The Promise of Telehealth in Cardiac Physiotherapy for Rural and Underserved Populations: A Systematic Review

Abstract

Background:

Cardiovascular diseases remain a leading cause of global morbidity and mortality. Cardiac rehabilitation (CR), particularly cardiac physiotherapy, is crucial for secondary prevention; yet access is suboptimal, especially for patients in rural and underserved populations due to logistical and socioeconomic barriers. Telehealth offers a promising solution to address these disparities.

Objective:

This systematic review aimed to synthesize evidence on the effectiveness, feasibility, and acceptability of telehealth-delivered cardiac physiotherapy interventions in rural and underserved populations and identify the associated barriers and facilitators.

Methods:

A comprehensive search was conducted across multiple databases. Studies investigating telehealth-delivered cardiac physiotherapy in rural/underserved populations were included. Due to heterogeneity in study designs, interventions, and outcomes, a narrative synthesis was performed. Qualitative and quantitative data were extracted on effectiveness, feasibility, acceptability, barriers, and facilitators.

Results:

Nine studies were included, employing diverse designs (randomized controlled trials, multimethod, feasibility, qualitative, codesign, and mixed methods). Telehealth-delivered cardiac physiotherapy demonstrated effectiveness in improving exercise capacity, cardiac risk profiles, weight management, and quality of life. It also enhanced CR attendance and completion rates. High feasibility and acceptability were reported, with patients valuing convenience and home access. Key facilitators included personalized support, staff adaptability, and codesign approaches. Persistent barriers included digital literacy, technological infrastructure limitations, socioeconomic factors, staffing issues, and potential patient isolation.

Conclusion:

Telehealth-delivered cardiac physiotherapy holds significant promise for expanding access and improving outcomes for rural and underserved populations. While effective and acceptable, successful implementation requires addressing digital, technological, and socioeconomic barriers. Leveraging identified facilitators and designing patient-centered interventions are crucial for equitable cardiovascular care.