Telerehabilitation in the Middle East North Africa Region: A Structured Review
A structured review using the PRISMA guidelines, MeSH keywords and eight health databases was conducted (1990 to March 2021). Telerehabilitation research evidence from the Middle East and North Africa region (MENA) was summarized. Twelve studies from Iran, Israel, Morocco, and Saudi Arabia met inclusion criteria; nearly all had been published within the past five years. Methodological quality was moderate to good in the four randomized controlled trials, five cohort-studies and three cross-section surveys. There were seven intervention studies in cardiovascular, musculoskeletal, neurology or burn rehabilitation and three patient perception and two practitioner perception studies. Narrative synthesis revealed content themes relating to rehabilitation availability and accessibility; patient/practitioner perceptions of telerehabilitation; telerehabilitation to augment traditional services; and barriers to telerehabilitation. Telerehabilitation practice in MENA has been demonstrated as feasible, acceptable to patients, and effective in practitioner-designed cohort specific programs. Practitioners are generally positive but lack experience and need training, enabling technological systems, and policy frameworks.
Abolghasemian, M., Ebrahimzadeh, M. H., Enayatollahi, M., Honarmand, K., Kachooei, A. R., Mehdipoor, S., Mortazavi, M. J., Mousavian, A., Parsa, A., Akasheh, G., Bagheri, F., Ebrahimpour, A., Fakoor, M., Moradi, R., & Razi, M. (2020). Iranian Orthopedic Association (IOA) response guidance to COVID-19 pandemic. Archives of Bone and Joint Surgery, 8(Suppl 1), 209–217. https://doi.org/10.22038/ABJS.2020.47678.2370
Agostini, M., Moja, L., Banzi, R., Pistotti, V., Tonin, P., Venneri, A., & Turolla, A. (2015). Telerehabilitation and recovery of motor function: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 21(4), 202–213. https://doi.org/10.1177/1357633X15572201
Alasfour, M., & Almarwani, M. (2020). The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: A randomized controlled trial. Disability and Rehabilitation, 1–8. https://doi.org/10.1080/09638288.2020.1836268
Aloyuni, S., Alharbi, R., Kashoo, F., Alqahtani, M., Alanazi, A., Alzhrani, M., & Ahmad, M. (2020). Knowledge, attitude, and barriers to telerehabilitation-based physical therapy practice in Saudi Arabia. Healthcare, 8(4), 460. https://doi.org/10.3390/healthcare8040460
Alqahtani, M. (2019). Preliminary analysis of perception, knowledge and attitude of home health patients using tele rehabilitation in Riyadh, Saudi Arabia. Bioscience Biotechnology Research Communications, 12(2), 309–316. https://doi.org/10.21786/bbrc/12.2/13
Azma, K., RezaSoltani, Z., Rezaeimoghaddam, F., Dadarkhah, A., & Mohsenolhosseini, S. (2018). Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial. Journal of Telemedicine and Telecare, 24(8), 560–565. https://doi.org/10.1177/1357633X17723368
Barlev, L., Keren-Avraham, Y., Heber, I., & Admon-Rik, G. (2015). People with disabilities in Israel 2015. State of Israel, Ministry of Justice, Commission for equal rights of persons with disabilities. https://brookdale-web.s3.amazonaws.com/uploads/2018/01/book-eng.pdf
Benjadid, M.S. (2019). 7.5 The organizations of physical and rehabilitation medicine in the world: The scope of physical and rehabilitation medicine in the Middle East and North Africa. Journal of the International Society of Physical and Rehabilitation Medicine, 2(Suppl. S1), 148-155. https://10.4103/jisprm.jisprm_34_19
Bonnechère, B., Van Vooren, M., Jansen, B., Van Sint, J.S., Rahmoun, M., & Fourtassi, M. (2017). Patients’ acceptance of the use of serious games in physical rehabilitation in Morocco. Games for Health, 6(5), 290–294. https://doi.org/10.1089/g4h.2017.0008
Brennan, D. M., Mawson, S., & Brownsell, S. (2009). Telerehabilitation: Enabling the remote delivery of healthcare, rehabilitation, and self-management. Advanced Technologies in Rehabilitation – Studies in Health Technology and Informatics, 145, 231-248. https://doi.org/10.3233/978-1-60750-018-6-231
Brennan, D., Tindall, L., Theodoros, D., Brown, J., Campbell, M., Christiana, D., Smith, D., Cason, J., & Lee, A. (2010). A blueprint for telerehabilitation guidelines. International Journal of Telerehabilitation, 2(2), 31–34. https://doi.org/10.5195/ijt.2010.6063
Bright, T., Wallace, S., & Kuper, H. (2018). A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. International Journal of Environmental Research and Public Health, 15(10), 2165. https://doi.org/10.3390/ijerph15102165
Critical Appraisal Skills Programme. (2018). CASP (Cohort study) Checklist. https://casp-uk.b-cdn.net/wp-content/uploads/2018/03/CASP-Cohort-Study-Checklist-2018_fillable_form.pdf
Critical Appraisal Skills Programme. (2020). CASP (Randomised Controlled Trial) Checklist. https://casp-uk.b-cdn.net/wp-content/uploads/2020/10/CASP_RCT_Checklist_PDF_Fillable_Form.pdf
Cusick, A., & Hamed El Sahly, R.M. (2018). People with disability in Libya are a medicalised minority: Findings of a scoping review. Scandinavian Journal of Disability Research, 20(1), 182–196. https://doi.org/10.16993/sjdr.2
Ferrer-Roca, O., & Sosa Iudicissa, M.C. (1999). Handbook of Telemedicine. Amsterdam, NY: IOS Press. Golebowicz, M., Levanon, Y., Palti, R., & Ratzon, N.Z. (2015). Efficacy of a telerehabilitation intervention programme using biofeedback among computer operators. Ergonomics, 58(5), 791–802. https://doi.org/10.1080/00140139.2014.982210
Human Rights Watch. (2014). One billion forgotten: Protecting the human rights of persons with disabilities. 2014. https://www.hrw.org/sites/default/files/related_material/2014%20disabilities_program_low.pdf
Human Rights Watch. (2020). Middle East and North Africa. https://www.hrw.org/middle-east/n-africa
Hung, K.N.G., & Fong, K.N. (2019). Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong Journal of Occupational Therapy, 32(1), 3–21. https://doi.org/10.1177/1569186119849119
Jafni, T.I., Baharu, M., Ismail, W., & Hanafi, M.H. (2019). Exploring barriers that affect telerehabilitation readiness: A case study of rehabilitation centre in Malaysia. In: Saeed, F., Gazem, M., Mohammed, F. & Busalim, A. (eds). Recent trends in data science and soft computing. IRT 2018. Advanced in Intelligent Systems and Computing Vol 843. Springer, Cham. https://doi-org.ezproxy.library.sydney.edu.au/10.1007/978-3-319-99007-1_70
Kalron, A., Tawil, H., Peleg-Shani, S., & Vatine, J.J. (2018). Effect of telerehabilitation on mobility in people after hip surgery: A pilot feasibility study. International Journal of Rehabilitation Research, 41(3), 244–250. https://doi.org/10.1097/MRR.0000000000000296
Kaneda T. & El-Saharty, S. (2017). Curbing the noncommunicable disease epidemic in the Middle East and North Africa: Prevention among young people is the key, Population Reference Bureau. Washington, DC: Population Reference Bureau.
Kargar, N., Deldar K, Ahmadabadi A, Froutan R, & Mazlom S.R. (2020). Can a self-care educational mobile application improve the quality of life of victims with hand burns? A randomized controlled trial. Crescent Journal of Medical and Biological Sciences, 7(4):497–502.
Kizony, R., Weiss, P. L., Harel, S., Feldman, Y., Obuhov, A., Zeilig, G., & Shani, M. (2017). Tele-rehabilitation service delivery journey from prototype to robust in-home use. Disability and Rehabilitation, 39(15), 1532–1540. https://doi.org/10.1080/09638288.2016.1250827
Langbecker, D., Caffery, L. J., Gillespie, N., & Smith, A. C. (2017). Using survey methods in telehealth research: A practical guide. Journal of Telemedicine and Telecare, 23(9), 770–779. https://doi.org/10.1177/1357633X17721814
Laver, K. E., Adey‐Wakeling, Z., Crotty, M., Lannin, N. A., George, S. & Sherrington, C. (2020). Telerehabilitation services for stroke. Cochrane Library, 2020(1). https://doi.org/10.1002/14651858.CD010255.pub3
McCue, M., Fairman, A., & Pramuka, M. (2010). Enhancing quality of life through telerehabilitation. Physical Medicine and Rehabilitation Clinics of North America, 21(1), 195–205. https://doi.org/10.1016/j.pmr.2009.07.005
McIntyre, M., Robinson, L.R., & Mayo, A. (2020). Practical considerations for implementing virtual care in physical medicine and rehabilitation: For the pandemic and beyond. American Journal of Physical Medicine & Rehabilitation, 99(6), 464–467. https://doi.org/10.1097/PHM.0000000000001453
Meyer, T., Gutenbrunner, C., Bickenbach, J., Cieza, A., Melvin, J., & Stucki, G. (2011). Towards a conceptual description of rehabilitation as a health strategy. Journal of Rehabilitation Medicine, 43(9), 765–769. https://doi.org/10.2340/16501977-0865
Ministry of Health. (2013). National E- Health Strategy. https://www.moh.gov.sa/en/Ministry/nehs/Pages/Ehealth.aspx
Molini-Avejonas, D. R., Rondon-Melo, S., Amato, C. A., & Samelli, A. G. (2015). A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare, 21(7), 367–376. https://doi.org/10.1177/1357633X15583215
Nabutovsky I, Ashri S, Nachshon A, Tesler R, Shapiro Y, Wright E, et al. (2020). Feasibility, safety, and effectiveness of a mobile application in cardiac rehabilitation. Israel Medical Association Journal, 22(6):357–63.
Nabutovsky, I., Nachshon, A., Klempfner, R., Shapiro, Y., & Tesler, R. (2020). Digital cardiac rehabilitation programs: the future of patient-centered medicine. Telemedicine Journal and e-Health, 26(1), 34–41. https://doi.org/10.1089/tmj.2018.0302
Nafai, S., Barlow, K., & Stevens-Nafai, E. (2017). OT in Morocco: Sustaining service-learning trips through telehealth. OT Practice, 22(2), 20-22
Niknejad, N., Ismail, W., Bahari M., & Nazari, B. (2021). Understanding telerehabilitation technology to evaluate stakeholders’ adoption of telerehabilitation services: A systematic literature review and directions for further research, Archives of Physical Medicine and Rehabilitation, 102 (7), 1390-1403. https://doi.org/10.1016/j.apmr.2020.12.014
Parmanto, B., Lewis, A.N., Graham, K., & Bertolet, M.H. (2016). Development of the Telehealth Usability Questionnaire (TUQ). International Journal of Telerehabilitation, 8(1): 3–10. doi: 10.5195/ijt.2016.6196
Peretti, A., Amenta, F., Tayebati, S.K., Nittari, G., & Mahdi, S.S. (2017). Telerehabilitation: Review of the state-of-the-art and areas of application. JMIR Rehabilitation and Assistive Technologies, 4(2), e7–e7. https://doi.org/10.2196/rehab.7511
Piron, L., Turolla, A., Tonin, P., Piccione, F., Lain, L., & Dam, M. (2008). Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home. Journal of Telemedicine and Telecare, 14(5), 257–260. https://doi.org/10.1258/jtt.2008.080304
Qureshi, A. Z., Ullah, S., Aldajani, A. A., Basson, P., Al Habter, A. M., Ali, T., Almubark, B. M., Al Atwi, M., Al Ibrahim, F., Alsuhaibani, A., & Al Jadid, M. S. (2021). Telerehabilitation guidelines in Saudi Arabia. Telemedicine Journal and e-Health. https://doi.org/10.1089/tmj.2020.0355
QSR International Pty Ltd. (2020) NVivo (released in March 2020), https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
Reilly, R., Evans, K., Gomersall, J., Gorham, G., Peters, M.D.J., Warren, S., O’Shea, R., Cass, A., & Brown, A. (2016). Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: A systematic review of mixed evidence. BMC Health Services Research, 16(1), 119–119. https://doi.org/10.1186/s12913-016-1363-0
Rosen, B., Waitzberg, R., & Merkur, S. (2015). Israel: health system review. Health Systems in Transition, 17(6), 1–212. PMID: 27050102
Sarfo, F.S., Ulasavets, U., Opare-Sem, O.K., & Ovbiagele, B. (2018). Tele-rehabilitation after stroke: An updated systematic review of the literature. Journal of Stroke and Cerebrovascular Diseases, 27(9), 2306–2318. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.013
Sarsak, H.I. (2020). Telerehabilitation services: A successful paradigm for occupational therapy clinical services? International Physical Medicine & Rehabilitation Journal, 5(2). http://dx.doi.org/10.15406/ipmrj.2020.05.00237
Schutte, J., Gales, S., Filippone, A., Saptono, A., Parmanto, B., & McCue, M. (2012). Evaluation of a telerehabilitation system for community-based rehabilitation. International Journal of Telerehabilitation, 4(1), 15–32. https://doi.org/10.5195/IJT.2012.6092
Stucki, G., Cieza, A., & Melvin, J. (2007). The International Classification of Functioning, Disability and Health: a unifying model for the conceptual description of the rehabilitation strategy. Journal of Rehabilitation Medicine, 39(4), 279–285. https://doi.org/10.2340/16501977-0041
Stucki, G., Reinhardt, J.D., & Grimby, G. (2007). Organizing human functioning and rehabilitation research into distinct scientific fields. Part II: conceptual descriptions and domains for research. Journal of Rehabilitation Medicine, 39(4), 299–307. https://doi.org/10.2340/16501977-0051
Tenforde, A. S., Hefner, J. E., Kodish-Wachs, J. E., Iaccarino, M. A., & Paganoni, S. (2017). Telehealth in physical medicine and rehabilitation: a narrative review. PM&R: The Journal of Injury, Function and Rehabilitation, 9(5), S51–S58. https://doi.org/10.1016/j.pmrj.2017.02.013
The Joanna Briggs Institute. (2013). Critical appraisal tools. https://jbi.global/critical-appraisal-tools
Thompson, S. (2017). Disability prevalence and trends. K4D Helpdesk Report. Brighton, UK: Institute of Development Studies. https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/13237
Torsney, K. (2003). Advantages and disadvantages of telerehabilitation for persons with neurological disabilities. NeuroRehabilitation, 18(2), 183–185. https://doi.org/10.3233/NRE-2003-18211
Ullah, S., Maghazil, A.M., Qureshi, A.Z., Tantawy, S., Moukais, I.S., & Aldajani, A.A. (2020). Knowledge and attitudes of rehabilitation professionals toward telerehabilitation in Saudi Arabia: A cross-sectional Survey. Telemedicine Journal and e-Health, 27(5), 587–591. https://doi: 10.1089/tmj.2020.0016
United Nations Economic and Social Commission for Western Asia (2018). Disability in the Arab region 2018. https://www.unescwa.org/publications/disability-arab-region-2018
United Nations Statistics Division (2020). Methodology: Standard country or area codes for statistical use (M49): Developing regions. https://unstats.un.org/unsd/methodology/m49/
Vision 2030 Kingdom of Saudi Arabia. (2016). National Transformation Program. https://vision2030.gov.sa/en/programs/NTP
World Federation of Occupational Therapists [WFOT] (2021) Position Statement: Occupational Therapy and Telehealth, WFOT, Retrieved, https://wfot.org/resources/occupational-therapy-and-telehealth
World Health Organization, United Nations Children's Fund. (2018). Global Conference on Primary Health Care: from Alma-Ata towards universal health coverage and the Sustainable Development Goals, Astana, Kazakhstan, 25 and 26 October 2018. https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf
World Health Organization. (2010). Opportunities and developments in Member States: Report on the second global survey on eHealth. https://www.who.int/goe/publications/goe_telemedicine_2010.pdf
World Health Organization. (2016). Atlas of eHealth country profiles: The use of eHealth in support of universal health coverage: based on the findings of the third global survey on eHealth 2015. https://www.who.int/publications/i/item/9789241565219
World Health Organization. (2017). Rehabilitation in health systems. [Reissued 2019 with editorial corrections] https://www.who.int/publications/i/item/9789241515986
World Health Organization. (2017). Global diffusion of eHealth: Making universal health coverage achievable: Report of the third global survey on eHealth. https://www.who.int/ehealth/en/
World Health Organization. (2020). Rehabilitation. https://www.who.int/news-room/fact-sheets/detail/rehabilitation
World Health Organization. (2011). World report on disability 2011. https://www.who.int/disabilities/world_report/2011/report.pdf
World Physiotherapy. (2019) Report of the World Physiotherapy/ INPTRA Digital Physical Therapy Practice Task Force, London, UK, World Physiotherapy. ISBN: 978-1-914952-11-1
Zahid, Z., Atique, S., Saghir, M.H., Ali, I., Shahid, A., & Malik, R.A. (2017). A Commentary on telerehabilitation services in Pakistan: Current trends and future possibilities. International Journal of Telerehabilitation, 9(1), 71–76. https://doi.org/10.5195/ijt.2017.6224
Ziadé, N., el Kibbi, L., Hmamouchi, I., Abdulateef, N., Halabi, H., Hamdi, W., Abutiban, F., el Rakawi, M., Eissa, M., & Masri, B. (2020). Impact of the COVID‐19 pandemic on patients with chronic rheumatic diseases: A study in 15 Arab countries. International Journal of Rheumatic Diseases, 11, 1550–1557. https://doi.org/10.1111/1756-185X.13960
Copyright (c) 2021 Naif Qasam Aljabri, Kim Bulkeley, Anne Cusick
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.
Grant numbers Doctoral Support Scholarship for NQA