Secondary Logo

Journal Logo

Thieves' Market

Telerehabilitation for Older Adults

Hayes, Donald DPT, PT, GTCCS, GCS

Author Information
doi: 10.1097/TGR.0000000000000282
  • Free


The corovavirus-2019 (COVID-19) pandemic has caused clinicians to modify how rehabilitation services are delivered. Telerehabilitation (TR) has been one of the primary means to continue to treat patients during this time. A scoping review found TR could be used for consultation with caregivers of older adults but was underutilized.1 Systematic reviews (SRs) of TR have found clinical outcomes similar/better compared with face-to-face (FTF) and compliance with home programs high.2,3 One SR looked at allied health care including PT and found telehealth as effective as FTF.4 Older patients and those living in rural areas have even greater benefit with TR.5 TR supports numerous clinical conditions including age-related comorbidities.6 TR improves patient access to care, prevents unnecessary delays in care, facilitates coordination of care, promotes collaboration within the health care team, and provides greater access to specialists.7,8 An SR found TR facilitated communication between patients and health care professionals to improve physical activity.9 The Rehabilitation Enhancing Aging through Connect Health (REACH) project demonstrated TR with some in-person visits reduced emergency department visits, improved gait speed, and raised Short Physical Performance Battery scores for older adults.10

Despite these advantages, older patients are less likely to choose TR.11 TR may be viewed as a cultural change by older patients not comfortable with technology.12 Therapist perceptions about TR also influence a patient's belief in its value. Studies have found clinicians have several concerns about the use of TR including patient safety, tech support, lack of physical contact, and developing rapport with the patient.13–15

Educating therapists that TR is an adjunct to, not a replacement of, FTF may ease some concerns.16 An example of a mixed or hybrid approach involved patients with subacute or chronic stroke utilizing 1 to 2 telephone calls, 1 to 2 home visits, and 2 to 8 TR visits and resulted in improved function, decreased depression, and decreased caregiver strain.17 Quality of life (QOL) and functional improvements for veterans were found with a hybrid approach of 75% TR and 25% FTF visits.18 Additionally, few academic programs include TR in the curriculum.19 A survey of PT/OT/NP students found mainly positive attitudes about telehealth but thought it clinically less useful and perceived interpersonal barriers.20

However, most patients have a positive view of telemedicine after using it.21 Use of patient-centered communication developed the same level of rapport as with FTF visits, and patients favored telehealth due to convenience.22 A study involving patients with hip or knee osteoarthritis (OA) found that preference for TR increased from 50% initially to 62% in the end.23 Patients after total knee arthroplasty found TR improved access to care and were able to develop a strong therapeutic relationship while having personal space.24 TR also lessens caregiver burden by reducing the need to transport a patient to appointments, thus reducing societal costs.25


TR has been found valid and reliable for many aspects of the clinical examination, but does have some limitations.26 Agreement in several assessment areas was found between FTF and TR of the neck, shoulders, low back, elbow, and hand conditions.27–31 TR has proven diagnostically comparable to FTF for lower limb musculoskeletal conditions.32 There was a high level of agreement between TR and FTF evaluation of a knee.33 A TR ankle examination consisting of functional movements, task, and self-applied orthopedic/neuro test was comparable to an FTF examination.34 Questionnaires like the Neck Disability Index, Oswestry, and Lower Extremity Functional Scale can be administered with TR and provide information on pain and function. Some software platforms have built-in goniometers and tape measures to assess range of motion and edema.

There is substantial evidence for treatment of musculoskeletal conditions with TR, especially as an adjunct to FTF. Examples of TR as an adjunct include booster sessions and a partial replacement of FTF for patients with chronic low back pain.35,36 An SR concluded TR combined with standard treatment may produce superior results compared with standard treatment alone.37 Some exercise programs have been created for TR, such as a high-dose shoulder program and knee OA.38,39 Many other exercise programs are easily adapted for TR. In addition to therapeutic exercise, treatment options include chair yoga, self-acupressure, and nerve mobilizations.40–43 Self-applied joint mobilizations have beneficial for several joints.44–47 Additionally, extended care for patients after hip fracture improved functional outcomes and is another advantage with TR.2,48

More studies demonstrating the benefits of TR involve post-joint replacement surgery. Systematic reviews have found TR at least as effective as FTF after total hip or knee arthroplasty.49–51 Compared against routine care, TR showed greater improvement in the Timed Up and Go (TUG) test.52 TR as an adjunct to FTF after hip surgery had greater improvements in gait speed, TUG, 2-minute walk test, 5 times sit to stand, and the 10-m walk test.53 Accuracy of exercise performance after total hip replacement was high.54 Telephone consultations reduced emergency department visits with patients after joint replacements.55 TR has also been found to reduce health care costs after total knee arthroplasty.56


TR lends itself well to the assessment and treatment of gait and balance disturbances. Longer fall programs have greater success than shorter ones, and TR provides these longer episodes of care.18 An SR found programs of less than 6 months reduced fall rate by 21% beyond 12 months and no difference in risk of falling between control and intervention groups while programs 6 to 12 months in length reduced fall rate 33% and the risk for falls decreased 36% beyond 12 months.57 Each component of a fall program (strength, endurance, balance, and acceptability to older adults) can be delivered with TR.58 Many clinical tests for these components translate easily to TR. An SR found 5 times sit to stand, TUG, functional reach, stepping activity, single-limb stance, and double-limb stance tests valid and reliable with TR.59 In some instances, a different test for the same system may be selected. Due to space limitations the 2-minute step test and the 4-m walk test are substitutions for the 6-minute and 10-meter walk tests, respectively.60 Strength and balance tests such as the 30-second chair rise, 30 1-arm curl, 8-ft TUG, and feet together/semi-tandem/tandem standing are able to be performed with TR as with FTF.60 There are several characteristics outlined for a clinical gait examination.61 Except for perturbation tests, other than when a technician assists, all other aspects are observable or measurable with TR. Low-cost motion analysis platforms have proven valid measurements for gait speed, stride length, gait cycle, sagittal plane range of motion at hip/knee/ankle, and upper extremity shoulder patterns.62 TR has also been used for gait device height assessment.63 A comparison between TR and in-person gait assessments found no differences in recommendations.64 Clinical tests such as the Berg Balance Scale (BBS) and the Performance-Oriented Mobility Assessment-Gait (POMA-G) are valid and reliable with TR.63,65 Studies have shown a licensed practical nurse used as a technician could be educated to assist in performance of tests such as the POMA, proprioception of the great toe, dynamic visual acuity, and could help to identify whether additional services were needed.66,67 The technician also provided safety guarding for the performance of some exercises.67

A TR balance program improved balance and strength and decreased depression.68 The Otago exercise program (OEP) has been shown to improve physical function in older adults.69 TR has been demonstrated effective in the delivery of the OEP.70 Tai chi delivered with TR improved balance and reduced fear of falling.71 The Balance Intensity Scale and verbal markers provide valid measurements for intensity of balance exercise with older adults and may be used with TR.72,73 Home safety assessments can be completed with TR before a patient leaves the hospital or skilled nursing facility.74 A home safety assessment that looked at patient self-care, mobility, household, and leisure activity was found feasible with TR.75 A high level of agreement was found between FTF and TR when measuring the height of items in a house.76

Many older adult patients have searched for smartphone applications (app) to improve their function. One study examined an app for the Functional Gait Assessment and found the app eliminated subjective errors and promoted self-care.77 Therapists should review patient-selected apps to determine accuracy of the information provided. Standardized reviews of smartphone balance apps found that many did not have scientific support or were not developed by a therapist.78,79

Vestibular dysfunctions such as hypofunction and benign paroxysmal positional vertigo (BPPV) are treatable with TR. Questionnaires may be used as screening tools for vestibular disorders and BPPV.80,81 Smartphone-recorded eye movement with the Dix-Hallpike maneuver had high sensitivity and specificity.82 When treating BPPV with TR, patient safety must be considered. A sensation of being thrown to the ground after canalithiasis repositioning maneuvers has occurred in some patients.83 Treatment of chronic vestibular syndrome showed TR alone and a hybrid approach had greater improvements in symptoms compared with usual care with the hybrid approach having the greatest reduction in stress, anxiety, and depression.84 Use of an iPod provided objective information about head turn frequency.85


Patients who have suffered strokes can benefit from TR to reach their maximum functional potential. An SR and meta-analysis found TR had similar outcomes/effect with activities of daily living, upper extremity/lower extremity function, balance, walking (or better), physical activity, and participation.86 Another SR and meta-analysis found no differences between TR and FTF with Barthel Index, BBS, Fugl-Meyer Upper Extremity, and Stroke Impact Scale.87 However, another SR found TR interventions have equal or better effects on motor, higher cortical, and mood disorders, BBS, Dynamic Gait Index, 10-m walk test, and Caregiver Strain Index.88 A scoping review found 58 different outcome measures used with TR/virtual reality after stroke.89 Equal effects to balance and functional mobility were found with TR as with FTF in a clinical setting.90

Parkinson disease is another neurological condition where TR benefits the patient. TR was found accurate and reliable for assessment of the timed stance test, TUG, step test, steps in 360 turn, BBS, and lateral/functional reach for patients with Parkinson disease.91 TR has been found to be valid and reliable with high-level agreement with FIM (except bowel management with modified independent and independent levels), UPDRS (except handwriting, action tremors, and speech volume), and Nine Hole Peg Test for patients with Parkinson disease.92 TR can be used to administer the Montreal Cognitive Assessment for patients with Parkinson disease.93 An SR found telehealth effective to improve motor impairment in subjects with Parkinson disease.94 TR used in combination with the Lee Silverman Voice Training Big program improved 6-minute walk distance and TUG time.95 Yoga and tai chi have moderate to high evidence and have been found effective with TR.40,71,96 Additionally, group-adapted tango dancing using TR has proven beneficial.97 A case study for a patient with cerebellar ataxia used TR for 59 of 60 visits with improvements in gait speed, TUG, and pegboard tests.98


TR has shown many positive outcomes for patients with cardiopulmonary conditions. TR used as a partial replacement for FTF visits for patients with pulmonary disease improved in dyspnea rating and 6-minute walk test (6MWT).36 An SR concluded TR was no different from traditional service delivery on the 6MWT, peak oxygen consumption, and QOL.99 The SR also concluded home program adherence seemed higher. The dropout rate and compliance with pulmonary rehab have been found higher with TR.100 A randomized controlled trial (RCT) found TR reduced risk of acute exacerbation and emergency visits for patients on maintenance pulmonary rehab.101 In Canada a nationwide initiative was developed to deliver pulmonary rehab with TR.102 Another RCT TR program for heart failure resulted in improved QOL and 6-minute walk distance with improvements sustained at 4 months.103 There is a framework for comprehensive pulmonary rehabilitation with TR.104


TR as a part of the treatment plan for common conditions found in the elderly such as diabetes, frailty, chronic pain, wounds, cancer, incontinence, and dementia has been beneficial. A diabetic telemedicine clinic improved glycemic control with enhanced access to clinical care.105 TR used for exercise and nutritional education improved balance, gait speed, and QOL in a frail elderly population.106 A prefrail older adult population used TR with a program based on the OEP and improved QOL.107 Elderly adults with sarcopenia utilized TR to increase muscle mass and sitting balance.108 Patients with chronic pain preferred TR for feedback and monitoring of their progression.109 A case study concluded TR could be used to deliver therapeutic neuroscience education remotely.110 Another case study for wound care found a similar result.111 Wound healing times were found shorter with telemedicine compared with traditional follow-up visits.112 TR used to treat various cancers has improved physical function, QOL, cognitive functioning, and decreased pain.113,114 Remote-guided exercise for patients with stable gliomas improved cardiorespiratory fitness.115 TR for stress incontinence improved symptoms and QOL.116,117 An SR found TR had comparable effects to FTF for cognitive rehabilitation in patients with mild cognitive impairment, Alzheimer disease, and frontotemporal dementia.118 TR reduced caregiver burden, stress, depression, and hours of care provided for patients with dementia.119


Technology advancements including wearable haptic bands to remotely replace a therapist's hands for guiding movement and clothing for monitoring vital signs with chronic patients.120,121 The UPDRS has poor to moderate correlation with different tasks and different times of day.122 Sensors worn by individuals with Parkinson disease all day can give insight into how a person performs in home throughout day and could give aggregate score.122 Sensors used for upper extremity movement could be used to identify typical from atypical movement across lifespan.123


TR has been a growing area for health care for decades and the COVID-19 pandemic has accelerated this growth. As the technology grows and more therapists become experienced with TR, its use will continue to grow. The Federation of State Boards of Physical Therapy provided recommendations for therapists using TR. These recommendations included recognizing changing patient and provider expectations, deconstruction of the traditional physical therapy encounter, being open to discovery, and being bold and visionary.124


1. Nobakht Z, Rassafiani M, Hosseini SA, Ahmadi M. Telehealth in occupational therapy: a scoping review. Int J Ther Rehabil. 2017;24(12):534–538. doi:10.12968/ijtr.2017.24.12.534.
2. Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil. 2009;31(6):427–447. doi:10.1080/09638280802062553.
3. Emmerson KB, Harding KE, Taylor NF. Providing exercise instructions using multimedia may improve adherence but not patient outcomes: a systematic review and meta-analysis. Clin Rehabil. 2019;33(4):607–618. doi:10.1177/0269215518819706.
4. Speyer R, Denman D, Wilkes-Gillan S, et al. Effects of telehealth by allied health professionals and nurses in rural and remote areas: a systematic review and meta-analysis. J Rehabil Med. 2018;50(3):225–235. doi:10.2340/16501977-2297.
5. Chern CC, Chen YJ, Hsiao B. Decision tree-based classifier in providing telehealth service. BMC Med Inform Decis Mak. 2019;19(1):104. doi:10.1186/s12911-019-0825-9.
6. Calvaresi D, Marinoni M, Dragoni AF, Hilfiker R, Schumacher M. Real-time multi-agent systems for telerehabilitation scenarios. Artif Intell Med. 2019;96:217–231. doi:10.1016/j.artmed.2019.02.001.
7. Cason J. Telehealth: a rapidly developing service delivery model for occupational therapy. Int J Telerehabil. 2014;6(1):29–35. doi:10.5195/ijt.2014.6148.
8. Savard L, Borstad A, Tkachuck J, Lauderdale D, Conroy B. Telerehabilitation consultations for clients with neurologic diagnoses: cases from rural Minnesota and American Samoa. NeuroRehabilitation. 2003;18(2):93–102.
9. Hakala S, Rintala A, Immonen J, Karvanen J, Heinonen A, Sjögren T. Effectiveness of technology-based distance interventions promoting physical activity: systematic review, meta-analysis and meta-regression. J Rehabil Med. 2017;49(2):97–105. doi:10.2340/16501977-2195.
10. Bean JF, Brown L, DeAngelis TR, et al. The Rehabilitation Enhancing Aging through Connected Health prehabilitation trial. Arch Phys Med Rehabil. 2019;100(11):1999–2005. doi:10.1016/j.apmr.2019.04.015.
11. Reed ME, Huang J, Graetz I, et al. Patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians. JAMA Netw Open. 2020;3(6):e205873. doi:10.1001/jamanetworkopen.2020.5873.
12. Foster MV, Sethares KA. Facilitators and barriers to the adoption of telehealth in older adults: an integrative review. Comput Inform Nurs. 2014;32(11):523–535. doi:10.1097/CIN.0000000000000105.
13. Damhus CS, Emme C, Hansen H. Barriers and enablers of COPD telerehabilitation—a frontline staff perspective. Int J Chron Obstruct Pulmon Dis. 2018;13:2473–2482. doi:10.2147/COPD.S167501.
14. Cottrell MA, Hill AJ, O'Leary SP, Raymer ME, Russell TG. Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: a qualitative study. Musculoskelet Sci Pract. 2017;32:7–16. doi:10.1016/j.msksp.2017.07.008.
15. Lawford BJ, Bennell KL, Kasza J, Hinman RS. Physical therapists' perceptions of telephone- and internet video-mediated service models for exercise management of people with osteoarthritis. Arthritis Care Res (Hoboken). 2018;70(3):398–408. doi:10.1002/acr.23260.
16. Scholten J, Poorman C, Culver L, Webster JB. Department of Veterans Affairs Polytrauma Telerehabilitation: twenty-first century care. Phys Med Rehabil Clin N Am. 2019;30(1):207–215. doi:10.1016/j.pmr.2018.08.003.
17. Bernocchi P, Vanoglio F, Baratti D, et al. Home-based telesurveillance and rehabilitation after stroke: a real-life study. Top Stroke Rehabil. 2016;23(2):106–115. doi:10.1080/10749357.2015.1120453.
18. Levy CE, Silverman E, Jia H, Geiss M, Omura D. Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes. J Rehabil Res Dev. 2015;52(3):361–370. doi:10.1682/JRRD.2014.10.0239.
19. Greenfield B, Musolino GM. Technology in rehabilitation: ethical and curricular implications for physical therapist education. J Phys Ther Educ. 2012;26(2):81–90.
20. Randall K, Steinheider B, Isaacson M, et al. Measuring knowledge, acceptance, and perceptions of telehealth in an Interprofessional Curriculum for Student Nurse Practitioners, Occupational Therapists, and Physical Therapists. J Interactive Learn Res. 2016;27(4):339–353.
21. Gustke SS, Balch DC, West VL, Rogers LO. Patient satisfaction with telemedicine. Telemed J. 2004;6(1):5–13. doi:10.1089/107830200311806.
22. Agha Z, Schapira RM, Laud PW, McNutt G, Roter DL. Patient satisfaction with physician-patient communication during telemedicine. Telemed J E Health. 2009;15(9):830–839. doi:10.1089/tmj.2009.0030.
23. Rini C, Porter LS, Somers TJ, et al. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. Pain. 2015;156(5):837–848. doi:10.1097/j.pain.0000000000000121.
24. Kairy D, Tousignant M, Leclerc N, Cote AM, Levasseur M. The patient's perspective of in-home telerehabilitation physiotherapy services following total knee arthroplasty. Int J Environ Res Public Health. 2013;10:3998–4011. doi:10.3390/ijerph10093998.
25. Kloek CJJ, van Dongen JM, de Bakker DH, Bossen D, Dekker J, Veenhof C. Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: a cluster randomized controlled trial. BMC Public Health. 2018;18(1):1082. doi:10.1186/s12889-018-5975-7.
26. Mani S, Sharma S, Omar B, Paungmali A, Joseph L. Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review. J Telemed Telecare. 2017;23(3):379–391. doi:10.1177/1357633X16642369.
27. Mani S, Sharma S, Singh DK. Concurrent validity and reliability of telerehabilitation-based physiotherapy assessment of cervical spine in adults with non-specific neck pain [published online ahead of print July 4, 2019]. J Telemed Telecare. doi:10.1177/1357633X19861802.
28. Steele L, Lade H, McKenzie S, Russell TG. Assessment and diagnosis of musculoskeletal shoulder disorders over the Internet. Int J Telemed Appl. 2012;2012:945745. doi:10.1155/2012/945745.
29. Truter P, Russell T, Fary R. The validity of physical therapy assessment of low back pain via telerehabilitation in a clinical setting. Telemed J E Health. 2014;20(2):161–167. doi:10.1089/tmj.2013.0088.
30. Lade H, McKenzie S, Steele L, Russell TG. Validity and reliability of the assessment and diagnosis of musculoskeletal elbow disorders using telerehabilitation. J Telemed Telecare. 2012;18(7):413–418. doi:10.1258/jtt.2012.120501.
31. Worboys T, Brassington M, Ward EC, Cornwell PL. Delivering occupational therapy hand assessment and treatment sessions via telehealth. J Telemed Telecare. 2018;24(3):185–192. doi:10.1177/1357633X17691861.
32. Russell T, Truter P, Blumke R, Richardson B. The diagnostic accuracy of telerehabilitation for nonarticular lower-limb musculoskeletal disorders. Telemed J E Health. 2010;16(5):585–594. doi:10.1089/tmj.2009.0163.
33. Richardson BR, Truter P, Blumke R, Russell TG. Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation. J Telemed Telecare. 2017;23(1):88–95. doi:10.1177/1357633X15627237.
34. Russell TG, Blumke R, Richardson B, Truter P. Telerehabilitation mediated physiotherapy assessment of ankle disorders. Physiother Res Int. 2010;15(3):167–175. doi:10.1002/pri.471.
35. Peterson S. Telerehabilitation booster sessions and remote patient monitoring in the management of chronic low back pain: a case series. Physiother Theory Pract. 2018;34(5):393–402. doi:10.1080/09593985.2017.1401190.
36. Jansen-Kosterink S, In't Veld RH, Hermens H, Vollenbroek-Hutten M. A telemedicine service as partial replacement of face-to-face physical rehabilitation: the relevance of use. Telemed J E Health. 2015;21(10):808–813. doi:10.1089/tmj.2014.0173.
37. Matheve T, Brumagne S, Timmermans AAA. The effectiveness of technology-supported exercise therapy for low back pain: a systematic review. Am J Phys Med Rehabil. 2017;96(5):347–356. doi:10.1097/PHM.0000000000000615.
38. Van Straaten MG, Cloud BA, Morrow MM, Ludewig PM, Zhao KD. Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation. Arch Phys Med Rehabil. 2014;95(10):1810–1817.e2. doi:10.1016/j.apmr.2014.05.004.
39. Azma K, RezaSoltani Z, Rezaeimoghaddam F, Dadarkhah A, Mohsenolhosseini S. Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: a randomized clinical trial. J Telemed Telecare. 2018;24(8):560–565. doi:10.1177/1357633X17723368.
40. Schulz-Heik RJ, Meyer H, Mahoney L, et al. Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga. BMC Complement Altern Med. 2017;17(1):198. doi:10.1186/s12906-017-1705-4.
41. Song HJ, Seo HJ, Lee H, Son H, Choi SM, Lee S. Effect of self-acupressure for symptom management: a systematic review. Complement Ther Med. 2015;23(1):68–78. doi:10.1016/j.ctim.2014.11.002.
42. Li LW, Harris RE, Tsodikov A, Struble L, Murphy SL. Self-acupressure for older adults with symptomatic knee osteoarthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2018;70(2):221–229. doi:10.1002/acr.23262.
43. Jeong UC, Kim CY, Park YH, Hwang-Bo G, Nam CW. The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. J Phys Ther Sci. 2016;28(1):46–50. doi:10.1589/jpts.28.46.
44. Ribeiro DC, Sole G, Venkat R, Shemmell J. Differences between clinician- and self-administered shoulder sustained mobilization on scapular and shoulder muscle activity during shoulder abduction: a repeated-measures study on asymptomatic individuals. Musculoskelet Sci Pract. 2017;30:25–33. doi:10.1016/j.msksp.2017.04.010.
45. Choung SD, Kwon OY, Park KN, Kim SH, Cynn HS. Short-term effects of self-mobilization with a strap on pain and range of motion of the wrist joint in patients with dorsal wrist pain when weight bearing through the hand: a case series. Man Ther. 2013;18(6):568–572. doi:10.1016/j.math.2013.06.001.
46. Reiman MP, Matheson JW. Restricted hip mobility: clinical suggestions for self-mobilization and muscle re-education. Int J Sports Phys Ther. 2013;8(5):729–740.
47. Cosby NL, Grindstaff TL. Restricted ankle dorsiflexion self-mobilization. Strength Cond J. 2012;34(3):58–60. doi:10.1519/SSC.0b013e31824526e8.
48. Auais MA, Eilayyan O, Mayo NE. Extended exercise rehabilitation after hip fracture improves patients' physical function: a systematic review and meta-analysis. Phys Ther. 2012;92(11):1437–1451. doi:10.2522/ptj.20110274.
49. Pastora-Bernal JM, Martín-Valero R, Barón-López FJ, Estebanez-Pérez MJ. Evidence of benefit of telerehabitation after orthopedic surgery: a systematic review. J Med Internet Res. 2017;19(4):e142. doi:10.2196/jmir.6836.
50. Panda S, Bali S, Kirubakaran R, Hagenberg A. Telerehabilitation and total knee arthroplasty: a systematic review and meta-analysis of randomised controlled trials. Int J Ther Rehabil. 2015;22:S6. doi:10.12968/ijtr.2015.22.Sup8.S6.
51. Jansson MM, Rantala A, Miettunen J, Puhto AP, Pikkarainen M. The effects and safety of telerehabilitation in patients with lower-limb joint replacement: a systematic review and narrative synthesis [published online ahead of print April 21, 2020]. J Telemed Telecare. doi:10.1177/1357633X20917868.
52. Agostini M, Moja L, Banzi R, et al. Telerehabilitation and recovery of motor function: a systematic review and meta-analysis. J Telemed Telecare. 2015;21(4):202–213. doi:10.1177/1357633X15572201.
53. Kalron A, Tawil H, Peleg-Shani S, Vatine JJ. Effect of telerehabilitation on mobility in people after hip surgery: a pilot feasibility study. Int J Rehabil Res. 2018;41(3):244–250. doi:10.1097/MRR.0000000000000296.
54. Antón D, Nelson M, Russell T, Goñi A, Illarramendi A. Validation of a Kinect-based telerehabilitation system with total hip replacement patients. J Telemed Telecare. 2016;22(3):192–197. doi:10.1177/1357633X15590019.
55. Hällfors E, Saku SA, Mäkinen TJ, Madanat R. A consultation phone service for patients with total joint arthroplasty may reduce unnecessary emergency department visits. J Arthroplasty. 2018;33(3):650–654. doi:10.1016/j.arth.2017.10.040.
56. Tousignant M, Moffet H, Nadeau S, et al. Cost analysis of in-home telerehabilitation for post-knee arthroplasty. J Med Internet Res. 2015;17(3):e83. doi:10.2196/jmir.3844.
57. Finnegan S, Seers K, Bruce J. Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis. Physiotherapy. 2019;105(2):187–199. doi:10.1016/
58. Gardner MM, Robertson MC, Campbell AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med. 2000;34(1):7–17. doi:10.1136/bjsm.34.1.7.
59. Puh U, Hoehlein B, Deutsch JE. Validity and reliability of the Kinect for assessment of standardized transitional movements and balance: systematic review and translation into practice. Phys Med Rehabil Clin N Am. 2019;30(2):399–422. doi:10.1016/j.pmr.2018.12.006
60. Briggs BC, Jain C, Morey MC, et al. Providing rural veterans with access to exercise through Gerofit. Fed Pract. 2018;35(11):16–23.
61. Pirker W, Katzenschlager R. Gait disorders in adults and the elderly: a clinical guide. Wien Klin Wochenschr. 2017;129(3-4):81–95. doi:10.1007/s00508-016-1096-4.
62. Parks MT, Wang Z, Siu KC. Current low-cost video-based motion analysis options for clinical rehabilitation: a systematic review. Phys Ther. 2019;99(10):1405–1425. doi:10.1093/ptj/pzz097.
63. Venkataraman K, Morgan M, Amis KA, et al. Tele-assessment of the Berg Balance Scale: effects of transmission characteristics. Arch Phys Med Rehabil. 2017;98(4):659–664.e1. doi:10.1016/j.apmr.2016.10.019.
64. Iwatsuki H, Fujita C, Maeno R, Matsuya A. Development of a telerehabilitation system for training physiotherapists in rural areas. J Telemed Telecare. 2004;10(suppl 1):51–52. doi:10.1258/1357633042614401.
65. Venkataraman K, Amis K, Landerman LR, Caves K, Koh GC, Hoenig H. Teleassessment of gait and gait aids: validity and interrater reliability. Phys Ther. 2020;100(4):708–717. doi:10.1093/ptj/pzaa005.
66. Cary MP Jr, Spencer M, Carroll A, et al. Benefits and challenges of delivering tele-rehabilitation services to rural Veterans. Home Healthc Now. 2016;34(8):440–446. doi:10.1097/NHH.0000000000000441.
67. Hoffman NB, Prieto NM. Clinical video telehealth for gait and balance. Fed Pract. 2016;33(2):34–38.
68. Sparrow D, Gottlieb DJ, Demolles D, Fielding RA. Increases in muscle strength and balance using a resistance training program administered via a telecommunications system in older adults. J Gerontol A Biol Sci Med Sci. 2011;66(11):1251–1257. doi:10.1093/gerona/glr138.
69. Kocic M, Stojanovic Z, Nikolic D, et al. The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65 years: a randomized controlled trial. Arch Gerontol Geriatr. 2018;75:112–118. doi:10.1016/j.archger.2017.12.001.
70. Bernocchi P, Giordano A, Pintavalle G, et al. Feasibility and clinical efficacy of a multidisciplinary home-telehealth program to prevent falls in older adults: a randomized controlled trial. J Am Med Dir Assoc. 2019;20(3):340–346. doi:10.1016/j.jamda.2018.09.003.
71. Wu G, Keyes LM. Group tele-exercise for improving balance in elders. Telemed J E Health. 2006;12(5):561–570. doi:10.1089/tmj.2006.12.561.
72. Farlie MK, Molloy E, Keating JL, Haines TP. Clinical markers of the intensity of balance challenge: observational study of older adult responses to balance tasks. Phys Ther. 2016;96(3):313–323. doi:10.2522/ptj.20140524.
73. Farlie MK, Keating JL, Molloy E, et al. The Balance Intensity Scales for therapists and exercisers measure balance exercise intensity in older adults: initial validation using Rasch analysis. Phys Ther. 2019;99(10):1394–1404. doi:10.1093/ptj/pzz092.
74. Romero S, Lee MJ, Simic I, Levy C, Sanford J. Development and validation of a remote home safety protocol. Disabil Rehabil Assist Technol. 2018;13(2):166–172. doi:10.1080/17483107.2017.1300345.
75. Renda M, Lape JE. Feasibility and Effectiveness of telehealth occupational therapy home modification interventions. Int J Telerehabil. 2018;10(1):3–14. doi:10.5195/ijt.2018.6244.
76. Hoffmann T, Russell T. Pre-admission orthopaedic occupational therapy home visits conducted using the Internet. J Telemed Telecare. 2008;14(2):83–87. doi:10.1258/jtt.2007.070808.
77. Perez AA, Labrador MA. A Smartphone-Based System for Clinical Gait Assessment. 2016 IEEE International Conference on Smart Computing (SMARTCOMP), Smart Computing (SMARTCOMP), 2016 IEEE International Conference on May 2016:1–8. doi:10.1109/SMARTCOMP.2016.7501675.
78. Moral-Munoz JA, Esteban-Moreno B, Herrera-Viedma E, Cobo MJ, Pérez IJ. Smartphone applications to perform body balance assessment: a standardized review. J Med Syst. 2018;42(7):119. doi:10.1007/s10916-018-0970-1.
79. Reyes A, Qin P, Brown CA. A standardized review of smartphone applications to promote balance for older adults. Disabil Rehabil. 2018;40(6):690–696. doi:10.1080/09638288.2016.1250124.
80. Stewart V, Mendis MD, Rowland J, Choy NL. Construction and validation of the vestibular screening tool for use in the emergency department and acute hospital setting. Arch Phys Med Rehabil. 2015;96(12):2153–2160. doi:10.1016/j.apmr.2015.08.413.
81. Imai T, Higashi-Shingai K, Takimoto Y, Masumura C, Hattori K, Inohara H. New scoring system of an interview for the diagnosis of benign paroxysmal positional vertigo. Acta Otolaryngol. 2016;136(3):283–288. doi:10.3109/00016489.2015.1121547.
82. Shah MU, Lotterman S, Roberts D, Eisen M. Smartphone telemedical emergency department consults for screening of nonacute dizziness. Laryngoscope. 2019;129(2):466–469. doi:10.1002/lary.27424.
83. Maranhão ET, Whitney SL, Maranhão-Filho P. Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo. Arq Neuropsiquiatr. 2018;76(8):534–538. doi:10.1590/0004-282X20180073.
84. van Vugt VA, van der Wouden JC, Essery R, et al. Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial. BMJ. 2019;367:l5922. doi:10.1136/bmj.l5922.
85. Huang K, Sparto PJ, Kiesler S, Siewiorek DP, Smailagic A. iPod-based in-home system for monitoring gaze-stabilization exercise compliance of individuals with vestibular hypofunction. J Neuroeng Rehabil. 2014;11:69. doi:10.1186/1743-0003-11-69.
86. Rintala A, Päivärinne V, Hakala S, et al. Effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning in stroke: a systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2019;100(7):1339–1358. doi:10.1016/j.apmr.2018.11.007.
87. Tchero H, Tabue Teguo M, Lannuzel A, Rusch E. Telerehabilitation for stroke survivors: systematic review and meta-analysis. J Med Internet Res. 2018;20(10):e10867. doi:10.2196/10867.
88. Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-rehabilitation after stroke: an updated systematic review of the literature. J Stroke Cerebrovasc Dis. 2018;27(9):2306–2318. doi:10.1016/j.jstrokecerebrovasdis.2018.05.013.
89. Veras M, Kairy D, Rogante M, Giacomozzi C, Saraiva S. Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation. J Telemed Telecare. 2017;23(6):567–587. doi:10.1177/1357633X16656235.
90. Schröder J, van Criekinge T, Embrechts E, et al. Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness. Disabil Rehabil Assist Technol. 2019;14(1):2–11. doi:10.1080/17483107.2018.1503738.
91. Russell TG, Hoffmann TC, Nelson M, Thompson L, Vincent A. Internet-based physical assessment of people with Parkinson disease is accurate and reliable: a pilot study. J Rehabil Res Dev. 2013;50(5):643–650. doi:10.1682/jrrd.2012.08.0148.
92. Hoffmann T, Russell T, Thompson L, Vincent A, Nelson M. Using the Internet to assess activities of daily living and hand function in people with Parkinson's disease. NeuroRehabilitation. 2008;23(3):253–261.
93. Stillerova T, Liddle J, Gustafsson L, Lamont R, Silburn P. Could everyday technology improve access to assessments? A pilot study on the feasibility of screening cognition in people with Parkinson's disease using the Montreal Cognitive Assessment via Internet videoconferencing. Aust Occup Ther J. 2016;63(6):373–380. doi:10.1111/1440-1630.12288.
94. Chen YY, Guan BS, Li ZK, et al. Application of telehealth intervention in Parkinson's disease: a systematic review and meta-analysis. J Telemed Telecare. 2020;26(1/2):3–13. doi:10.1177/1357633X18792805.
95. Charlotte AC, Paul TY, Catherine PS, Scott MH. Use of a telehealth system to enhance a home exercise program for a person with Parkinson disease: a case report. J Neurol Phys Ther. 2018;42(1):22–29. doi:10.1097/NPT.0000000000000209.
96. Moon S, Sarmento CVM, Colgrove Y, Liu W. Complementary health approaches for people with Parkinson disease. Arch Phys Med Rehabil. 2020;101(8):1475–1477. doi:10.1016/j.apmr.2020.03.024.
97. Seidler KJ, Duncan RP, McNeely ME, Hackney ME, Earhart GM. Feasibility and preliminary efficacy of a telerehabilitation approach to group adapted tango instruction for people with Parkinson disease. J Telemed Telecare. 2017;23(8):740–746. doi:10.1177/1357633X16668092.
98. Pilloni G, Shaw M, Feinberg C, et al. Long term at-home treatment with transcranial direct current stimulation (tDCS) improves symptoms of cerebellar ataxia: a case report. J Neuroeng Rehabil. 2019;16(1):41. doi:10.1186/s12984-019-0514-z.
99. Hwang R, Bruning J, Morris N, Mandrusiak A, Russell T. A systematic review of the effects of telerehabilitation in patients with cardiopulmonary diseases. J Cardiopulm Rehabil Prev. 2015;35(6):380–389. doi:10.1097/HCR.0000000000000121.
100. Tsai LL, McNamara RJ, Moddel C, Alison JA, McKenzie DK, McKeough ZJ. Home-based telerehabilitation via real-time videoconferencing improves endurance exercise capacity in patients with COPD: the randomized controlled TeleR Study. Respirology. 2017;22(4):699–707. doi:10.1111/resp.12966.
101. Vasilopoulou M, Papaioannou AI, Kaltsakas G, et al. Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. Eur Respir J. 2017;49(5):1602129. doi:10.1183/13993003.02129-2016.
102. Selzler AM, Wald J, Sedeno M, et al. Telehealth pulmonary rehabilitation: a review of the literature and an example of a nationwide initiative to improve the accessibility of pulmonary rehabilitation. Chron Respir Dis. 2018;15(1):41–47. doi:10.1177/1479972317724570.
103. Peng X, Su Y, Hu Z, et al. Home-based telehealth exercise training program in Chinese patients with heart failure: a randomized controlled trial. Medicine (Baltimore). 2018;97(35):e12069. doi:10.1097/MD.0000000000012069.
104. Garvey C, Singer JP, Bruun AM, Soong A, Rigler J, Hays S. Moving pulmonary rehabilitation into the home: a clinical review. J Cardiopulm Rehabil Prev. 2018;38(1):8–16. doi:10.1097/HCR.0000000000000287.
105. Valencia WM, Botros D, Vera-Nunez M, Dang S. Diabetes treatment in the elderly: incorporating geriatrics, technology, and functional medicine. Curr Diab Rep. 2018;18(10):95. doi:10.1007/s11892-018-1052-y.
106. Bruns ERJ, Argillander TE, Schuijt HJ, et al. Fit4SurgeryTV at-home prehabilitation for frail older patients planned for colorectal cancer surgery: a pilot study. Am J Phys Med Rehabil. 2019;98(5):399–406. doi:10.1097/PHM.0000000000001108.
107. Dekker-van Weering M, Jansen-Kosterink S, Frazer S, Vollenbroek-Hutten M. User experience, actual use, and effectiveness of an information communication technology-supported home exercise program for pre-frail older adults. Front Med (Lausanne). 2017;4:208. doi:10.3389/fmed.2017.00208.
108. Hong J, Kim J, Kim SW, Kong HJ. Effects of home-based tele-exercise on sarcopenia among community-dwelling elderly adults: body composition and functional fitness. Exp Gerontol. 2017;87(pt A):33–39. doi:10.1016/j.exger.2016.11.002.
109. Cranen K, Groothuis-Oudshoorn CG, Vollenbroek-Hutten MM, IJzerman MJ. Toward patient-centered telerehabilitation design: understanding chronic pain patients' preferences for web-based exercise telerehabilitation using a discrete choice experiment. J Med Internet Res. 2017;19(1):e26. doi:10.2196/jmir.5951.
110. Louw A. Therapeutic neuroscience education via e-mail: a case report. Physiother Theory Pract. 2014;30(8):588–596. doi:10.3109/09593985.2014.912255.
111. Visco DC, Shalley T, Wren SJ, et al. Use of telehealth for chronic wound care: a case study. J Wound Ostomy Continence Nurs. 2001;28(2):89–95. doi:10.1067/mjw.2001.113244.
112. Le Goff-Pronost M, Mourgeon B, Blanchère JP, Teot L, Benateau H, Dompmartin A. Real-world clinical evaluation and costs of telemedicine for chronic wound management. Int J Technol Assess Health Care. 2018;34(6):567–575. doi:10.1017/S0266462318000685.
113. Cheville AL, Moynihan T, Herrin J, Loprinzi C, Kroenke K. Effect of collaborative telerehabilitation on functional impairment and pain among patients with advanced-stage cancer: a randomized clinical trial. JAMA Oncol. 2019;5(5):644–652. doi:10.1001/jamaoncol.2019.0011.
114. Galiano-Castillo N, Cantarero-Villanueva I, Fernández-Lao C, et al. Telehealth system: a randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors. Cancer. 2016;122(20):3166–3174. doi:10.1002/cncr.30172.
115. Gehring K, Kloek CJ, Aaronson NK, et al. Feasibility of a home-based exercise intervention with remote guidance for patients with stable grade II and III gliomas: a pilot randomized controlled trial. Clin Rehabil. 2018;32(3):352–366. doi:10.1177/0269215517728326.
116. Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int. 2015;116(6):955–964. doi:10.1111/bju.13091.
117. Conlan L, Thompson J, Fary R. An exploration of the efficacy of telehealth in the assessment and management of stress urinary incontinence among women in rural locations. Aust N Z Continence J. 2016;22(3):58–64.
118. Cotelli M, Manenti R, Brambilla M, et al. Cognitive telerehabilitation in mild cognitive impairment, Alzheimer's disease and frontotemporal dementia: a systematic review. J Telemed Telecare. 2019;25(2):67–79. doi:10.1177/1357633X17740390.
119. Nissen RM. Best Practice Model for Delivery of Telehealth Occupational Therapy Services for Clients with Dementia and Their Caregivers. Published January 2017.
120. Barmpoutis A, Alzate J, Beekhuizen S, et al. Assessment of haptic interaction for home-based physical tele-therapy using wearable devices and depth sensors. Stud Health Technol Inform. 2016;220:33–38.
121. Angelidis PA. Personalised physical exercise regime for chronic patients through a wearable ICT platform. Int J Electron Healthc. 2010;5(4):355–370. doi:10.1504/IJEH.2010.036207.
122. Parisi F, Ferrari G, Giuberti M, et al. Body-sensor-network-based kinematic characterization and comparative outlook of UPDRS Scoring in leg agility, sit-to-stand, and gait tasks in Parkinson's disease. IEEE J Biomed Health Inform. 2015;19(6):1777–1793. doi:10.1109/JBHI.2015.2472640.
123. Smith BA, Lang CE. Sensor measures of symmetry quantify upper limb movement in the natural environment across the lifespan. Arch Phys Med Rehabil. 2019;100(6):1176–1183. doi:10.1016/j.apmr.2019.01.004.
124. Billings M, Russell T. Telehealth: research update & novel applications to meet the triple aim. Fed State Boards Phys Ther Winter Forum. 2015;30(2).

physical therapy; telehealth; telerehabilitation

© 2020 Wolters Kluwer Health, Inc. All rights reserved.