title: A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation.
abstract: OBJECTIVE
  To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities.
  
  
  METHODS
  Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale.
  
  
  RESULTS
  Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, rehabilitation for speech-language impairments, and rehabilitation for varied clienteles. Clinical outcomes were generally improved following a telerehabilitation intervention and were at least similar to or better than an alternative intervention. Clinical process outcomes, such as attendance and compliance, were high with telerehabilitation although few comparisons are made to alternative interventions. Consultation time tended to be longer with telerehabilitation. Satisfaction with telerehabilitation was consistently high, although it was higher for patients than therapists. Few studies examined healthcare utilization measures and those that did reported mixed findings with respect to adverse events, use of emergency rooms and doctor visits. Only five of the studies examined costs. There is some preliminary evidence of potential cost savings for the healthcare facility.
  
  
  CONCLUSIONS
  While evidence is mounting concerning the efficacy and effectiveness of telerehabilitation, high-quality evidence regarding impact on resource allocation and costs is still needed to support clinical and policy decision-making.
authors: Department of Health Administration, University of Montreal, Canada. dahlia.kairy@umontreal.ca
authors: Dahlia
authors: D
authors: Kairy
authors: Pascale
authors: P
authors: Lehoux
authors: Claude
authors: C
authors: Vincent
authors: Martha
authors: M
authors: Visintin
mesh_terms: D006296:Health Services / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D012046:Rehabilitation / Q000191:economics / Q000379:methods*; D017216:Telemedicine / Q000191:economics