Feasibility of Telerehabilitation-Monitored Functional Electrical Stimulation on Walking and Quality of Life in People With Multiple Sclerosis: A Case Series.

BACKGROUND: Foot drop in people with multiple sclerosis (MS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve the gait of people with foot drop, yet various barriers restrict widespread use. The purpose of this case series was to examine the feasibility of a telerehabilitation-monitored FES device and report changes in functional mobility and QOL in people with moderate MS-related disability. METHODS: FES use was progressed over 8 weeks via 3 telerehabilitation sessions. Feasibility of telerehabilitation was assessed by percentage of telerehabilitation visits completed and participant-reported satisfaction. At baseline and study completion, functional mobility with and without FES were assessed by the Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), and 2-Minute Walk Test (2MWT), Multiple Sclerosis Impact Scale (MSIS-29), and the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Fatigue was assessed via the Modified Fatigue Impact Scale (MFIS) before and after the intervention. RESULTS: Eleven participants (mean age = 50.4 years [SD 10.8]; 2 males) completed the study. All (33/33) telerehabilitation visits were completed and participants attained high levels of satisfaction with no adverse events. At 8 weeks, compared to baseline, there were clinically meaningful improvements on the T25FW, 2MWT, and TUG for 45%, 55%, and 82% of participants, respectively. Clinically meaningful improvements on the MSIS-29 and MSWS-12 were also recorded for 64% and 36% of participants, respectively. CONCLUSIONS: Telerehabilitation was safe and feasible for FES intervention, and improvements in functional mobility and QOL were observed. Telerehabilitation to monitor FES may improve access and reduce patient burden; therefore, studying its efficacy is warranted.

Teleassessment using five times sit-to-stand test in older adults with and without Parkinson's disease: Guidelines and barriers.

BACKGROUND AND PURPOSE: Assessing lower limb strength, balance, and fall risk are crucial components of rehabilitation, especially for the older adult population. With the growing interest in telehealth, teleassessment has been investigated as an alternative when in-person assessments are not possible. The Five Times Sit-to-Stand test (5TSTS) provides a quick measure of balance during chair transfers, muscle power, endurance, and the hability to change and maintain body position, and is highly recommended by guidelines. However, the literature is unclear about the viability and safety of teleassessment using the 5TSTS in older adults with and without Parkinson's disease (PD). This study aimed to evaluate the reliability of teleassessment using the 5TSTS and to determine its feasibility and safety for older adults with and without PD. METHODS: This cross-sectional study included older adults with and without PD who were evaluated remotely through a videoconference platform. To ensure effective and comprehensive instructions for the test, we developed a guideline called OMPEPE (an acronym for: Objective; Materials; Position-Start; Execution; Position-End; Environment). We assessed the 5TSTS intra- and inter-rater reliability by comparing scores obtained from the same examiner and from different examiners, respectively. Participants and examiners completed online surveys to provide information about feasibility and safety. RESULTS: Twelve older adults with PD and 17 older adults without PD were included in this study (mean ages 69.0 and 67.6 years, respectively). Based on the participants' perspectives and the absence of adverse effects, teleassessment using the 5TSTS is feasible and safe for older adults with and without PD. Excellent intra- and inter-rater reliability (intraclass correlation coefficient >0.90) was found for all measurements of the 5TSTS. DISCUSSION: This study demonstrated the feasibility, safety, and reliability of teleassessment using the 5TSTS. The guidelines developed may help health professionals minimize barriers and safely conduct an online assessment that includes a physical test such as the 5TSTS in older adults with or without PD. In addition to addressing technological barriers, the OMPEPE guideline might ensure the optimal execution of evaluations. CONCLUSION: Teleassessment using the 5TSTS for older adults with and without PD is feasible and safe. Both synchronous (i.e., live) and asynchronous (i.e., recorded) online 5TSTS tests demonstrate excellent intra- and inter-rate reliability.

Insights on Telecommunication Use by Rehabilitation Therapists Before, During, and Beyond COVID-19.

Objective: To determine if the use of telerehabilitation among rehabilitation therapists during the first 11 months of the COVID-19 pandemic increased, if therapists' identified plans to continue use after the pandemic, and to understand challenges that therapists face in using telerehabilitation, and to evaluate viable use-cases for telerehabilitation. Design: A survey was conducted among clinicians containing questions about tools being used before, during, and after (planned) COVID-19. Statistical analysis was conducted to evaluate the increase in actual usage of telerehabilitation during the pandemic and planned usage after the pandemic. Setting: The study was survey-based and conducted remotely via online distribution. Participants: 387 participants (90.2% women) with an average age of 40.1 years participated in the survey and satisfied selection criteria. On average, they practiced for 14.8 years. Main Outcome Measures: No interventions were made. Survey item results were used for analysis. Results: Therapists used telerehabilitation more frequently during COVID-19 as compared with before COVID-19. Therapist use of video calls more than tripled (288.89% increase) during COVID-19. Speech therapists were far more likely to adopt telerehabilitation than physical therapists or occupational therapists. 18.9% of therapists planned to use video-based remote communication with patients after COVID-19. 31% of therapists who had not previously used telerehabilitation prior to the pandemic anticipated using it post-pandemic. Most therapists (88%) believed that discussion-based activities could be done remotely. Conclusions: COVID-19 has affected the way therapists interact with patients. These changes may have lasting effect on patient interactions and a perceived potential for future use of telerehabilitation is evident. Therapists who had already made use of remote communication had more optimistic outlooks on the future utility of these mediums, indicating that exposure favors future use. Therapists anticipate a potential increase in utilization of Video-Based Telerehabilitation post-pandemic but have faced and expect to face challenges in use of telerehabilitation. While disparities and obstacles to access pose challenges, the progress made during COVID-19 is promising.

Telerehabilitation in Colombia: A Country Report and Qualitative Analysis During the Covid-19 Pandemic - Perceptions of Healthcare Providers and Patients.

Given Colombia's status as a middle-income country with healthcare challenges, leveraging telemedicine could significantly benefit hard-to-reach regions, under-resourced and underserved communities. This study provides a comprehensive overview of the country's telerehabilitation landscape, exploring the clinicians' and patients' perspectives during the COVID-19 pandemic through systematic review and qualitative analysis. Sixteen therapists and three patients were identified via snowball sampling. The literature review was scarce and scattered across various topics in the country; some studies delved into specific aspects like legislative frameworks and patient outcomes from different medical specialties. The qualitative analysis demonstrates that despite the learning curve, telerehabilitation strengthens therapeutic support, enhances patient autonomy, fosters a positive patient-provider relationship, achieves treatment goals, promotes family involvement, reduces time and costs, and ensures continuity of therapy services. This study identified research gaps, challenges, and opportunities in telerehabilitation in a Latin American country. Adopting telemedicine technologies in low- and middle-income countries could significantly enhance their healthcare systems.

Telerehabilitación respiratoria en fibrosis quística: experiencia de pacientes, padres y profesionales durante la pandemia de COVID-19. Estudio cualitativo

Introducción: la rehabilitación respiratoria (RR) se recomienda en pacientes con fibrosis quística (FQ). Durante la pandemia de COVID-19 los programas de RR debieron cerrarse o migrar a modalidades de telerehabilitación, imponiendo nuevos desafíos a pacientes y equipos de salud. El objetivo de este estudio fue explorar las percepciones de pacientes, padres y profesionales sobre la transición a la telerehabilitación respiratoria durante la pandemia de COVID-19. Método: estudio cualitativo. Se consideraron pacientes con FQ mayores de 8 años. También a padres y equipos de salud. El tamaño muestral se determinó mediante saturación teórica. Se realizaron entrevistas semiestructuradas y grupos focales vía Zoom. El análisis de datos se realizó mediante los métodos de codificación abierta y axial. El análisis se realizó utilizando el software Atlas. Ti 7.5.7. Resultados: se incluyó a 4 pacientes adultos, 1 pediátrico y 2 padres, además de 4 profesionales de equipos de salud. Existió una percepción general positiva respecto a la RR y la telerehabilitación. Entre las barreras destacó la falta de equipamiento para la telerehabilitación en domicilio y la organización diaria de los pacientes. Entre los facilitadores destacó la disponibilidad de equipos y redes que permitieran la conectividad y el apoyo familiar. Existió una valoración positiva hacia la continuidad de la telerehabilitación en la etapa post pandémica. Conclusiones: la telerehabilitación fue percibida como una alternativa viable y efectiva, sin embargo, aspectos de la conectividad, disponibilidad de equipamiento y la rutina diaria de los pacientes debe ser considerada a la hora de implementar modalidades telemáticas de atención.

Introduction: Pulmonary rehabilitation (PR) is recommended in patients with Cystic Fibrosis (CF). During the COVID-19 pandemic, PR programs had to migrate to telerehabilitation modalities, imposing new challenges for patients and health teams. The objective of this study was to explore the perceptions of patients, parents, and professionals regarding the transition to respiratory telerehabilitation experienced during the COVID-19 pandemic. Method: Qualitative study. Parents and health teams were included in the case of patients with CF over eight years old. Theoretical saturation determined the sample size. Semi-structured interviews and focus groups were conducted using the Zoom platform. Data analysis was carried out using open and axial coding methods. The analysis was performed using Atlas Ti software 7.5.7. Results: Four adult patients, one pediatric patient, two parents, and four health team professionals entered the study. There was a positive perception regarding PR and telerehabilitation. Among the barriers, the lack of equipment for telerehabilitation at home and the daily organization of patients stood out. Among the facilitators, the availability of equipment and networks that allowed connectivity and family support stood out. Patients rated the continuity of telerehabilitation in the post-pandemic stage positively. Conclusions: Telerehabilitation was perceived as a viable and effective alternative; however, aspects related to connectivity, availability of equipment, and the daily routine of patients must be considered when implementing telematics care modalities.

Effect of Telerehabilitation on Pulmonary Function, Functional Capacity, Physical Fitness, Dyspnea, Fatigue, and Quality of Life in COVID-19 Patients: A Systematic Review and Metanalysis.

Background: This study aimed to demonstrate the technological means used to offer telerehabilitation and to evaluate the effect of physical exercise on the population affected by COVID-19. Methods: Clinical trials were searched in the electronic databases Cochrane Library, PubMed/MEDLINE, EBSCO (CINAHL), PEDro, and Web of Science from January 16 to 19, 2023. The effect measure was estimated as mean difference (MD) or standard MD (SMD) with 95% confidence intervals (CI). Subgroup analysis was used to study potential moderating factors. Results: Twenty-four articles, describing trials with a total of 1,344 individuals affected by COVID-19, were included in the qualitative synthesis and 14 articles in the meta-analysis. The pooled results revealed that telerehabilitation improves the functional capacity (MD 79.65 [63.57, 95.73]m, p < 0.00001), agility (MD -0.69 [-1.33, -0.04] s, p = 0.04), lower limb strength and endurance (SMD 0.74 [0.52, 0.96], p < 0.00001), forced expiratory volume in 1 s (MD 0.22 [-0.04, 0.49] L, p = 0.10), and dyspnea (SMD -0.94 [-1.64, -0.24], p = 0.009). The dynamic muscular resistance training associated or not with other exercise modalities led to improvements in muscular strength (MD 4.69 [0.44, 8.94] kg, p = 0.03) and fatigue (SMD -0.97 [-1.74, -0.20], p = 0.01). In addition, telerehabilitation showed improvements in the quality of life in the contagious-phase COVID-19 patients. Although this intervention improved inspiratory muscle strength (MD 13.71 [5.41, 22.0] cmH2O, p = 0.001), it did not favor forced vital capacity. Conclusions: Telerehabilitation contributed to improving functional capacity, inspiratory muscle strength, physical fitness, and quality of life, and reducing dyspnea and fatigue in COVID-19 adult survivors.

Educational telerehabilitation program for women with pelvic floor dysfunctions after gynecological pelvic cancer treatment: protocol study for a randomized and controlled clinical trial.

BACKGROUND: Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical-emotional factors of participants post-treatment for gynecological pelvic cancer. METHODS: Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results. DISCUSSION: Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women's quality of life.

Real-time telerehabilitation for chronic respiratory disease and post-COVID-19: A systematic review and meta-analysis.

INTRODUCTION: Telerehabilitation may facilitate access and adherence to pulmonary rehabilitation. Given the heterogeneity in existing telerehabilitation studies, it is still necessary to identify the most effective, safe, and cost-efficient strategy for clinical implementation, as well as the necessary level of supervision during telerehabilitation. The aim of this review was to determine the effectiveness and safety of real-time telerehabilitation for chronic respiratory diseases and post-COVID-19 compared to no-rehabilitation, center-based rehabilitation or asynchronous telerehabilitation. METHODS: A comprehensive search was conducted in six databases until 30 April 2023. Clinical trials of real-time telerehabilitation supervised via videoconference in adults with diagnosis of any chronic respiratory disease or post-COVID-19 were included. RESULTS: Twelve studies with 1540 participants were included. Very-low to moderate certainty evidence showed no difference between real-time telerehabilitation and center-based pulmonary rehabilitation. Studies included in this review reported high adherence rates to real-time telerehabilitation and completion rate, with no difference compared to center-based pulmonary rehabilitation. When compared to no-rehabilitation, the results of this review provide low-certainty evidence that real-time telerehabilitation may have a potential effect on exercise capacity at the end of the intervention, with no better results in others outcomes. No studies comparing real-time telerehabilitation with asynchronous telerehabilitation were found. CONCLUSION: Real-time telerehabilitation is safe and it seems to promote similar effects to center-based pulmonary rehabilitation. However, the certainty of this evidence ranged from very-low to moderate. Therefore, real-time telerehabilitation offers an alternative to center-based pulmonary rehabilitation models. This review provides a clear definition of real-time telerehabilitation, facilitating results interpretation and clinical applicability.

Early Exercise Through Telerehabilitation After Bariatric Surgery: Is It Feasible?

PURPOSE: The feasibility of early telerehabilitation after bariatric surgery is unknown. The objective of this study was to assess the feasibility and perception of engaging in the online exercise protocol in patients during the first month after bariatric surgery. MATERIAL AND METHODS: A total of 67 patients, enrolled in a telerehabilitation program following bariatric surgery, completed a survey assessing their perception of the intensity, discomfort, and safety during exercise sessions. RESULTS: Forty percent of participants began exercising between 5 and 10 days after surgery. Seventy-one percent of patients did not experience discomfort during the first month of exercise, and those who reported discomfort mainly mentioned dizziness and abdominal pain. No significant differences were found in the presence of discomfort among different types of surgeries performed. There was a significant difference in the presence of discomfort between patients who started exercising before and after 15 days of surgery, with less discomfort reported in the group that started after 15 days. Ninety-eight percent of patients felt safe during online exercise sessions. Most participants perceived the intensity of the sessions as moderate. The most frequently mentioned benefits of exercise were increased energy, mood, and feeling more active. CONCLUSION: Telerehabilitation conducted during the first month after bariatric surgery was feasible and well tolerated by patients, providing a safe alternative for those patients who face difficulties with in-person interventions.

Efficacy of pulmonary telerehabilitation on exercise tolerance, fatigue, perceived exertion, depression, and quality of life in COVID-19 survivors / Eficácia da telereabilitação pulmonar na tolerância ao exercício, fadiga, percepção de esforço, depressão e qualidade de vida em sobreviventes de COVID-19

INTRODUCTION: Telerehabilitation advanced significantly with the emergence of COVID-19 and the recommendation of limiting physiotherapist-patient contact time whenever practicable. The effectiveness of telerehabilitation on those who had a longer stay in hospital and on oxygen support following discharge is still under question. OBJECTIVES: To evaluate the effects after six weeks of pulmonary telerehabilitation on exercise tolerance, fatigue level, perceived exertion, symptoms of depression and quality of life in patients surviving COVID-19. MATERIALS AND METHODS: A quasi-experimental study was conducted on 25 post-COVID-19 patients following discharge in a home environment setting. The participants were advised to prepare equipment such as oxygen concentrator, B-type oxygen cylinder (backup), lengthy oxygen tubes, finger pulse oximeter, mini static pedal exerciser, incentive spirometry, weight cuffs or water bottles and sandbags. After six weeks of telerehabilitation, the patients underwent assessments including initial oxygen saturation (SPO2), heart rate, peak oxygen demand during exercise to maintain baseline SPO2, peak heart rate, maximum drop in SPO2, recovery time to baseline SPO2 measured with a pulse oximeter and stopwatch, peak perceived exertion using the Borg Dyspnea Scale, peak fatigue score using the visual analog scale (VASF), quality of life assessed with the SF-36 questionnaire, and mental health status evaluated with the Hamilton Depression Scale (HAMD). One-way repeated measure ANOVA and paired t-test were used. RESULTS: Significant improvements following the intervention on the initial SPO2 (F (2.12, 23.13) = 21.0, p< 0.05) and quality of life also showed significant improvement (mean difference =29.92, p< 0.05). CONCLUSION: Six weeks of comprehensive pulmonary telerehabilitation with simple equipment improved tolerance to exercise, fatigue, perceived exertion, symptoms of depression and quality of life for post-COVID-19 patients.

INTRODUÇÃO: A telereabilitação avançou significativamente com o surgimento da COVID-19 e a recomendação de limitar o tempo de contato entre fisioterapeutas e pacientes sempre que possível. A eficácia da telereabilitação em pacientes que permaneceram mais tempo no hospital e necessitaram de suporte de oxigênio após a alta ainda está em questão. OBJETIVO: Para avaliar os efeitos após seis semanas de telereabilitação pulmonar na tolerância ao exercício, nível de fadiga, percepção de esforço, sintomas de depressão e qualidade de vida em pacientes sobreviventes de COVID-19. MATERIAIS E MÉTODOS: Foi realizado um estudo quase-experimental com dezesseis pacientes pós-COVID-19 selecionados de um hospital multispecializado. Os participantes foram orientados a preparar equipamentos como concentrador de oxigênio, cilindro de oxigênio tipo B (reserva), tubos de oxigênio longos, oxímetro de pulso, exercitador de pedal estático, espirômetro incentivador, pesos de tornozelo ou garrafas d'água e sacos de areia. Após seis semanas de telereabilitação, os pacientes foram submetidos a avaliações, incluindo saturação inicial de oxigênio (SPO2), frequência cardíaca, demanda máxima de oxigênio durante o exercício para manter a SPO2 basal, frequência cardíaca máxima, queda máxima na SPO2, tempo de recuperação para SPO2 basal medido com um oxímetro de pulso e cronômetro, esforço percebido máximo usando a Escala de Dispneia de Borg, pontuação máxima de fadiga usando a escala analógica visual (VASF), qualidade de vida avaliada com o questionário SF-36 e estado de saúde mental avaliado com a Escala de Depressão de Hamilton (HAMD). RESULTADOS: Melhorias significativas após a intervenção foram observadas na SPO2 inicial (F (2,12, 23,13) = 21,0, p <0,05) e na frequência cardíaca (F (1,839, 20,23) = 43,73, p <0,05), demanda máxima de oxigênio durante o exercício para manter a SPO2 basal (F (1,487, 16,36) = 8,96, p <0,05), esforço percebido máximo (F (5, 55) = 112,51, p <0,05), pontuação máxima de fadiga (F (1,755, 19,30) = 67,44, p <0,05), frequência cardíaca máxima (F (1,798, 19,78) = 50,99, p <0,05), queda máxima na SPO2 (F (2,467, 27,14) = 41,46, p <0,05) e tempo máximo de recuperação para alcançar a SPO2 basal (F (5, 55) = 78,89, p <0,05). A análise de seis semanas pós-intervenção nos sintomas depressivos (diferença média = 11,25, p <0,05) e na qualidade de vida também mostrou melhoria significativa (diferença média = 29,92, p <0,05). CONCLUSÃO: Seis semanas de telereabilitação pulmonar abrangente com equipamentos simples melhoraram a tolerância ao exercício, a fadiga, a percepção de esforço, os sintomas de depressão e a qualidade de vida em pacientes pós-COVID-19.

Effects of telerehabilitation on cardiac remodeling and hemodynamics parameters in hypertensive older adults: A randomized controlled trial.

OBJECTIVE: This study aimed to assess the effects of telerehabilitation with multimodal exercise on cardiac remodeling and blood pressure in hypertensive older adults. METHODS: Thirty-two hypertensive older adults (66.7 ± 5.33 years; 29.5 ± 4.22 Kg/m2; 24 female) were randomized into either a telerehabilitation or a control group. Echocardiographic parameters and blood pressure were assessed before and after the 16-week intervention. The exercise program was supervised, individualized, and offered 3×/week via videoconference. RESULTS: Blood pressure significantly decreased after telerehabilitation when compared to the control group, presenting a large effect size. The moderate effect size in relative and posterior wall thickness (g = 0.63; g = 0.61), shortening fraction (g = 0.54), and ejection fraction (g = 0.68). CONCLUSION: As a preliminary study, telerehabilitation is favorable to promote a moderate clinical improvement of some cardiac morphofunctional parameters and reduce blood pressure in hypertensive older adults.

Perceptions of individuals with Parkinson's disease about a telerehabilitation protocol performed during the COVID-19 pandemic: a qualitative study.

PURPOSE: To understand the perceptions and meaning of the experience of individuals with Parkinson's disease (PD) when participating in a telerehabilitation protocol during COVID-19 pandemic. METHODS: This is a qualitative descriptive analytical study with a phenomenological basis, regarding the individuals' perceptions of telerehabilitation. The interviews were conducted by a semi-structured interview guide and carried out via recorded phone calls, which were later transcribed, categorized, and analyzed based on the principles of phenomenology according to the propositions of Martins and Bicudo. RESULTS: From the qualitative analysis, four themes that configure the structure of the phenomenon emerged: 1) Expectations regarding physical therapy through telerehabilitation during the pandemic; 2) Experiences of the new routine; 3) Perceptions about oneself in the light of the proposed telerehabilitation program; 4) A view of the protocol. CONCLUSION: Apprehension and fear were present during the implementation of the protocol, however, previous experience with face-to-face physical therapy and the team allowed feelings of happiness, contentment, welcomeness, and satisfaction with the possibility of resuming the activities. The individuals actively participated in the program with commitment and co-responsibility, but the lack of physical contact, limited equipment, and constant concern for the safety and individuality of the participants must be emphasized.

The use of telerehabilitation was a necessary therapeutic alternative during the COVID-19 pandemic period and has currently been consolidated as a complementary resource in the treatment of individuals with Parkinson's disease (PD).The perceptions of people with PD who have experienced telerehabilitation treatment can influence clinical decision-making regarding the use of this tool in this population.Telerehabilitation is useful when distance separates the patient from the healthcare team, it reduces travel time and expenses and can intensify the amount of treatment.According to our interpretation, telerehabilitation requires a good internet connection and restricts physical contact, so hybrid use of rehabilitation modalities (in-person and remote) could be an interesting option.

Remote activities of cognitive stimulation for older adults during the COVID-19 pandemic: a systematic review / Atividades de estímulo cognitivo remoto em idosos durante a pandemia da COVID-19: revisão sistemática / Actividades de estimulación cognitiva remota en ancianos durante la pandemia de COVID-19: revisión sistemática

Abstract: Cognitive stimulation activities for older adults are generally carried out in face-to-face workshops. However, during the COVID-19 pandemic, these activities and consultations became remote due to social isolation, enabling care to continue safely. This study aims to analyze the remote cognitive stimulation and/or telerehabilitation activities for older people that were carried out as an intervention during the COVID-19 pandemic. This is a systematic review study with five selected articles, conducted according to the PRISMA statement methodology. Among the main results, the feasibility and acceptance of remote cognitive stimulation activities using technologies during the pandemic stand out, reflecting on future and expanded use for different realities and cultures. the studies reviewed also indicate the stabilization and improvement of the cognitive state and of depressive and anxious feelings, as well as the maintenance of independence of these participants, with an increase in scores on scales applied before and after the interventions. In conclusion, the activities carried out in cognitive stimulation and/or telerehabilitation therapies for older adults as an intervention during the COVID-19 pandemic had an average of 47 participants; the technologies used for the activities were tablet and personal computer; pre-installed programs were the most used strategy; and the interventions lasted from 1 to 3 months, with activities 2 to 3 times per week. The reinvention of techniques aimed at stimulating and rehabilitating the cognitive health of the older adults, via technologies as a strategy to replace or complement face-to-face activities, promotes the cognitive and mental health and independence of the older population.

Resumo: As atividades de estímulo cognitivo em idosos são geralmente realizadas por meio de oficinas presenciais; porém durante a pandemia da COVID-19, com o isolamento social, as atividades e consultas passaram a ser remotas para não interromper os cuidados. O objetivo deste estudo é analisar as atividades de estímulo cognitivo remoto e/ou telerreabilitação em idosos como intervenção durante a pandemia da COVID-19. Esta é uma revisão sistemática de cinco artigos selecionados, conduzida segundo a metodologia PRISMA. Os principais resultados incluem a viabilidade e aceitação de atividades de estímulo cognitivo remoto utilizando tecnologias durante a pandemia, refletindo em uso futuro e ampliado para diferentes realidades e culturas. Estudos também apontam para a estabilização e melhoria do estado cognitivo, dos sentimentos de depressão e ansiedade e da manutenção da independência desses participantes, com aumento nas pontuações nas escalas aplicadas depois das intervenções. Conclui-se que as atividades realizadas em terapias de estímulo cognitivo e/ou telerreabilitação em idosos como intervenção durante a pandemia da COVID-19 tiveram em média 47 participantes, os dispositivos tecnológicos utilizados foram o tablet e o computador, os programas pré-instalados foram a estratégia mais utilizada, com duração da intervenção de 1 a 3 meses e atividades realizadas 2 a 3 vezes por semana. A reinvenção de técnicas que visam estimular e reabilitar a saúde cognitiva dos idosos, incluindo o uso de tecnologias como estratégia para substituir ou complementar as atividades presenciais, promove a saúde cognitiva e mental e a independência dos idosos.

Resumen: Las actividades de estimulación cognitiva en ancianos generalmente se realizan mediante talleres presenciales; pero, durante la pandemia de COVID-19, con el aislamiento social, las actividades y consultas se volvieron remotas para no interrumpir los cuidados. El objetivo de este estudio es analizar las actividades de estimulación cognitiva remota o telerrehabilitación en ancianos como intervención durante la pandemia de COVID-19. Se trata de una revisión sistemática de cinco artículos seleccionados, realizada según la metodología PRISMA. Los principales resultados incluyen la viabilidad y aceptación de actividades de estimulación cognitiva remota utilizando tecnologías durante la pandemia, lo que refleja un uso futuro y ampliado para diferentes realidades y culturas. Los estudios también apuntan a la estabilización y mejora del estado cognitivo, de los sentimientos de depresión y ansiedad y de la conservación de la independencia de estos participantes, con un aumento en las puntuaciones en las escalas aplicadas tras las intervenciones. Se concluye que las actividades realizadas en terapias de estimulación cognitiva o telerrehabilitación en ancianos como intervención durante la pandemia de COVID-19 tuvieron un promedio de 47 participantes, los dispositivos tecnológicos utilizados fueron la tableta y la computadora, los programas preinstalados fueron la estrategia más utilizada, con una duración de la intervención de 1 a 3 meses y actividades realizadas de 2 a 3 veces por semana. La reinvención de técnicas que tienen como objetivo estimular y rehabilitar la salud cognitiva de los ancianos, incluido el uso de tecnologías como estrategia para reemplazar o complementar las actividades presenciales, promueve la salud cognitiva y mental y la independencia de los ancianos.

Reducing the burden of caregivers in Huntington's by using an online interventional neuropsychological approach: a pilot study / Reduzindo a sobrecarga dos cuidadores na doença de Huntington usando uma abordagem neuropsicológica interventiva online: um estudo piloto

ABSTRACT Huntington's disease (HD) is a hereditary, neurodegenerative disease characterized by motor, cognitive, and behavioral issues. As the disease progresses, people become dependent on their caregivers leading to a significant burden. There is a lack of effective neuropsychological intervention to support this population. Objective: To develop an online neuropsychological intervention and evaluate its effects in decreasing the HD caregiver burden. Methods: This qualitative pilot study was conducted online during the COVID-19 pandemic in Brazil. We selected a convenience sample of five informal caregivers of HD patients (mean 46.2 years old). At baseline, participants were assessed via an individual online neuropsychology interview/screening, covering demographic data. Subsequently, we conducted 20 online 90-minute sessions of the psychological consultation over 12 months. Each session was structured in three stages: 1) Welcoming; 2) Breathing and mindfulness practice; and 3) Discussion of themes about the group's needs based on the main complaints. A second intervention assessment was applied. Results: None of the caregivers were provided with details about HD at the time of diagnosis and later care. The necessity to care for a person with a rare genetic disease was added to caregivers' already-existing working routine and home services, causing a symptom of overload. After the neuropsychological intervention, all participants reported feeling less burdened by caring, improved self-care and conflict resolution with the person with HD through expanding behavioral repertoire focused on emotions and communication. Conclusion: Online neuropsychologic intervention can reduce the burden of HD caregivers. More comprehensive studies should investigate these findings.

RESUMO A doença de Huntington (DH) é hereditária e neurodegenerativa, caracterizada por problemas motores, cognitivos e comportamentais. À medida que avança, os pacientes dependem cada vez mais de cuidadores, gerando uma sobrecarga significativa. Há uma carência de intervenções neuropsicológicas eficazes para apoiar esta população. Objetivo: Desenvolver uma intervenção neuropsicológica online e avaliar seus efeitos na redução da sobrecarga do cuidador em DH. Métodos: Este estudo piloto qualitativo ocorreu online, durante a pandemia de COVID-19 no Brasil. Selecionamos uma amostra de conveniência de cinco cuidadores informais de pacientes com DH (média de 46,2 anos). Inicialmente, realizamos triagens neuropsicológicas online, abrangendo dados demográficos e entrevistas. Subsequentemente, conduzimos 20 sessões de 90 minutos ao longo de 12 meses, estruturadas em: 1) acolhimento, 2) prática de respiração e mindfulness e 3) discussão das necessidades do grupo com base nas principais queixas. Após a intervenção, realizamos uma segunda avaliação. Resultados: Constatamos que os cinco cuidadores não foram adequadamente educados pelos profissionais de saúde sobre a DH após o diagnóstico. A responsabilidade de cuidar da pessoa com DH foi agregada à sua rotina de trabalho e serviços domiciliares, ocasionando um sintoma de sobrecarga. Após a intervenção neuropsicológica online, todos os participantes relataram menos sobrecarga relacionada ao cuidado das pessoas com DH, melhoraram o autocuidado e a resolução de conflitos por meio da ampliação do repertório comportamental focado nas emoções e na comunicação. Conclusão: A intervenção neuropsicológica online pode diminuir a sobrecarga dos cuidadores em DH. Estudos mais abrangentes devem investigar esses resultados.

Telehealth and oropharyngeal dysphagia: An integrative review / Telessaúde e disfagia orofaríngea: uma revisão integrativa

ABSTRACT Purpose: to analyze the telehealth speech therapy approach in patients with oropharyngeal dysphagia and determine the applications and effects of this practice. Methods: the following descriptors were used for selection: Telerehabilitation, Telemedicine, "Remote Consultation", "Healthcare Delivery", "Distance Counseling", "Therapy, Computer-Assisted", "Speech-Language Pathology", "Speech Therapy", "Swallowing Disorders", Dysphagia, "Bottle Feeding" and "Enteral Nutrition" in PubMed, MedLine, Scopus and Web of Science databases and in the gray literature, by Google Scholar and ProQuest. Studies were selected without time limits, in Portuguese, English and Spanish, that described the applicability and/or effects of telehealth in speech therapy practice in patients with swallowing disorders/dysphagia, regardless of gender and age. For analysis, the following were considered: level of scientific evidence and recommendation, telehealth modality, objectives, methods and results/conclusion. Literature Review: 490 articles were found and, after exclusion of duplicates, analysis of titles, abstracts and reading of full articles, 22 studies were selected. The articles were classified into telehealth modalities: tele-education, telediagnosis, teleconsulting, teleregulation and telemonitoring. Conclusion: the telehealth modalities described had a great potential to promote significant improvements in patients presented with swallowing disorders/dysphagia, suggesting them as viable for speech therapy services. Among them, teleconsultation was the least addressed.

RESUMO Objetivo: analisar a abordagem fonoaudiológica por meio da telessaúde em pacientes com disfagia e determinar as aplicações e efeitos desta prática. Métodos: para seleção foram utilizados os descritores: Telerehabilitation, Telemedicine, "Remote Consultation", "Delivery of Health Care", "Distance Counseling", "Therapy, Computer-Assisted", "Speech-Language Pathology", "Speech Therapy", "Deglutition Disorders", Dysphagia, "Bottle Feeding" e "Enteral Nutrition" nas bases de dados PubMed, MedLine, Scopus e Web of Science e na literatura cinzenta, por meio do Google Acadêmico e ProQuest. Foram selecionados estudos sem delimitação de tempo, nas línguas português, inglês e espanhol, que descrevessem a aplicabilidade e/ou efeitos da telessaúde na prática fonoaudiológica junto à pacientes com alteração da deglutição/disfagia, sem restrição de sexo e idade. Para análise considerou-se: nível de evidência científica e recomendação, modalidade de telessaúde, objetivos, métodos e resultados/conclusão. Revisão da Literatura: foram encontrados 490 artigos e, após exclusão de duplicatas, análise dos títulos, resumos e leitura completa dos artigos, 22 estudos foram selecionados. Os artigos foram classificados nas modalidades da telessaúde: tele-educação, telediagnóstico, teleconsultoria, telerregulação e telemonitoramento. Conclusão: as modalidades de telessaúde descritas tiveram grande potencial para promover melhoras significativas em pacientes com alteração de deglutição/disfagia, sugerindo-as como viáveis para serviços fonoaudiológicos. Entre elas, a teleconsulta foi a menos explorada.

The Effect of Telerehabilitation on Physical Fitness and Depression/Anxiety in Post-COVID-19 Patients: A Randomized Controlled Trial.

Aim: The aim of this research was to evaluate the impact of a telerehabilitation program on physical fitness, muscle strength, and levels of depression and anxiety in post-COVID-19 patients. Methods: Thirty-two individuals recovered from COVID-19 (48.20±12.82 years) were allocated into either a telerehabilitation (TG n=16) or control (CG n=16) group. Physical fitness, handgrip strength, depression and anxiety levels were assessed before and after an 8-week intervention. Results: There was a significant improvement in muscle strength in both groups. Physical fitness significantly increased compared to the CG at the end of the intervention. Levels of anxiety and depression significantly decreased after the intervention when compared to the CG. Conclusion: Eight weeks of functional telerehabilitation training is a viable and efficient way to rehabilitate patients affected by COVID-19, as it improved physical conditioning and mental health.

Pulmonary Telerehabilitation for People With Chronic Obstructive Pulmonary Disease in Brazil: A Mixed-Methods Feasibility Study.

This study assessed the feasibility of pulmonary telerehabilitation‧s (PTR) acceptability, implementation, practicality, and adaptation for people with Chronic Obstructive Pulmonary Disease (COPD) in Brazil. It also explored associations with clinical and socioeconomic features of Brazilians with COPD. This mixed-method study included thirty-one participants with COPD (age 62±10 years; FEV1= 72±14% predicted). Most participants (74.2%) reported good PTR session acceptability on the System Usability Scale and scores of 4.6±0.3 and 4.5±0.6 on a 1-5 Likert-type scale of implementation and practicality, respectively. Participants suggested adaptations for better comfort on the exercise bike and varying exercise modalities. PTR acceptability was associated with participants' younger age (rs=-0.57, p<0.01) and higher education (rs=0.51, p<0.01). PTR is feasible for people with COPD in Brazil regarding acceptability, implementation, practicality, and adaptation. Younger age and higher educational level are associated with greater PTR acceptability.

Efectos de un Programa de Ejercicios y Educación en Dolor mediante Tele-rehabilitación en la Calidad de Vida de Mujeres Jóvenes con Dismenorrea Primaria / Effects of an Exercise and Pain Education Program via Telerehabilitation on the Quality of Life of Young Women with Primary Dysmenorrhea

Introducción. La dismenorrea primaria afecta la calidad de vida de mujeres jóvenes. Este estudio investiga los efectos de un protocolo de ejercicios y educación en dolor mediante telerehabilitación. Objetivo. Determinar los efectos de un protocolo de ejercicios y educación en dolor y su impacto en la calidad de vida mediante tele-rehabilitación en mujeres jóvenes con dismenorrea primaria. Métodos. Se realizó un estudio experimental pre y post test con un grupo control, utilizando tele-rehabilitación. Participaron 21 mujeres jóvenes con dismenorrea primaria, asignadas aleatoriamente a dos grupos: el grupo experimental (10 mujeres) y el grupo control (11 mujeres). Se utilizaron cuestionarios específicos de calidad de vida relacionada con la menstruación y dolor (cuestionario breve de McGill) para evaluar los efectos del programa de ejercicios y educación en dolor. Resultados. En el grupo control, no se observaron diferencias significativas en las puntuaciones de calidad de vida relacionada con la menstruación ni en la intensidad del dolor antes y después de la intervención (p>0,05). En contraste, el grupo experimental experimentó mejoras significativas en ambas áreas después de la intervención (todos los p<0,001). Conclusiones. Este estudio demuestra que un protocolo de ejercicios y educación en dolor realizado mediante telerehabilitación tiene un impacto positivo y significativo en la calidad de vida y la intensidad del dolor percibido en mujeres jóvenes con dismenorrea primaria. Estos resultados sugieren que la telerehabilitación puede ser una estrategia efectiva para abordar este problema de salud en esta población.

Background. Primary dysmenorrhea impacts the quality of life of young women. This study investigates the effects of an exercise and pain education protocol through telerehabilitation. Objective: To determine the effects of an exercise and pain education protocol and its impact on the quality of life through telerehabilitation in young women with primary dysmenorrhea. Methods: A pre and post-test experimental study with a control group was conducted using telerehabilitation. Twenty-one young women with primary dysmenorrhea participated, randomly assigned to two groups: the experimental group (10 women) and the control group (11 women). Specific questionnaires related to menstruation-related quality of life and pain (McGill short-form questionnaire) were used to assess the effects of the exercise and pain education program. Results: In the control group, no significant differences were observed in menstruation-related quality of life scores or pain intensity before and after the intervention (p>0.05). In contrast, the experimental group experienced significant improvements in both areas after the intervention (all p<0.001). Conclusion: This study demonstrates that an exercise and pain education protocol conducted through telerehabilitation has a positive and significant impact on the perceived quality of life and pain intensity in young women with primary dysmenorrhea. These results suggest that telerehabilitation can be an effective strategy for addressing this health issue in this population.

One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study.

BACKGROUND: Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS: In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS: We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION: An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER: Open Science Framework ( https://osf.io/tqmz2/ ).

Efficacy of telerehabilitation exercise in patients with chronic neck pain: a protocol for a non-inferiority randomized controlled trial.

The aim of this study is to investigate if telerehabilitation is just as effective as the same face-to-face exercise program in patients with chronic neck pain (NP). 140 participants will participate in this non-inferiority randomized controlled trial. Primary outcomes will be pain intensity and disability, and secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, anxiety and depression symptoms, self-efficacy for pain and global perceived effect. It will be collected at baseline, 6 weeks and 6 months after intervention. The analysis of non-inferiority will be calculated by mixed linear models considering the non-inferiority margin. The results of this clinical trial will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with NP. Brazilian Clinical Trials Registry (RBR-6VBSMB). Clinical Trial Registration: REBEC (Brazilian Registry of Clinical Trials) RBR-6VBSMB (ClinicalTrials.gov).

What is this article about? This study aims to compare the effect of face-to-face and telerehabilitation treatment for chronic neck pain, since it is the third condition that causes most disability in the world among musculoskeletal conditions. In addition, because its prevalence occurs at an economically active age, it generates a drop in productivity and absenteeism at work. Due to the high public health expenses with chronic neck pain, telerehabilitation is a tool with great potential for reducing waiting lists and barriers to therapy success (transport, time, money). What do the results of the study mean? This is the first clinical trial to investigate the efficacy of telerehabilitation exercise in patients with chronic neck pain and the results will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with neck pain and may help patients experience less pain and disability and become more self-sufficient in managing their chronic condition.