Feasibility of Telerehabilitation in Orthotic Care: A Systematic Review of Acceptability, Implementation Outcomes, and Clinical Effectiveness

Imagine a world where the distance between a patient and their doctor no longer dictates the quality of care they receive. For decades, rehabilitation has been a journey requiring physical presence: a patient must travel to a clinic, sit in a waiting room, and undergo hands-on adjustments to the braces, splints, or supports that help them walk, hold objects, or straighten their spine. These devices, known as orthotics, are vital tools that restore independence and mobility, yet the traditional model of care is often blocked by geography, cost, and the sheer difficulty of traveling while injured. In recent years, technology has offered a potential bridge across these gaps. By using video calls, mobile apps, and smart sensors, clinicians can now guide patients through recovery from their own homes. This approach, called telerehabilitation, promises to bring high-quality support to those who cannot easily leave their houses, but the medical community has needed to know if it truly works as well as the old way, and if patients and doctors can actually trust it.

A team of researchers set out to answer these questions by gathering and analyzing every available study that tested this digital approach in orthotic care. They looked at twelve different studies involving nearly six hundred people from eight countries, ranging from children with spinal curvatures to older adults recovering from strokes or knee surgeries. Their goal was not just to see if the technology worked, but to understand if it was practical to use, if people liked it, and if it led to better health outcomes than the traditional face-to-face visits. The researchers sifted through data on how easy the systems were to learn, how much time patients spent training, and whether the physical results matched those achieved in a clinic. They also examined the real-world logistics, such as whether this method could save money on hospital stays or reduce the need for patients to travel between different medical centers.

The findings suggest that this digital shift is not just a temporary workaround, but a viable, and in some cases superior, method of care. The review found that patients and therapists alike found the technology easy to use and highly acceptable. On average, participants engaged in about one hour and forty-five minutes of active training each week through these remote platforms. When asked to rate the systems, users gave them high marks for usability, with scores indicating that the technology was intuitive and reliable enough for daily life. Perhaps most importantly, the clinical results showed that remote care could match, and sometimes even beat, the results of in-person treatment. For instance, patients with scoliosis, a condition where the spine curves abnormally, saw a greater reduction in their spinal angle when treated remotely compared to those treated traditionally. Similarly, individuals recovering from knee surgery or stroke showed significant improvements in movement and function, with some groups achieving better scores on standard physical tests than those who visited a clinic in person.

Beyond the physical recovery, the study highlighted massive operational benefits that ripple through the entire healthcare system. In one major implementation, the use of remote monitoring allowed a hospital to eliminate eighty-one transfers of patients between facilities, saving thousands of kilometers of travel and approximately one point two million dollars in costs. It also shortened the time patients needed to stay in the hospital, cutting the average length of stay from over nine days to just over four days, with no increase in complications or readmissions. The technology proved capable of handling a wide variety of needs, from guiding hand exercises for tendon repairs to monitoring the fit of braces for spinal fractures. The tools used ranged from simple video calls on smartphones to sophisticated smart braces equipped with sensors that could track movement and send data directly to a therapist.

However, the path to fully replacing the clinic is not without its hurdles. The researchers identified specific areas where the digital approach still struggles. The most significant barrier is the inability for a therapist to physically touch the patient. In orthotic care, feeling the skin, checking the fit of a brace by hand, and adjusting the device with tactile precision are often essential. While sensors can measure movement, they cannot yet replicate the human hand's ability to palpate a joint or feel a muscle. This limitation is particularly challenging for acute injuries, where patients may feel a heightened fear of moving or damaging their repair, leading to anxiety that is harder to soothe through a screen. Additionally, the technology relies on a stable internet connection, and dropouts in service can disrupt the flow of care. The study also noted that creating custom-made braces entirely online remains difficult, often requiring a mix of remote guidance and an initial in-person visit for fabrication.

Despite these challenges, the evidence points toward a future where care is a blend of both worlds. The researchers concluded that the most effective model is likely a hybrid one, where a patient visits a clinic for the initial fitting and hands-on assessment, and then continues their recovery at home under remote supervision. This approach leverages the convenience and cost savings of digital tools while respecting the physical necessities of orthotic care. The review makes it clear that telerehabilitation is not a magic solution that fixes every problem, but it is a powerful, feasible, and cost-effective alternative that can expand access to care for people who were previously left behind by the limitations of geography and mobility. By combining the best of both physical and digital worlds, the healthcare system can offer a more flexible, efficient, and patient-centered path to recovery.