Facilitators and Barriers to Participation in Exercise-Based Telerehabilitation in Individuals with Stroke: A Scoping Review of Quantitative and Qualitative Studies

Abstract

Background:

Barriers to stroke rehabilitation, including travel and other costs, impact women more, but may be mitigated with telerehabilitation. This scoping review aimed to identify and describe facilitators and barriers to participation in exercise-based telerehabilitation after stroke. Our secondary aim was to explore whether gender-related facilitators or barriers exist to participation.

Methods:

Six electronic databases were searched for studies exploring facilitators and barriers to participation in exercise-based telerehabilitation in community-dwelling adults with stroke. A list of key constructs was developed and provided a definition, and mapped onto one or more domains of the Theoretical Domains Framework (TDF).

Results:

Thirty-eight studies were identified (n = 882 participants). The most commonly reported facilitators were mapped onto the TDF domain “environmental context and resources,” and included the following: acceptable audio and video features, accessibility, convenience/flexibility of the training schedule and variety of games, and therapist communication skills. Other facilitators included ease of use (TDF “skills” domain), comfort with technology (“knowledge,” “skills”), self-perceived improvements in physical function (“reinforcement”), enjoyment (“emotion,” “reinforcement”), positive feedback/encouragement from family/friends (“social influences”), and the usefulness of telerehabilitation (“intentions,” “reinforcement”). Barriers included challenges with internet speed and connectivity and adjusting and/or wearing the device(s) (“environmental”). Men and women reported facilitators related to “skills” and “knowledge” to participate in telerehabilitation, but few studies described gender-related factors.

Discussion:

We found that many facilitators and few barriers exist to participation in exercise-based telerehabilitation for men and women with stroke, whereby the environmental and resources domain of the TDF was represented by most constructs.