Stampa, Susanne

Due to the coronavirus pandemic, telerehabilitation has become increasingly important worldwide. While the effectiveness of telerehabilitation is considered proven for many indications, there is comparatively little knowledge about the implementation conditions. Therefore, this scoping review summarises the current state of facilitating and inhibiting factors that may influence the uptake of telerehabilitation. The review follows the JBI methodology for scoping reviews. The Article search was carried out in five databases (MEDLINE, EMBASE, Web of Science, Cochrane and Psyndex) in May 2022, with an update in October 2023. Two independent researchers identified relevant studies according to the inclusion and exclusion criteria. The Consolidated Framework for Implementation Research served as the theoretical basis for the categorisation of the facilitating and inhibiting criteria in the organisational context. A total of 28 studies (timespan 2012 to 2023) have been included. The most relevant barriers identified are technical issues and a lack of technical skills. The factors considered most favourable for implementation are patients’ motivation and the involvement of high-level leaders. The results provide clear indications of factors that inhibit and facilitate implementation, but also show that further research is needed.

Background: Digital transformation in the field of rehabilitation has gained significant momentum in recent years. It is seen as a means of addressing key societal challenges, such as demographic change, the shortage of skilled workers, and social exclusion. The COVID-19 pandemic acted as a catalyst in this regard. In order to comply with hygiene regulations and maintain rehabilitation services during the pandemic, many rehabilitation facilities increasingly turned to digital alternatives. Some of these services had already been approved by the cost bearer before the pandemic and were now used more extensively (e.g. the IRENA® aftercare services), whilst others were granted temporary approval by the cost bearer via a simplified approval process (e.g. the digital provision of services for addiction disorders). In addition, many facilities quickly digitised services previously delivered in person on their own initiative (e.g. training programmes for rehabilitation patients). Although the effectiveness of digitally supported services is now considered proven for many indications, there is still relatively little evidence regarding the conditions of composition, acceptance and implementation. However, these factors are essential for a sustainable integration into standard care and are therefore examined in this work. Methodology: This paper comprises four individual studies. At the beginning of the research project, a scientific literature review was conducted to assess the current state of international research in the field of implementing digitally supported rehabilitation services. The subsequent methodological approach was based on a sequential-explanatory mixed-methods design aimed at integrating qualitative and quantitative methods of empirical social research. The subject of the research project was first analyzed using quantitative methods (study 2 and 3) and then examined in greater depth through a qualitative approach (study 4). The results led to recommendations for action. Results: In the implementation process of digitally supported rehabilitation services, support from management, flexibility in terms of time and location, and the involvement and motivation of staff have shown to be particularly beneficial. On the other hand, technical difficulties, a lack of resources, and financial and regulatory conditions that are perceived as inadequate have caused an inhibiting effect. Overall, the acceptance of digitally supported services among rehabilitation patients is high. Habit (β = .340, p < .001), Hedonic Motivation (β = .300, p < .001), and Performance Expectancy (β = .298, p < .001) all have a significant positive influence on Attitudinal Acceptance. Conclusion: Sustainable integration of digitally supported services requires not only the measurement of effectiveness but also systematic implementation and acceptance research. In this context, existing frameworks and models should be consistently adapted to the specific research topic and empirically validated. The recommendations for action derived from the studies can serve as an important first step in identifying factors that facilitate or hinder implementation processes and in promoting the acceptance of digitally supported services.

Stampa, Susanne

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