Aims. To evaluate the quality of systematic reviews on telerehabilitation. Methods. The AMSTAR - Assessment of Multiple Systematic Reviews - checklist was used to appraise the evidence related to the systematic reviews. Results. Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i) analysis of the grey literature; ii) a list of the excluded studies and their characteristics; iii) the identification of possible source of bias and the assessment of its likehood; iv) an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the high-scored systematic reviews telerehabilitation resulted at least as effective as usual care: 1) in the short term treatment of mental health related to people affected by spinal cord injury; 2) in rural communities for treating patients affected by chronic conditions; 3) in treating common pathologies (mainly asthma) affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. Conclusions. In the authors' knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies.

OBJECTIVE: This study examines how telerehabilitation becomes part of existing and new clinical routines and identifies factors that enable or constrain its routine use. METHODS: An in-depth case study of a telemedicine program in rehabilitation implemented between an urban specialized rehabilitation center and a rural regional rehabilitation center was conducted. Using a conceptual framework based on Giddens' theory of structuration, a qualitative analysis was carried out using four data sources: focus groups and phone interviews (with health professionals, managers, and patients and their family members); telerehabilitation video recordings; and project documents (e.g., proposals, requests for funding, summaries, agendas of meetings, operating procedures, patient handouts, and tools for clinicians). RESULTS: In two rehabilitation programs for 1) patients who sustained a traumatic brain injury and 2) those who sustained a spinal cord injury, telerehabilitation was successfully incorporated into routine clinical practices for activities such as interdisciplinary care plans. However, for specialized clinical consultations or long-term patient follow-up, telerehabilitation was not successfully incorporated. Factors that facilitated or prevented the integration of telerehabilitation in routine practices stemmed from both the structure (norms, rules, resources, and values) and the agent (e.g., users of telerehabilitation, including clinicians, managers, and patients and their families) and include 1) shared beliefs and assumptions held by patient care team members regarding the nature of the clinical activities, and the perceptions of patients and their family members; 2) clinical and organizational leadership; 3) extent and type of telerehabilitation use; 4) available resources; and 5) collaborations already in place or needing to be developed. CONCLUSIONS: This study provides empirical evidence of how telerehabilitation activities may become integrated into routine day-to-day clinical activities.

OBJETIVO: En este estudio se analiza cómo la telerrehabilitación se convierte en parte de las rutinas clínicas nuevas y las ya existentes, y se determinan los factores que facilitan o limitan su uso habitual. MÉTODOS: Se llevó a cabo un estudio exhaustivo de casos de un programa de telemedicina en el ámbito de la rehabilitación puesto en marcha entre un centro urbano especializado en rehabilitación y un centro regional de rehabilitación en una zona rural. Mediante el empleo de un marco conceptual basado en la teoría de la estructuración de Giddens, se realizó un análisis cualitativo a partir de cuatro fuentes de datos: grupos de discusión y entrevistas por teléfono (dirigidas a profesionales de la salud, gerentes, y pacientes y sus familiares); grabaciones de video de sesiones de telerrehabilitación; y documentos del proyecto (por ejemplo, propuestas, solicitudes de financiamiento, resúmenes, programas de reuniones, procedimientos operativos, folletos dirigidos a los pacientes y herramientas destinadas a los médicos). RESULTADOS: En dos programas de rehabilitación dirigidos a pacientes que habían sufrido un traumatismo cerebral y a pacientes con una lesión de la médula espinal, la telerrehabilitación fue incorporada exitosamente a las prácticas clínicas corrientes de actividades como los planes de atención interdisciplinaria. Sin embargo, cuando se trataba de consultas clínicas especializadas o seguimiento de pacientes a largo plazo, la incorporación de la telerrehabilitación no resultó exitosa. Los factores que facilitaron o impidieron la integración de la telerrehabilitación en las prácticas corrientes provinieron tanto de la estructura (normas, reglas, recursos y valores) como de los agentes (es decir, los usuarios de la telerrehabilitación, incluidos los médicos, los gerentes, y los pacientes y sus familias) e incluyeron: 1) las creencias y suposiciones compartidas por los miembros del equipo asistencial del paciente con respecto a la naturaleza de las actividades clínicas, y las percepciones de los pacientes y sus familiares; 2) el liderazgo clínico y organizativo; 3) el grado y tipo de uso de la telerrehabilitación; 4) los recursos disponibles; y 5) las colaboraciones ya implantadas o que aún debían lograrse. CONCLUSIONES: Este estudio aporta evidencia empírica de cómo las actividades de telerrehabilitación pueden integrarse en las actividades clínicas habituales.