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The COVID-19 pandemic has required an increased need for rehabilitation activities applicable to patients with chronic diseases. Telerehabilitation has several advantages, including reducing clinic visits by patients vulnerable to infectious diseases. Digital platforms are often used to assist rehabilitation services for patients in remote settings. Although web portals for medical use have existed for years, the technology in telerehabilitation remains a novel method.
This scoping review investigated the functional features and theoretical approaches of web portals developed for telerehabilitation in patients with chronic diseases.
PubMed and Web of Science were reviewed to identify articles associated with telerehabilitation. Of the 477 nonduplicate articles reviewed, 35 involving 14 portals were retrieved for the scoping review. The functional features, targeted diseases, and theoretical approaches of these portals were studied.
The 14 portals targeted patients with chronic obstructive pulmonary disease, cardiovascular, osteoarthritis, multiple sclerosis, cystic fibrosis diseases, and stroke and breast cancer survivors. Monitoring/data tracking and communication functions were the most common, followed by exercise instructions and diary/self-report features. Several theoretical approaches, behavior change techniques, and motivational techniques were found to be utilized.
The web portals could unify and display multiple types of data and effectively provide various types of information. Asynchronous correspondence was more favorable than synchronous, real-time interactions. Data acquisition often required assistance from other digital tools. Various functions with patient-centered principles, behavior change strategies, and motivational techniques were observed for better support shifting to a healthier lifestyle. These findings suggested that web portals for telerehabilitation not only provided entrance into rehabilitation programs but also reinforced participant-centered treatment, adherence to rehabilitation, and lifestyle changes over time.
Chronic diseases are the leading causes of death worldwide. The World Health Organization has reported that chronic diseases are responsible for almost 60% of deaths worldwide [
Telerehabilitation is defined as rehabilitation activities performed using information provided by communication technologies over a distance [
Web portals have the potential to be a core digital component for patient-centered telerehabilitation, however, relatively few have been adapted for telerehabilitation [
This study was designed to map the functional features of web portals utilized for telerehabilitation targeting chronic diseases. Although systematic reviews are preferred for answering clearly defined questions, a scoping review method is considered useful for answering broad questions [
A literature search of the international online bibliographic databases PubMed [
Data extraction and charting were performed according to Arksey and O’Malley’s guideline [
Of the 644 articles initially identified by keywords, 477 remained after the removal of duplicates. An additional 5 articles were found through manual searching.
Flow diagram of article identification.
Five portals were for patients with chronic obstructive pulmonary disease (COPD) [
A summary of functional features and the 14 portals. A colored circle indicates a functional feature. The number in a circle denotes the number of portals that employ the functional feature. A colored circle with a dotted line is associated with the principle of patient-centered care. Yellow boxes on a gray circle indicate a web portal. The number in parenthesis denotes the number of functional features the portal implemented. P1: ActiveHeart; P2: ActivOnline; P3: e-Exercise; P4: HeartPortal; P5: IBMS; P6: “A web portal”; P7: TELEKAT portal; P8: “A web application”, P9: “A webpage for self-management”; P10: e-CUIDATE system; P11: “A web portal”; P12: “A web platform; P13: LifeCIT website; P14: “A website”. IBMS: Integrated Care Portal Multiple Sclerosis; TELEKAT: telehomecare, chronic patients, and the integrated health care system; P: portal; PROs: patient reported outcomes.
Some functional features are considered to be associated with the principle of patient-centered care. Respect for patients’ values can be attempted by PRO, diary function, and the participatory design process, which several portals followed [
A list of included studies.
Portal name and references | Project name | Diseases | Functional features | Required additional systems | |
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TTPa | Heart disease | Communication, exercise instructions, education, participation of relatives, narratives of othersb | The shared care platform, MyMedic, Fitbit, sphygmomanometer, scale | |
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Dinesen et al [ |
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Dinesen et al [ |
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Melholt et al [ |
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ActionPACTc | Cystic fibrosis (later used for COPDd and bronchiectasis) | Monitoring/tracking data, communication, goal settings, scheduling/reminder | Step counter (Fitbit, mobile phone or pedometer) | |
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Cox et al [ |
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Liacos et al [ |
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Cox et al [ |
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e-Exercise | Knee/hip osteoarthritis | Exercise instructions, education, PROse, scheduling/reminder, baseline assessment | Face-to-face sessions | |
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Kloek et al [ |
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Kloek et al [ |
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Kloek et al [ |
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de Vries et al [ |
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Bossen et al [ |
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Future patient | Heart failure | Monitoring/tracking data, communication, exercise instructions, diary, education, participation of relatives, goal settings (via communication and diary function), PROs, narratives of others | Sphygmomanometer, scale, data transmitter, step counters, sleep sensor, iPad | |
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Joensson et al [ |
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Dinesen et al [ |
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—g | Multiple sclerosis | Monitoring/tracking data, diary, education, participation of relatives, PROs (via diary function), scheduling/reminder, news, medication, access to a health care record (multiple sclerosis care record), patient administration form, patient-specific pathways | MSDS3Dh, multiple sclerosis case record | |
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Voigt et al [ |
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— | COPD | Monitoring/tracking data, diary | Activity coach (smartphone and accelerometer) | |
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Tabak et al [ |
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TELEKAT | COPD | Monitoring/tracking data, communication, education (via communication function), participation of relatives | MyMedic/MyMedicPlus, scale, sphygmomanometer, oximeter, spirometer | |
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Dinesen et al [ |
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Haesum et al [ |
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Dinesen et al [ |
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Jensen et al [ |
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Dinesen et al [ |
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Dinesen et al [ |
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Huniche et al [ |
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SmartCareCAD | Coronary artery disease | Monitoring/tracking data, communication, participation of relatives, goal setting, scheduling/reminder | Mio alpha, hip-worn accelerometer | |
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Brouwers et al [ |
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— | COPD | Monitoring/tracking data, exercise instructions, diary | Treadmill, iPad, iPad holder, web conference application, pulse oximeter | |
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Zanaboni et al [ |
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Hoaas et al [ |
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Zanaboni et al [ |
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e-CUIDATE | Breast cancer survivors | Communication, exercise instructions, diary, PROs (via communication function), news | Telephone call | |
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Ariza-Garcia et al [ |
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Galiano-Castillo et al [ |
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Galiano-Castillo et al [ |
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Galiano-Castillo et al [ |
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— | COPD | Monitoring/tracking data, communication, exercise instructions, diary | Activity coach (smartphone and accelerometer) | |
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Tabak et al [ |
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— | Multiple sclerosis | Monitoring/tracking data, communication, exercise instructions, diary, news | An ad hoc tracking system for determination of posture, ToF cameraj | |
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Eguiluz-Perez and Garcia-Zapirain [ |
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LifeCIT | Poststroke | Monitoring/tracking data, communication, exercise instructions, diary, participation of relatives, goal setting, baseline assessment | C-Mitt (a glove to restrict functional hand movement) | |
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Burridge et al [ |
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iTrain | COPD | Monitoring/tracking data, communication, exercise instructions, diary, goal setting, scheduling/reminder | Treadmill, iPad, iPad holder, web conference application, pulse oximeter | |
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Hoaas et al [ |
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Zanaboni et al [ |
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aTTP: teledialog telerehabilitation program.
bInterviews, stories, and experiences of other patients or relatives who have the same disease.
cActionPACT: the active online physical activity in the cystic fibrosis trial.
dCOPD: chronic obstructive pulmonary disease.
ePROs: patient-reported outcomes.
fIBMS: integrated care portal multiple sclerosis.
gNot specified.
hIntegration of the multiple sclerosis documentation system.
iTELEKAT: telehomecare, chronic patients, and the integrated health care system.
jTime-of-flight camera.
kConstraint-induced therapy.
Theoretical approaches were observed in 8 portals. Among them,
Some studies were not “theory based” but introduced theories in their study concept, thus we considered them as “theory mentioned.”
The BCTs and MTs were identified by the authors’ descriptions in the included articles, as well as referring to a taxonomy of BCTs proposed by Abraham and Michie [
Mode of delivery is also known to influence behavior [
Theoretical approaches, BCTs, MTs, and modes of delivery employed in the 14 portals. Yellow square, theory applied; light yellow squares, theory or model mentioned without specifies on the mode of implication; green squares, BCT applied; light green squares, BCT mentioned without specifies on the mode of implication; green circles, through an additional system; orange squares, mode of delivery applied; orange circles, through an additional system including another digital platform used simultaneously, video consultation with HCP, or face-to-face session as part of the intervention; I: theory based; II: theory mentioned; III: theory not mentioned; BCT: behavior change technique; HCP: health care provider; IBMS: integrated care portal multiple sclerosis; MT: motivational technique; MoD: mode of delivery; TELEKAT: telehomecare, chronic patients, and the integrated health care system.
The objective of this scoping review was to investigate functional features and theoretical approaches of web portals developed for telerehabilitation programs in patients with chronic diseases, as well as any characteristics that can be observed through the investigation. As a result, monitoring/tracking data were found to be the most common function in telerehabilitation portals. Data monitoring by patients allowed them to gain self-management skills, which is a key for controlling chronic diseases [
Taken together, we propose several key concepts that can be addressed in the development of a telerehabilitation web portal. The advantage of web portals is their ability to unify and provide various information, which can be shared by many stakeholders, including patients’ relatives. By contrast, acquiring data and real-time correspondence often demand an extra system. Regarding the weakness of data acquisition and real-time correspondence, providing patients with a tablet or smartphone with a Bluetooth connection may help solve such problems, as exemplified in some studies [
Theoretical approaches were found in more than half of the portals analyzed, and BCTs were often mentioned in those studies. Current knowledge of BCTs, however, may not be sufficient to understand BCTs used for telerehabilitation platforms. For instance, although monitoring/tracking data are associated with BCTs and MTs in several web portal articles [
Web portals are not only practical tools to collect data or supply exercise instructions. If remote monitoring by health care professionals is the only goal, portals may not be necessary to be developed. Patients with chronic diseases often require lifestyle changes. Through patient-centered functions, web portals deliver various useful support for patients with chronic diseases. Web portals also assist rehabilitation to become part of patients’ daily routines, which is considered a key to guiding successful disease management [
International consensus about web portals for telerehabilitation is scarce. To effectively extract the characteristics, rather strict inclusion criteria were applied in this study. As mentioned in the “Methods” section, portals developed for purposes other than telerehabilitation were excluded, as were clinician portals, portals targeting other than chronic diseases, web applications designed for a single purpose, and web services with limited time of access. In this manner, we were able to bring out some characteristic features of web portals for telerehabilitation. We believe that our findings can be used in comparative studies of digital platforms of telerehabilitation in future investigations. Another limitation is that some of the projects described in this review are currently ongoing, suggesting that the functions of their portals may be improved in the future. Finally, this study did not include the cost of utilities, or patients’ and health care professionals’ experiences and perspectives when using the portals.
Telerehabilitation has several advantages, including reducing the need to visit clinics by patients vulnerable to infectious diseases. The global COVID-19 pandemic has increased the need for telerehabilitation. Web portals have the potential to be a core digital component for patient-centered telerehabilitation. The common functional features of 14 web portals studied in this scoping review were monitoring/tracking data provided by 11 portals; communication, 10; exercise instructions, 9; diary/self-report functions, 9; relatives’ participation, 6; goal settings, 5; and education, 5. Although different functional features addressed various purposes, the underlying concept was to facilitate rehabilitation to become a part of patients’ everyday lives. Web portals were able to unify and display multiple types of data and could effectively provide various types of information. Asynchronous correspondence was more favorable than synchronous, real-time interactions. Data acquisition often demanded other digital tools. As much as 8 out of 14 portals employed theoretical approaches to some degree, and various patient-centered functions were observed. As is usual in web applications, security updates were the responsibility of service providers, and thus such platforms may be especially suitable for participants who are unfamiliar with digital technologies. These findings suggested that web portals for telerehabilitation not only provide entrance into rehabilitation programs but also reinforce patient-centered treatment, adherence to rehabilitation, and lifestyle changes over time.
Descriptions of each portal.
the active online physical activity in the cystic fibrosis trial
behavior change technique
chronic obstructive pulmonary disease
integrated care portal multiple sclerosis
Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews
patient-reported outcomes
telehomecare, chronic patients, and the integrated health care system
teledialog telerehabilitation program
This work was supported by a JSPS KAKENHI grant (20H04055). We thank Kenta Takahashi of Juntendo University Information Center for sharing his knowledge of computer science. We also thank Ai Nakahata of Juntendo University Academic Media Center (Library) for her professional assistance. Finally, we thank David Price and Swetha Anand for their help with the editorial preparation of the manuscript.
TT, NK, TK, and HD are affiliated with a department funded by Philips Japan; Asahi KASEI Corporation; Inter Reha Co, Ltd; and Toho Holdings Co, Ltd based on collaborative research agreements.