Are We Ready for Telerehabilitation to Become Mainstream? Opinion About Upper Extremity Orthopedic Conditions

By Thierry Lienou, OTD, OTR/L, CAPS, ATP



Lienou T. Are we reaady for telerehabilitation to become mainstream? Opinion about upper extremity orthopediuc conditions. HPHR. 2021;40.  


Are we ready for telerehabilitation to become mainstream? Opinion about upper extremity orthopedic conditions


The COVID-19 outbreak accelerated the expansion of telehealth services due to the limitation in hospital visits to reduce the virus propagation and due to the implementation of physical distancing measures. Many healthcare professionals, including physical rehabilitation specialists relied on telehealth services as a solution to maintain continuity of care. The literature shows that telerehabilitation might improve or at least maintain the continuity of rehabilitation care and services by making them more efficient and cost-effective. The current research on telerehabilitation could have many implications on clinicians treating adults with orthopedic injuries. However, there needs to be more data to support the effectiveness of the variety of telehealth platforms with orthopedic conditions in different contexts. I believe that physical rehabilitation specialists should use the current research as a guide to safely use telehealth when traditional rehabilitation is not possible such as in cases where the service recipients are in remote areas or who cannot travel to in-person.

Relevance of telerehabilitation of upper extremity orthopedic conditions

The COVID-19 outbreak accelerated the expansion of telehealth services as a measure to limit the virus (Krasovsky et al., 2021). Individuals were encouraged to stay at home rather than come to the hospital to reduce their chances of being exposed to the virus. These individuals potentially had serious illnesses or injuries which would have necessitated prolonged inpatient rehabilitation or ongoing outpatient rehabilitation care. Therefore, many healthcare professionals, including physical rehabilitation specialists relied on telehealth services as a solution to maintain continuity of care while patients stayed home (Krasovsky et al., 2021). These specialists may include occupational therapists, physical therapists, or hand therapists that have access to telerehabilitation platforms. Also, orthopedic upper extremity injuries are among the most common to the body. For example, more than half of the adult population in the U.S. has at least one yearly episode of pain that limits the functionality of their upper extremities during activities of daily living. It is widely accepted that physical rehabilitation is essential to improving functional outcomes and promoting the return to daily activities after an orthopedic injury.  Moreover, correctly functioning upper-extremity joints is necessary for an individual to effectively engage in daily activities (Cui et al., 2019; Macías-Hernández et al., 2016; Marik & Roll, 2017; Jiang et al., 2018).

Current research on telerehabilitation and upper extremity orthopedic conditions

There have been many studies conducted to determine if telerehabilitation is as effective as face-to-face physical rehabilitation. Telerehabilitation involves providing rehabilitation services from a distance, with patients and healthcare providers using technology to communicate (Macías-Hernández et al., 2016). Services are delivered from a remote location using telecommunication, information technology, or digital systems that are specifically designed for the diagnosis or the location of the patient (Dias Correia et al., 2019). Examples of telerehabilitation platforms include video conferences, digital systems, virtual exercise rehabilitation assistants, video/photo interfaces, over-the-phone supervision, virtual reality, and cell phone applications.


The literature shows that telerehabilitation might improve or maintain the continuity of rehabilitation care and services by making them cost-effective. Moreover, telerehabilitation is known to be a valid medium for physical rehabilitation specialists to be able to remotely carry out several components of a physical examination, including observation and analysis, muscle strength tests, and assessment of the joint range of motion (Lade et al., 2012). In the Ericksson et al. (2009) study, telerehabilitation using video conferencing showed statistically superior results over traditional outpatient therapy in improving pain, quality of life (QoL), range of motion (ROM), and daily life function for individuals who sustained a shoulder replacement. The Martinez-Rico et al. (2018) study demonstrated statistically superior results of phone based telerehabilitation over traditional home exercise programs for improving the ROM of individuals who sustained a shoulder instability surgery. Moreover, video and over-the-phone telerehabilitation have been demonstrated to produce statistically equivalent outcomes to traditional face-to-face therapy and outpatient therapy for improving shoulder function and ROM (Ismail & El Shorbagy, 2014; Pastora-Bernal et al., 2018) and for improving pain, function, and QoL (Martinez-Rico et al., 2018) for individuals with shoulder arthroscopic subacromial decompression and arthroscopic anterior shoulder stabilization. Worboys et al. (2018) also demonstrated equivalent levels between telerehabilitation using a video/phone interface and traditional rehabilitation for improving ROM and pain of individuals with a variety of hand injuries. These injuries include fractures, dislocations, bone fusion, tendon conditions, nerve conditions, pain, amputation, and wound infection.

Clinical implications of telerehabilitation

The current research on telerehabilitation could have many implications on how physical rehabilitation specialists handle upper extremity orthopedic injuries. However, this depends on the telerehabilitation platform used and the targeted outcome. The studies presented earlier indicate that patients who sustained a shoulder replacement, a shoulder instability surgery, a shoulder arthroscopic subacromial decompression, or an arthroscopic anterior shoulder stabilization and patient with a variety of hand injuries reported better quality of care and improved pain and function, or demonstrated improved ROM when having telerehabilitation through a variety of platforms. These studies are significant because video conferences and over-the-phone supervision can be easily applied by the practitioner to address pain, range of motion, daily function, and quality of life of individuals at a distance with results that are statistically equivalent or superior  to traditional outpatient therapy or home exercise programs without compromising recovery. This could contribute to solving the issues identified by Pastora-Bernal et al. (2018), who reported that people with orthopedic injuries living in remote locations may not have access to in-person rehabilitation services.

Opinion on using telerehabilitation

Evidence based practice is critical for physical rehabilitation specialists to be able to support and justify telerehabilitation, and therefore, to influence telehealth policy during the current Covid-19 pandemic. The current research should guide physical rehabilitation specialists to safely use telerehabilitation to treat individuals with upper extremity orthopedic injuries. They should implement the platforms presented in the research when treating individuals with similar conditions. It is important to acknowledge that the literature on telerehabilitation and upper extremity orthopedic injuries is limited. In order to establish telerehabilitation as a recognized means of therapeutic intervention for upper extremity orthopedic conditions, I believe that the current general knowledge should be reinforced by more research. The goal of the research should be to validate its effectiveness compared to traditional rehabilitation. It should also focus on the difficulties that patient or clinicians could face when using these technological platforms in order to explore potential solutions. Indeed, even though video/phone platforms, virtual reality interfaces, and mobile applications were shown to yield comparable results to traditional rehabilitation targeting specific outcomes, the difficulties related to technology use or access could negatively impact the quality of the service provided and the outcome.


The author acknowledges Mr. Rebeka Grossman for guidance and review of this manuscript.

Disclosure Statement

By submitting this manuscript to HPHR, the author declares that: they contributed to the creation of the submission, and grant HPHR permission to review and (if selected) publish their work. They do not have personal, commercial, academic, or financial interests that influence the research and opinions represented in the work submitted to HPHR, and the submission is not under consideration by another publication and/or has not previously been published elsewhere.


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About the Author

Dr. Thierry Lienou, OTD, OTR/L, CAPS, ATP

Dr. Thierry Lienou is a clinical assistant professor at Howard University Department of Occupational Therapy. He is the primary professor for the assistive technology course at Howard University and has experience working with virtual tele simulation at the University’s Clinical Skills and Simulation Center. Dr. Lienou focuses his practice on telehealth, marginalized and underserved populations, and healthcare delivery in less resource settings. He also emphasizes his research on opportunities for healthcare professionals from underserved and marginalized socio-economic background.