This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs.
Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. CINAHL, Medline, PubMed, and Cochrane Library were searched from the earliest available date to August, 2022. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences (SMD) and 95% confidence intervals (CIs). Certainty of evidence was determined by applying Grading of Recommendation, Assessment, Development and Evaluation (GRADE) criteria.
Eleven studies (10 randomised) with 1400 participants (mean age 65 to 74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, six-minute walk distance, timed up and go test, and quality of life and had lower health-care costs compared to face-to-face physiotherapy. Compared to no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, six-minute walk distance and timed up and go test speed.
Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
This review found older adults participating in physiotherapy-led telerehabilitation do not appear to be at greater risk of adverse events or falls compared to older adults who were completing their rehabilitation face-to-face. This may be because the telerehabilitation interventions were supervised by trained physiotherapists who could modify and tailor exercises to ensure safety. This review also found that adherence to exercise sessions was better via telerehabilitation compared to face-to-face which may be attributed to the removal of common barriers to accessing face-to-face rehabilitation such as transportation, physical access, fatigue and mobility issues.
Since older adults were able to safely engage in physiotherapist-led, exercise-based telerehabilitation, they also improved their physical function, activity outcomes and quality of life. Given that telerehabilitation was not inferior to face-to-face rehabilitation across a variety of patient outcomes (quality of life, six-minute walk distance, timed up and go test, knee flexion ROM and knee extensor strength), it appears the mode of physiotherapy delivery (i.e. face-to-face versus videoconferencing), is less important than the content of rehabilitation programs for improving outcomes.
Delivery of telerehabilitation by physiotherapists demonstrated potential cost savings compared to face-to-face rehabilitation. This has positive, widespread implications for older adults who may have difficulty accessing physiotherapy in a clinic setting due to travel and cost and therefore missing out on vital interventions.
By utilising telerehabilitation, health services can improve accessibility and better meet growing demand for services due to an aging population by increasing the capacity of the services to provide high quality physiotherapy to a greater volume of patients.
older adults
exercise
