Journal of Medical Internet Research

In recent years, remote exercise services (“telerehabilitation”) have been increasingly explored and implemented, including in supportive cancer care, on the promise of greater convenience, access independent of geographic location, reduced infection risk, and cost savings. Ethical commentary on telehealth in general is substantial, but sustained discussion of questions specific to telerehabilitation remains comparatively sparse. As contributors to PREFERBALE-II, a European Union–funded project evaluating live-remote exercise for people recovering from cancer treatment, we sought practical guidance on how to deliver such services responsibly, and found little to work with. This prompted this viewpoint, which sets out our own position as researchers and clinicians engaged in this work. We draw on a purposive sample of professional guidance documents, which were assembled through our professional networks and a supplementary web search, and on a narrative reading of qualitative studies chosen to represent accounts of benefits as well as burdens. We read these documents through an analytical lens of responsible innovation. We make 3 arguments. First, the ethical content of current telerehabilitation guidance is largely confined to the products and processes of innovation, covering safety, privacy, consent, and compliance, while the question of purpose, that is, whether, for whom, and why remote rehabilitation should be offered at all, is left largely unasked. Anticipation appears only implicitly, and reflexivity, inclusion, and responsiveness barely at all. Responsibility is repeatedly delegated to individual professionals without commensurate structural support. Second, the situated experience of users and professionals forms part of the ethics of telerehabilitation and is not merely data to be assessed. Reported benefits and burdens depend on social context, including age, digital literacy, connectivity, caregiver availability, language, and sensory or cognitive impairment, so an equity claim made for the modality in general may not hold for the individual patient. Third, the ethics of telerehabilitation consequently has to be institutionalized across 3 overlapping domains: the interpersonal and experiential quality of remote care, the legal and institutional conditions of delivery, and the positioning of telerehabilitation within health systems. We address these arguments primarily to rehabilitation professionals and the associations and standard-setting bodies that issue guidance for them, and secondarily to digital health and ethical, legal, and social implications researchers, policymakers, and health-system decision-makers who commission or implement such services. We offer an agenda for a broader ethics conversation across professional societies, curricula, and affected publics, together with observations from a consortium put forward as hypotheses for study.

The COVID-19 pandemic accelerated the adoption of virtual care, including patient-to-provider asynchronous secure messaging (ASM). However, while ASM offers access and convenience, the surge in message volume can increase physician workload and contribute to burnout. Furthermore, it has raised additional concerns about message appropriateness, medicolegal liability, and sustainability of this communication virtual care modality.

Large language models (LLMs) are increasingly used to generate and evaluate patient-facing medical materials. Through persona prompting, LLMs can be instructed to simulate responses from individuals with different demographic and experiential backgrounds, offering a scalable approach for approximating patient feedback. However, it remains unclear how closely these simulated persona-based responses reflect real patient perspectives, and whether this alignment is consistent across demographic subgroups.

AI enables increasingly personalized health care, but the data required intensifies long-standing concerns about privacy, confidentiality, and trust as the European Health Data Space (EHDS) expands the primary and secondary use of health data. This viewpoint examines how the EHDS reshapes the personalization-privacy paradox in AI-enabled health care and under what conditions it can manage, rather than resolve, this paradox. Drawing on privacy calculus theory, we analyze the patient-practitioner relationship, the flow of data from primary to secondary use, and the governance mechanisms introduced by Regulation (EU) 2025/327, including data access bodies, data permits, differentiated opt-out rights, and privacy-preserving technologies. We identify 5 governance conditions: purpose-specific governance, accessible opt-out design, practitioner-mediated transparency, privacy-preserving infrastructure, and independent oversight of secondary use actors. When these conditions are met, the EHDS can sustain trust while enabling personalization. We conclude that the EHDS does not eliminate the paradox but can provide a governance architecture to manage it, depending more on implementation quality and patient engagement than on the ambition of the framework itself.

Depression is heterogeneous and dynamic, and changes in observable behavior may accompany some of its clinical manifestations. Digital devices offer new opportunities to capture this behavior in naturalistic settings continuously. However, the specific digital features captured through device interactions and their relationships to depression-related outcomes have yet to be synthesized, and their potential relevance to functional constructs is unclear. The research domain criteria (RDoC) may provide a conceptual framework for exploring potential links between digital behaviors and functional constructs.

The rise of online mental health communities has reshaped the ways individuals seek and receive mental health support. Although online mental health communities (OMHCs) offer a valuable space for peer support, including through experience-sharing, they also present challenges, including moderation practices to cultivate supportive interactions and secure member safety. No comprehensive framework of moderation practices has been established. Developing such an understanding is important, as moderators play a central role in facilitating a sense of community and determining whether OMHCs function as safe and supportive spaces.

Smart care robots are increasingly viewed as a potential way to address care burden and support care quality in long-term care facilities. However, their integration into routine care practice remains limited, and the conditions required for their effective implementation are not yet well understood from the perspective of frontline nursing assistants.

Use of secure messaging within the patient portal has grown rapidly over recent years, yet clinical workflows, staffing models, and billing practices have generally not been comprehensively adapted to support this increasing volume of messages. Little is known about the characteristics of patients who are high-volume message senders, and we lack a nuanced understanding of patient messaging intensity beyond measures accounting for sheer volume, limiting health system efforts to anticipate message-related workflow demands and allocate resources effectively.

Globally, the carbon footprint of the health care sector is significant and growing, and digital health care technologies (DHTs) offer unique opportunities to reduce the carbon footprint of health and care systems. However, their environmental impact has not been adequately investigated.

Patient access to their electronic health records (EHRs) could improve care and reduce errors by enabling patient contribution to documentation. However, interactive functions that support such engagement remain underresearched.

Engagement with suicide-related content online is often assumed to be harmful, yet many individuals with lived experience describe such content as supportive or even life-preserving. Despite policy and clinical concerns, little is known about how people intentionally or unintentionally encounter this content, how they interpret it, and how these experiences shape perceived harm or benefit.

Patients with cancer frequently experience complex and multidimensional symptom burdens. Standardized patient-reported outcome measures provide structured approaches to symptom assessment but may not capture the full range of symptom-related and psychosocial concerns expressed in patients’ narratives. Patient-generated social media data offer a complementary source for examining how these concerns are expressed online.