Opoku Eric Nkansah, Paul Lorna, Antwi Derrick, Thomson Katie, Asibey Shadrack Osei, Brady Marian C, van Wijck Frederike, Sarfo Fred Stephen
Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland.
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
PLOS Digit Health. 2025 Jul 7;4(7):e0000911. doi: 10.1371/journal.pdig.0000911. eCollection 2025 Jul.
Neurological conditions including stroke, multiple sclerosis, and Parkinson's significantly contribute to disability and mortality globally. A significant proportion of these cases are found in Low and Middle Income Countries (LMICs). Telerehabilitation has emerged as a promising approach to overcome the geographical, financial, and logistical barriers to rehabilitation in LMICs. However, to date, no review has assessed the effectiveness of telerehabilitation in LMICs. This systematic review aims to evaluate the effectiveness of telerehabilitation for adults with neurological conditions in LMICs. A systematic search of databases (PubMed, EMBASE, CINAHL, MEDLINE, Cochrane central registry for clinical trials, and the World Health Organization (WHO) Global Health Library) was conducted to identify relevant studies published from 1st January 1990-20th April 2024. To accurately capture relevant studies, search terms were closely aligned with PICO elements of the review question. PRISMA and AMSTAR guidelines were used to guide the conduct of this review which only included clinical trials. Joanna Briggs Institute (JBI) critical appraisal tools were used to assess the methodological quality of included studies.Out of 430 identified studies, 16 met the inclusion criteria. There was notable heterogeneity in telerehabilitation content, approaches, dose, delivery methods and follow-up periods. Given the heterogeneity, a narrative analysis was conducted. Findings from the included studies suggest that telerehabilitation can lead to similar or superior outcomes compared to conventional rehabilitation. However, only a third of the included studies incorporated follow-up assessments, and among those, sustained benefits were observed in only a few outcomes. The lack of long-term follow-up data makes it difficult to draw conclusions about the sustained effectiveness of telerehabilitation.This systematic review indicates a promising potential for telerehabilitation to enhance outcomes for adults with neurological conditions living in LMICs. However, the lack of long-term follow-up data limits understanding of sustained benefits. High-quality, methodologically rigorous research with extended follow-up is needed to determine the long-term effectiveness of telerehabilitation. Establishing this evidence base is critical for integrating telerehabilitation into healthcare strategies and policy.
包括中风、多发性硬化症和帕金森氏症在内的神经系统疾病在全球范围内对残疾和死亡率有重大影响。这些病例中有很大一部分出现在低收入和中等收入国家（LMICs）。远程康复已成为一种有前景的方法，可克服LMICs地区康复过程中的地理、资金和后勤障碍。然而，迄今为止，尚无综述评估远程康复在LMICs中的有效性。本系统综述旨在评估远程康复对LMICs中患有神经系统疾病的成年人的有效性。我们对数据库（PubMed、EMBASE、CINAHL、MEDLINE、Cochrane临床试验中央注册库和世界卫生组织（WHO）全球健康图书馆）进行了系统检索，以识别1990年1月1日至2024年4月20日发表的相关研究。为了准确捕捉相关研究，检索词与综述问题的PICO要素紧密对齐。PRISMA和AMSTAR指南用于指导本综述的开展，该综述仅纳入临床试验。使用乔安娜·布里格斯研究所（JBI）的批判性评估工具来评估纳入研究的方法学质量。在430项已识别的研究中，16项符合纳入标准。远程康复的内容、方法、剂量、交付方式和随访期存在显著异质性。鉴于这种异质性，我们进行了叙述性分析。纳入研究的结果表明，与传统康复相比，远程康复可带来相似或更好的结果。然而，纳入研究中只有三分之一进行了随访评估，其中只有少数结果观察到持续益处。缺乏长期随访数据使得难以就远程康复的持续有效性得出结论。本系统综述表明，远程康复对于改善LMICs中患有神经系统疾病的成年人的治疗效果具有广阔前景。然而，缺乏长期随访数据限制了我们对持续益处的理解。需要开展高质量、方法严谨且随访期延长的研究，以确定远程康复的长期有效性。建立这一证据基础对于将远程康复纳入医疗保健战略和政策至关重要。
