Telerehabilitation
Telemedicine involves using information and communication technologies to provide care and education at a distance (Solomon et al. 2022). Telerehabilitation is a subset of telemedicine defined as the provision of rehabilitation services at a distance using telecommunication technology, incorporating prevention and treatment (Russell 2007). The first-known telerehabilitation study involving people with SCI was an RCT by Soopramanien et al. (2005) testing the effectiveness of post-discharge support. The COVID-19 pandemic resulted in a significant shift in the adoption trajectory of telerehabilitation and remote monitoring technologies for many health professionals, including physical therapists (Ferguson 2022).
Recently, some systematic reviews (Lee et al. 2021; Touchett et al. 2022; Solomon et al. 2022) have been published evaluating the effectiveness and potential barriers of “telespinalcordinjury” or “teleSCI” (term coined at the International Spinal Cord Society Annual Scientific Meeting in Vienna, Austria on 2016); however, only one study (Villiger et al. 2017) assessed walking interventions/outcome measures. Most recently, two studies have been conducted to test telerehabilitation using walking outcome measures, among other outcomes, in people with SCI whose rehabilitation plan was affected because of COVID-19 (García-Rudolph et al. 2024a) or due to war conflicts (Fathe et al. 2024).
Discussion
There are too few studies currently to determine the effectiveness of a telerehabilitation approach on walking (or precursors to walking) in people with SCI.
One case control study by García-Rudolph et al. (2024a) found no significant differences on FIM, SCIM, or WISCI scores whether people were in the ‘teleSCI’ group or in the traditional rehabilitation control group. A small prospective controlled trial tested a 6-month at home rehabilitation program with war veterans; Fathe et al. (2024) largely found no significant differences between telerehab and in-person groups on muscle strength or other anthropomorphic measures. In a small pre-post study, Villiger et al (2017) tested the feasibility and effectiveness of an at-home VR lower limb rehabilitation program called ‘YouKicker’; after 4 weeks, they found significant improvements in LEMS, but not in 6MWT, WISCI II, or SCIM scores.
Conclusions
There is level 2 evidence (from 1 prospective controlled trial: Fathe et al. 2024) that a 6-month home telerehabilitation program focused on different whole-body exercises, resistance exercises, and aerobic training provides few differences in muscle strength or other anthropomorphic measures compared to controls in people with complete chronic SCI.
There is level 3 evidence (from 1 case control study: García-Rudolph et al. 2024a) that a teleSCI intervention (comprising fitness exercises classes, one-to-one physiotherapy/occupational therapy sessions, SCI-specific exercises prepared videos, and scheduled phone-calls with nurses and physicians) provides similar improvements in mobility (WISCI) and functional outcomes (FIM and SCIM) as traditional rehabilitation in patients with acute SCI.
There is level 4 evidence (from 1 pre-post study: Villiger et al. 2017) that a home VR intervention focused on lower limb exercises for four weeks provides significant improvements in LEMS but not in 10MWT, 6MWT, WISCI, and SCIM in participants with incomplete and chronic SCI.
