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低收入和中等收入国家(LMICs)的低成本远程康复:克服获取障碍并改善医疗服务提供

Low-Cost Telerehabilitation in Low- and Middle-Income Countries (LMICs): Overcoming Barriers to Access and Improving Healthcare Delivery.

作者信息

Surya Nirmal, Someshwar Hitav Pankaj

机构信息

Chairman and Consultant Neurologist, Surya Neuro Center, Mumbai, Maharashtra, India.

Physiotherapy School and Center, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India.

出版信息

NeuroRehabilitation. 2025 Feb;56(1):30-36. doi: 10.1177/10538135241303349. Epub 2025 Feb 9.

DOI:10.1177/10538135241303349
PMID:40183166
Abstract

BackgroundTelerehabilitation (TR) holds promise for addressing healthcare disparities in low- and middle-income countries (LMICs), where access to rehabilitation services is often limited due to economic, geographical, and infrastructure barriers. Despite its potential, TR faces unique challenges in LMICs, including inadequate digital infrastructure, limited access to affordable devices, and variable internet connectivity.ObjectiveThis study investigates the feasibility, barriers, and outcomes of implementing low-cost TR interventions in LMICs.MethodA narrative review was conducted where studies were analyzed for outcomes including cost-effectiveness, patient adherence, and clinical efficacy.ResultsFindings indicate that low-cost TR can significantly improve accessibility to rehabilitation in LMICs, with positive clinical outcomes for patients with stroke, musculoskeletal disorders, and chronic pain. TR led to a 40-60% reduction in travel-related costs for patients, with adherence rates comparable to in-person sessions. However, limited access to reliable internet and devices were major barriers, particularly in rural areas, highlighting a digital divide within LMIC populations. Innovative solutions, such as asynchronous video-based therapy, were found effective in overcoming connectivity challenges.ConclusionLow-cost TR is a viable approach to enhancing rehabilitation accessibility in LMICs, offering substantial reductions in cost and travel barriers. Addressing infrastructure challenges through scalable, offline-enabled platforms could enhance TR's reach and efficacy. Further research is necessary to develop sustainable TR models tailored to the specific needs of LMICs.

摘要

背景

远程康复(TR)有望解决低收入和中等收入国家(LMICs)的医疗保健差距问题,在这些国家,由于经济、地理和基础设施障碍,获得康复服务的机会往往有限。尽管具有潜力,但远程康复在低收入和中等收入国家面临着独特的挑战,包括数字基础设施不足、难以获得价格合理的设备以及网络连接不稳定。

目的

本研究调查在低收入和中等收入国家实施低成本远程康复干预措施的可行性、障碍和效果。

方法

进行了一项叙述性综述,分析研究结果,包括成本效益、患者依从性和临床疗效。

结果

研究结果表明,低成本远程康复可以显著提高低收入和中等收入国家康复服务的可及性,对中风、肌肉骨骼疾病和慢性疼痛患者有积极的临床效果。远程康复使患者与出行相关的成本降低了40%-60%,依从率与面对面治疗相当。然而,可靠的网络和设备难以获取是主要障碍,特别是在农村地区,这凸显了低收入和中等收入国家人群中的数字鸿沟。事实证明,诸如基于异步视频的治疗等创新解决方案能有效克服连接方面的挑战。

结论

低成本远程康复是提高低收入和中等收入国家康复服务可及性的可行方法,能大幅降低成本和出行障碍。通过可扩展的、支持离线功能的平台解决基础设施挑战,可以扩大远程康复的覆盖范围并提高其效果。有必要开展进一步研究,以开发适合低收入和中等收入国家特定需求的可持续远程康复模式。

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