Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Western University, London, Ontario, Canada.
PLoS One. 2024 Nov 19;19(11):e0313440. doi: 10.1371/journal.pone.0313440. eCollection 2024.
OBJECTIVE: This scoping review aimed to map existing research on adverse events encountered during telerehabilitation delivery, across rehabilitation populations. This includes identifying characteristics of adverse events (frequency/physical/non-physical, relatedness, severity) and examining adverse events by different modes of telerehabilitation delivery and disease states. INTRODUCTION: Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic for remote service delivery. However, no prior scoping review, systematic review, or meta-analysis has identified and summarized the current primary research on adverse events in telerehabilitation. Understanding adverse events, such as falls during physiotherapy or aspiration pneumonia during speech therapy, is crucial for identifying limitations and optimizing delivery through risk mitigation and quality indicators. This understanding could also help to improve the uptake of telerehabilitation among clinicians and patients. This review addresses this gap by summarizing published literature on adverse events during telerehabilitation. METHODS: The review followed the Joanna Briggs Institute framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The review protocol was registered and published on Open Science Framework. A comprehensive search across multiple databases (MEDLINE ALL/EMBASE/APA PsycINFO/CENTRAL/CINAHL) was conducted. Screening, extraction, and synthesis were performed in duplicate and independently. Data extraction followed the Template for Intervention Description and Replication framework and also involved extraction on authors, publication year (pre- or post-COVID), population, sample size, and modes of telerehabilitation delivery (asynchronous, synchronous, hybrid). For synthesis, data were summarized quantitatively using numerical counts and qualitatively via content analysis. The data were grouped by intervention type and by type of adverse event. INCLUSION CRITERIA: This scoping review included qualitative and quantitative studies published between 2013-2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery were included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants were excluded. RESULTS: The search identified 11,863 references, and 81 studies were included in this review with a total of 3,057 participants (mean age:59.3 years; females:44.6%). Modes of telerehabilitation delivery (whether asynchronous, synchronous or hybrid) used in the studies included videoconferencing (52), phone calls (25), text messaging (4), email (6), mobile apps (10), and internet-based virtual reality systems (3). A total of 295 adverse events occurred during 84,534 sessions (0.3%), with the majority being physical (e.g., falls or musculoskeletal pain), non-serious/non-severe/mild, and unrelated to (i.e., not caused by) to the telerehabilitation provided. CONCLUSIONS: From the 81 included studies, telerehabilitation was delivered with related adverse events being rare, and mostly characterized as mild/non-severe. A comparable occurrence of adverse events (~30%) was found between asynchronous and synchronous telerehabilitation studies. When categorized by disease type, cardiac telerehabilitation studies had the most frequent adverse events. Detailed reporting of telerehabilitation interventions and adverse event characteristics is recommended for future studies (i.e., use of TIDieR reporting guidelines). Telerehabilitation has the potential to make rehabilitation services more accessible to patients; however, more evidence on the safety of telerehabilitation is needed.
目的:本范围综述旨在绘制现有远程康复服务中遇到的不良事件研究,涵盖康复人群。这包括确定不良事件的特征(频率/身体/非身体、相关性、严重程度),并按不同的远程康复交付模式和疾病状态检查不良事件。
介绍:远程康复是远程医疗的一个分支,在 COVID-19 大流行期间,远程康复服务得到了广泛应用。然而,以前没有范围综述、系统综述或荟萃分析确定和总结了远程康复中当前的主要不良事件研究。了解不良事件,如物理治疗期间的跌倒或言语治疗期间的吸入性肺炎,对于通过风险缓解和质量指标识别限制和优化交付至关重要。这种理解还有助于提高临床医生和患者对远程康复的接受度。本综述通过总结远程康复期间不良事件的已发表文献来解决这一差距。
方法:该综述遵循乔安娜布里格斯研究所的框架,并遵循首选报告项目的扩展范围综述指南。该综述方案已在开放科学框架上注册并发布。对多个数据库(MEDLINE ALL/EMBASE/APA PsycINFO/CENTRAL/CINAHL)进行了全面搜索。筛选、提取和综合均由两人独立进行。数据提取遵循干预描述和复制模板框架,还包括作者、出版物年份(COVID 前/后)、人口、样本量以及远程康复交付模式(异步、同步、混合)的提取。对于综合,数据使用数值计数进行定量总结,并通过内容分析进行定性总结。数据按干预类型和不良事件类型分组。
纳入标准:本范围综述包括 2013-2023 年间发表的定性和定量研究,用英语书写,并在任何地理区域进行。包括所有模式的远程康复交付。排除系统评价、荟萃分析、评论、方案、意见文章、会议摘要和少于 5 名参与者的病例系列。
结果:搜索共确定了 11863 篇参考文献,81 项研究纳入本综述,共涉及 3057 名参与者(平均年龄:59.3 岁;女性:44.6%)。研究中使用的远程康复交付模式(异步、同步或混合)包括视频会议(52)、电话(25)、短信(4)、电子邮件(6)、移动应用程序(10)和基于互联网的虚拟现实系统(3)。在 84534 次治疗中发生了 295 次不良事件(0.3%),大多数是身体(如跌倒或肌肉骨骼疼痛)、非严重/非严重/轻度,与提供的远程康复无关(即不是由远程康复引起的)。
结论:从 81 项纳入的研究中可以看出,远程康复的不良事件发生率较低,且大多为轻度/非严重。异步和同步远程康复研究中发现了类似的不良事件发生率(~30%)。按疾病类型分类,心脏远程康复研究的不良事件发生率最高。建议未来的研究详细报告远程康复干预和不良事件特征(即使用 TIDieR 报告指南)。远程康复有可能使康复服务更容易为患者所接受;然而,需要更多关于远程康复安全性的证据。
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