Effectiveness of telerehabilitation for adults with neurological conditions in low and middle income countries: A systematic review

Neurological conditions including stroke, multiple sclerosis, and Parkinson’s significantly contribute to disability and mortality globally. A significant proportion of these cases are found in Low and Middle Income Countries (LMICs). Telerehabilitation has emerged as a promising approach to overcome the geographical, financial, and logistical barriers to rehabilitation in LMICs. However, to date, no review has assessed the effectiveness of telerehabilitation in LMICs. This systematic review aims to evaluate the effectiveness of telerehabilitation for adults with neurological conditions in LMICs. A systematic search of databases (PubMed, EMBASE, CINAHL, MEDLINE, Cochrane central registry for clinical trials, and the World Health Organization (WHO) Global Health Library) was conducted to identify relevant studies published from 1st January 1990–20th April 2024. To accurately capture relevant studies, search terms were closely aligned with PICO elements of the review question. PRISMA and AMSTAR guidelines were used to guide the conduct of this review which only included clinical trials. Joanna Briggs Institute (JBI) critical appraisal tools were used to assess the methodological quality of included studies.Out of 430 identified studies, 16 met the inclusion criteria. There was notable heterogeneity in telerehabilitation content, approaches, dose, delivery methods and follow-up periods. Given the heterogeneity, a narrative analysis was conducted. Findings from the included studies suggest that telerehabilitation can lead to similar or superior outcomes compared to conventional rehabilitation. However, only a third of the included studies incorporated follow-up assessments, and among those, sustained benefits were observed in only a few outcomes. The lack of long-term follow-up data makes it difficult to draw conclusions about the sustained effectiveness of telerehabilitation.This systematic review indicates a promising potential for telerehabilitation to enhance outcomes for adults with neurological conditions living in LMICs. However, the lack of long-term follow-up data limits understanding of sustained benefits. High-quality, methodologically rigorous research with extended follow-up is needed to determine the long-term effectiveness of telerehabilitation. Establishing this evidence base is critical for integrating telerehabilitation into healthcare strategies and policy.Author summary: This systematic review evaluates the effectiveness of telerehabilitation for adults with neurological conditions in Low and Middle Income Countries (LMICs). Despite the significant burden of neurological conditions in LMICs, there is a lack of evidence regarding the effectiveness of telerehabilitation in this context. Through a rigorous search of key databases and adherence to PRISMA and AMSTAR guidelines, 16 studies were identified for inclusion. The review highlights considerable heterogeneity in telerehabilitation interventions, yet suggests that such programmes could yield comparable or even superior outcomes to conventional rehabilitation methods. However, it emphasises the necessity for further high-quality research with long-term follow-up to conclusively establish the effectiveness of telerehabilitation across LMIC settings over time. This evidence is crucial for informing healthcare strategies and policy decisions regarding the integration of telerehabilitation into neurological care in LMICs.