this is the case.

It might be that giving instructions on exercises while patients are in familiar surroundings makes it easier for them to integrate these exercises into their daily routine and home environment.

Alternatively, physiotherapists might spend more time and place greater emphasis on the home exercise program during telerehabilitation sessions, as they cannot use hands-on techniques.

This could improve understanding of the prescribed exercises and enhance motivation, thereby increasing adherence.

What about satisfaction?

Satisfaction ratings were generally quite high, exceeding 75 per cent in 10 of the 12 studies we reviewed for this outcome.

This indicates that videoconferencing telerehabilitation meets patient expectations about as well as in-person physiotherapy does.

It is important to note that the studies included in our review involved participants who were randomly assigned to either telerehabilitation or in-person sessions.

In clinical practice, patients may be able to choose their preferred delivery mode, but our results suggest that, on average, patients will find telerehabilitation satisfactory regardless of their initial preferences.

This reinforces that patients are likely to be just as satisfied with telerehabilitation as they are with traditional in-person physiotherapy.

What further research is needed in this area?

We think that it is important for any researchers involved in a clinical trial on telerehabilitation to investigate and report on attendance, adherence and satisfaction.

Several high-quality trials were excluded from this review because they did not report these outcomes.

In addition, there are still many unresolved questions about why telerehabilitation improves attendance and adherence, which are worth exploring.

Addressing the challenge of blinding in trials is also important, especially for subjective outcomes like satisfaction.

As participants know they are receiving telerehabilitation or in-person therapy, finding creative ways to mask the study aims or comparison groups could help reduce bias.

>>Dr. Joshua Simmich is a researcher at the University of Queensland’s RECOVER Injury Research Centre. His research encompasses various technologies in rehabilitation, such as exergames, mobile health, wearables, artificial intelligence and their applications in improving patient outcomes.