Telerreabilitação: evidências atuais e futuras aplicações

Abstract

Telerehabilitation is defined as the use of a set of resources and technologies of information and communication that allow remote treatment. It has been considered a viable and affordable delivery of health care for people with disabilities, helping to overcome different barriers to access the face-to-face programs. Among the several benefits of telerehabilitation, highlight the capacity to improve the quality of care and increase the equity of access to rehabilitation services, favoring the resolubility of cases, reducing costs and optimizing resources. However, to date there is no consensus as to the effectiveness of exercise-based interventions delivered through telerehabilitation for adults with physical disabilities. Thus, the objective of this dissertation was to investigate the effectiveness of exercise by telerehabilitation in improving pain, physical function and quality of life of adults with physical disabilities through a systematic review with meta-analysis. Initially, a structured search was performed on the following databases: AMED, MEDLINE, CINAHL, SPORTDiscus, EMBASE, PEDro, Cochrane, PsycINFO. We considered only randomized clinical trials (RCT) that evaluated telerehabilitation protocols that included aerobic physical exercises and / or kinesiotherapy. The population included adults (≥18 years) with physical disability. Comparisons were made with two groups: control without intervention and other interventions or active control. The outcomes were pain, physical function and quality of life. The processes of study selection, data extraction and analysis followed the protocol registered in PROSPERO database (CRD42019122824). GRADE determined the strength of current evidence. As a result, 13.007 records were identified by searching the databases. After the screening and eligibility evaluation processes, 54 RCT were included in the final analysis. When telerehabilitation was compared to other interventions, the results showed evidence of moderate quality evidence of small effects of telerehabilitation in reducing pain intensity at long-term (SMD: -0.2; 95% CI: -0.3 to -0.1) and high quality evidence of small effects of telerehabilitation in the improvement of the quality of life at short-term (SMD: 0.3; 95% CI: 0.1 to 0.5). Estimates also showed moderate quality of evidence for no difference between telerehabilitation and other intervention in the improvement of physical function at short-term (95% CI: -0.1 to 0.5) and long-term (95% CI: -0.1 to 0.2), and quality of life at long-term (95% CI: -0.1 to 0.4). The results showed that telerehabilitation appears to be as or more effective than other interventions for improvement pain at long-term, physical function at short- and long-term, and quality of life at short- and long-term. In addition, this strategy of offering rehabilitation seems to be promising in several clinical categories such as musculoskeletal, oncological and cardiovascular, presenting results equivalent to or better than other interventions in improving pain, physical function and quality of life. However, studies of better methodological quality comparing telerehabilitation with control group without intervention are still necessary to assert its benefit and effect.