Filleul Arthur, Drolet Marie-Josée, Sigouin Jennifer, Hudon Anne, Kairy Dahlia
Unité de recherche en éthique pragmatique de la santé, Institut de recherches cliniques de Montreal, Montreal, Quebec, Canada
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada.
BMJ Open. 2025 May 8;15(5):e099728. doi: 10.1136/bmjopen-2025-099728.
Telerehabilitation (also known as virtual rehabilitation) refers to the use of telecommunication technologies to deliver remote rehabilitation services synchronously or asynchronously to patients. Systematic reviews seem to validate the efficacy and efficiency of telerehabilitation services for diverse patient conditions while offering in addition potential cost savings in healthcare. However, integrating telerehabilitation into clinical settings raises several ethical issues, including the risk of exacerbating existing health inequities in the provision of care. Despite the apparent scarcity of the literature addressing ethical issues related to telerehabilitation, some of these fundamental concerns have already been discussed in health ethics publications. The main objectives of this study are therefore to first scrutinise what has been published to date and second to critically examine the way in which these dimensions have been conceptualised, especially the philosophical and ethical conceptions on which they are based.
To meet these objectives, we will conduct a Critical Interpretive Synthesis (CIS). By using an iterative and interactive process, a CIS aims to critically examine the literature and develop a theoretical understanding grounded in review studies. As per the steps described by Dixon-Woods, we will start by conducting a systematic search of the literature within five selected databases: CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. The search strategy will be based on two main concepts: (1) telerehabilitation and (2) ethics. This systematic search will be completed by other research strategies: searching the list of references of selected articles and contacting experts within and outside our team's expertise. Search results will be imported within the Covidence software to be assessed for relevance. We will include all empirical and non-empirical articles that specifically investigate or discuss the ethical dimensions of telerehabilitation. Only studies published in English and French will be included. The search and selection of the articles will be carried out interactively and inductively throughout the stages of extraction and development of a theoretical understanding of the data to fill emerging conceptual gaps. The analysis and critical synthesis will be led by the first author but carried out by our multidisciplinary research team. This study, through its critical dimension, has the potential to provide a more comprehensive overview of the many ethical issues surrounding telerehabilitation.
This review does not require ethical approval. We aim to publish the results in a peer-reviewed journal and do presentations at local, national and/or international research meetings and workshops for all stakeholders.
远程康复（也称为虚拟康复）是指利用电信技术为患者同步或异步提供远程康复服务。系统评价似乎证实了远程康复服务对各种患者情况的有效性和效率，同时还可能节省医疗保健成本。然而，将远程康复纳入临床环境引发了几个伦理问题，包括在提供护理方面加剧现有健康不平等的风险。尽管关于远程康复伦理问题的文献明显匮乏，但其中一些基本问题已经在健康伦理出版物中得到讨论。因此，本研究的主要目标是，首先仔细审查迄今为止已发表的内容，其次批判性地审视这些问题的概念化方式，尤其是其背后的哲学和伦理观念。
为实现这些目标，我们将进行一项批判性解释性综合研究（CIS）。通过迭代和互动过程，CIS旨在批判性地审视文献，并基于综述研究形成理论理解。按照迪克森 - 伍兹所描述的步骤，我们将首先在五个选定的数据库中进行系统的文献检索：护理学与健康领域数据库（CINAHL）、荷兰医学文摘数据库（EMBASE）、医学期刊数据库（MEDLINE）、科学引文索引数据库（Web of Science）和心理学文摘数据库（PsycINFO）。检索策略将基于两个主要概念：（1）远程康复和（2）伦理。此次系统检索将通过其他研究策略来完成：搜索所选文章的参考文献列表，并联系我们团队专业领域内外的专家。检索结果将导入Covidence软件进行相关性评估。我们将纳入所有专门研究或讨论远程康复伦理层面的实证和非实证文章。仅纳入以英文和法文发表的研究。文章的检索和筛选将在对数据进行理论理解的提取和发展的各个阶段以互动和归纳的方式进行，以填补新出现的概念空白。分析和批判性综合将由第一作者主导，但由我们的多学科研究团队进行。本研究通过其批判性维度，有可能更全面地概述围绕远程康复的诸多伦理问题。
本综述无需伦理批准。我们旨在将研究结果发表在同行评审期刊上，并在地方、国家和/或国际研究会议及研讨会上向所有利益相关者进行汇报。
