Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta-Meta-Analysis.

ABSTRACT

OBJECTIVE: Telerehabilitation is an option that should be adapted as soon as possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta-meta-analysis (MMA) of the available scientific evidence was performed to determine whether telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. METHODS: A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta-meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews, MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. RESULTS: Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference = 0.18; 95% CI = 0.03-0.34). CONCLUSION: The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. IMPACT The advantages of lower cost and less interference by the rehabilitation processes in patients' daily life could justify implementing telerehabilitation in clinical settings in the coronavirus disease 2019 era.