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This scoping review aimed to map existing research on adverse events encountered during telerehabilitation delivery, across rehabilitation populations. This includes identifying characteristics of adverse events (frequency/physical/non-physical, relatedness, severity) and examining adverse events by different modes of telerehabilitation delivery and disease states. Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic for remote service delivery. However, no prior scoping review, systematic review, or meta-analysis has identified and summarized the current primary research on adverse events in telerehabilitation. Understanding adverse events, such as falls during physiotherapy or aspiration pneumonia during speech therapy, is crucial for identifying limitations and optimizing delivery through risk mitigation and quality indicators. This understanding could also help to improve the uptake of telerehabilitation among clinicians and patients. This review addresses this gap by summarizing published literature on adverse events during telerehabilitation. The review followed the Joanna Briggs Institute framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The review protocol was registered and published on Open Science Framework. A comprehensive search across multiple databases (MEDLINE ALL/EMBASE/APA PsycINFO/CENTRAL/CINAHL) was conducted. Screening, extraction, and synthesis were performed in duplicate and independently. Data extraction followed the Template for Intervention Description and Replication framework and also involved extraction on authors, publication year (pre- or post-COVID), population, sample size, and modes of telerehabilitation delivery (asynchronous, synchronous, hybrid). For synthesis, data were summarized quantitatively using numerical counts and qualitatively via content analysis. The data were grouped by intervention type and by type of adverse event. This scoping review included qualitative and quantitative studies published between 2013-2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery were included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants were excluded. The search identified 11,863 references, and 81 studies were included in this review with a total of 3,057 participants (mean age:59.3 years; females:44.6%). Modes of telerehabilitation delivery (whether asynchronous, synchronous or hybrid) used in the studies included videoconferencing (52), phone calls (25), text messaging (4), email (6), mobile apps (10), and internet-based virtual reality systems (3). A total of 295 adverse events occurred during 84,534 sessions (0.3%), with the majority being physical (e.g., falls or musculoskeletal pain), non-serious/non-severe/mild, and unrelated to (i.e., not caused by) to the telerehabilitation provided. From the 81 included studies, telerehabilitation was delivered with related adverse events being rare, and mostly characterized as mild/non-severe. A comparable occurrence of adverse events (~30%) was found between asynchronous and synchronous telerehabilitation studies. When categorized by disease type, cardiac telerehabilitation studies had the most frequent adverse events. Detailed reporting of telerehabilitation interventions and adverse event characteristics is recommended for future studies (i.e., use of TIDieR reporting guidelines). Telerehabilitation has the potential to make rehabilitation services more accessible to patients; however, more evidence on the safety of telerehabilitation is needed.

This scoping review aims to map the existing research on adverse events during the delivery of telerehabilitation. Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic as a means to deliver rehabilitation services remotely. However, there exists a research gap as there has yet to be any scoping review, systematic review, or meta-analysis published to identify and summarize the current primary research on adverse events related to telerehabilitation as a whole. It is important to understand how adverse events, such as falls during physiotherapy or aspiration pneumonia during speech language pathology sessions, are associated with telerehabilitation delivery. This will help to identify key limitations for optimizing telerehabilitation delivery by allowing for the development of key risk-mitigation measures and quality indicators. It can also help improve the uptake of telerehabilitation among clinicians and patients. This review aims to fill this research gap by conducting a search of published literature on adverse events in telerehabilitation. Anticipated key findings of this scoping review include identifying the characteristics and frequencies of adverse events during telerehabilitation, the patient populations and types of telerehabilitation associated with the most adverse events, and the quality of reporting of adverse events. The review follows the Joanna Briggs Institute (JBI) methodological framework and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol has been registered and published on Open Science Framework. A comprehensive search strategy was implemented across multiple databases (MEDLINE ALL, EMBASE, APA PsycINFO, CENTRAL, and CINAHL). All stages (screening, extraction, and synthesis) will be conducted in duplicate and independently, with data extraction following the TIDieR framework, along with authors, year of publication (before or after COVID), population and sample size, and specific mode/s of telerehabilitation delivery. For synthesis, data will be summarized quantitatively using numerical counts and qualitatively via content analysis. The data will be grouped by intervention type and by type of adverse event. This scoping review will include qualitative and quantitative studies published between 2013 and 2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery (asynchronous, synchronous, or hybrid) will be included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants will be excluded.

Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented. The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally. The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis. A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of \"infrastructure, equipment, and space\" and \"leadership and organizational support\"; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit. Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future.

Telerehabilitation involves the delivery of rehabilitation services over a distance through communication technologies. In contrast to traditional in-person rehabilitation, telerehabilitation can help overcome barriers including geographic distance and facility use. There is evidence to suggest that telerehabilitation can lead to increased patient engagement and adherence to treatment plans. However, limited research exists on the association of telerehabilitation with adverse events, potentially hindering its broader adoption and use in health care. This systematic review of randomized controlled trials aims to summarize existing research on adverse events related to telerehabilitation delivery. This review was conducted according to the methodological framework outlined by the Joanna Briggs Institute. Studies were identified from MEDLINE ALL, Embase, APA PsycINFO, CENTRAL, and CINAHL. Included studies were randomized controlled trials published between 2013 and 2023, written in English, and had no geographic or delivery mode restrictions. Data extraction used the TIDieR (Template for Intervention Description and Replication) framework, along with authors, publication year, sample size, specific telerehabilitation modes, and the incidence, type, severity, and relatedness of reported adverse events. Methodological quality was assessed using the Cochrane risk of bias tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. Search results identified 9022 references, of which 37 randomized controlled trials met the criteria for inclusion. There were a total of 3166 participants, with a mean age of 57.4 (SD 11.3) years, and 1023 (32.3%) being female participants. Various delivery modes were used, with videoconferencing emerging as the most frequently used method. A total of 201 adverse events were recorded during 65,352 sessions (0.31% or 3.1 per 1000 sessions). These events were predominantly physical (eg, falls and palpitations), nonserious or mild, and not directly attributed to the telerehabilitation intervention. Additionally, 34 (92%) of included studies implemented various safety practices including vital sign monitoring, safety checklists, and scheduled check-ins with study personnel. This review demonstrates that telerehabilitation exhibits a generally safe profile as an alternative to in-person rehabilitation, with most reported adverse events being rare, nonserious or mild, and unrelated to telerehabilitation protocols. However, more extensive research with detailed reporting on adverse event characteristics is needed. Moreover, future research should evaluate the effectiveness of different safety practices and their association with adverse events. An enhanced understanding of potential risks in telerehabilitation can foster broader adoption while ensuring its safe implementation among health care providers and patients.

The ability to drive an automobile is a central aspect of independent living for many older adults (Ragland, Satariano, & MacLeod, 2004). Much of the research in the field of driving and the elderly has focused on accident situations in which older drivers are over-involved, with little attention placed on developing and evaluating methods to enhance driving abilities. This thesis is comprised of two manuscripts, one examining the effectiveness of retraining programs for older drivers, and the other exploring older adults' perceptions of driving, concerns/difficulties associated with driving, and factors stimulating interest and participation in a driving program. The first manuscript presents a systematic review of the most recent literature on evidence regarding the effectiveness of retraining programs for older drivers. Reviewed articles were grouped according to the intervention studied: physical retraining, visual perception or education. Randomized controlled trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale (PEDro, 2006) and interpreted following Foley's quality assessment (Foley, Teasell, Bhogal, & Speechley, 2003). Each intervention was then rated for effectiveness based on Sackett's levels of evidence (Sackett, Richardson, Rosenberg, & Haynes, 2000). Six RCTs, one pre- post-study design and one descriptive study met the inclusion criteria, one investigating physical retraining, one a visual perception intervention, five using an educational intervention and one examining a combination of all three, in addition to traffic engineering improvements. There is limited evidence that physical retraining (Level 2a) and visual perception retraining (Level 2a) improve driving related skills in older drivers. There is moderate evidence that educational interventions improve driving awareness and driving behavior (Level 1a), but do not reduce crashes (Level 1b) in older drivers. This suggests that while the evidence is limited, it is sufficiently encouraging to merit further research on interventions for healthy older drivers. In the second manuscript, the authors explore activities seniors use driving for, when and where they drive, importance of driving, perceived driving habits, behavioral changes as people age, and factors stimulating interest and participation in a driving program. Three focus groups (n=18), conducted using a structured format, were held with former and current drivers, 75 years and older, living in Montreal, Canada. Discussions were audiotaped, transcribed, and analyzed to identify themes/key points. Participants reported driving for short and long-distance trips, personal and leisure activities, or in situations where walking was not practical or possible. They indicated driving during days and evenings, on city streets and highways. Frequently reported changes and difficulties included reduced evening vision, slowing response times, and road signs not being clear or visible. The principle results indicated that participants were enthusiastic about a driving program and perceived a need for content such as: traffic law refreshers, retraining of driving-related skills, as well as an on-road driving component. An objective, comprehensive clinical assessment and on-road evaluation were also deemed important. Furthermore, participants expressed preference for a program offered sometime between 11am-to-5pm for one-to-two hours, once or twice weekly. This focus group research is the first step in a research agenda aimed at developing effective and practical driving interventions for healthy older drivers based on their desired needs and interests.