OCCUPATIONAL THERAPY IN THE CONTEXT OF DIGITALIZATION: AN ANALYSIS OF THE EFFECTIVENESS OF TELE-REHABILITATION INTERVENTIONS

Abstract

As the digitalization of healthcare systems progresses, occupational therapy is adapting by integrating telerehabilitation modalities. The findings include an updated synthesis of telehealth occupational therapy interventions provided separately and with interdisciplinary health care teams. They expand occupational therapy's scope of practice to include interventions provided across the lifespan for rehabilitation and habilitation needs and include effectiveness by conditions. The aim of this narrative review is to synthesize the evidence regarding the effectiveness, safety, and limitations of telerehabilitation interventions applied within the field of occupational therapy, to evaluate implementation and equity factors, and to propose practical recommendations for clinicians and policymakers. Existing literature suggests that in certain clinical contexts (for example, post-stroke recovery), telerehabilitation provides outcomes comparable to shortand medium-term face-to-face therapies; evidence specific to occupational therapy is promising but heterogeneous, and issues related to equity and standardization remain significant barriers.

Headnote

Abstract: As the digitalization of healthcare systems progresses, occupational therapy is adapting by integrating telerehabilitation modalities. The findings include an updated synthesis of telehealth occupational therapy interventions provided separately and with interdisciplinary health care teams. They expand occupational therapy's scope of practice to include interventions provided across the lifespan for rehabilitation and habilitation needs and include effectiveness by conditions.

The aim of this narrative review is to synthesize the evidence regarding the effectiveness, safety, and limitations of telerehabilitation interventions applied within the field of occupational therapy, to evaluate implementation and equity factors, and to propose practical recommendations for clinicians and policymakers.

Existing literature suggests that in certain clinical contexts (for example, post-stroke recovery), telerehabilitation provides outcomes comparable to shortand medium-term face-to-face therapies; evidence specific to occupational therapy is promising but heterogeneous, and issues related to equity and standardization remain significant barriers.

Keywords: occupational therapy, telehealth, telerehabilitation;

Introduction

The digitalization of healthcare services has accelerated markedly over the past decade, with the COVID-19 pandemic further catalyzing the integration of telehealth into therapeutic practice. Occupational therapy- whose core mission is the restoration and optimization of functional performance in activities of daily living (ADLs)-is undergoing a pivotal transformation. Digital platforms now enable remote assessment, intervention, and monitoring, yet questions regarding efficacy, safety, and ethical implications necessitate rigorous evaluation. The purpose of this article is to synthesize contemporary evidence and propose a practical framework for the implementation of tele-occupational therapy. Professional organizations formally recognize telehealth as a legitimate mode of service delivery, while underscoring the need for standardized procedures and structured clinician training.1

Large-scale analyses, including Cochrane reviews, suggest that telerehabilitation may yield outcomes comparable to those of in-person therapy for selected functional domains-particularly among post-stroke populations-provided that interventions are well structured, appropriately dosed, and consistently monitored. Many studies report non-inferiority on established functional measures (e.g., Barthel Index, Functional Independence Measure) as well as on shortto mid-term quality-of-life indicators. Nonetheless, the heterogeneity of intervention formats (e.g., synchronous videoconferencing, assistive digital applications, teleconsultation models) complicates broader generalization and limits the ability to draw universal conclusions.

Systematic reviews focusing specifically on occupational therapy document a steady increase in empirical studies evaluating tele-OT across pediatrics, geriatrics, neurorehabilitation, and chronic disease management. Findings frequently indicate improvements in ADL performance, patient satisfaction, and adherence to therapeutic programs. However, methodological variability-encompassing small-sample randomized controlled trials, pilot studies, and observational designs- continues to constrain the strength of the evidence base.

Target Populations

Stroke, a consistent body of evidence supports the non-inferiority of telerehabilitation for selected functional and communication outcomes in specific post-stroke subgroups. Interventions involving motor retraining, functional re-education, and caregiver-directed coaching can be effectively delivered through remote formats.2

Pediatrics, tele-OT models employing parent-mediated interventions-particularly for autism spectrum disorder and developmental delays-demonstrate promising results. Benefits include improved caregiver engagement, enhanced implementation fidelity, and increased adherence to therapeutic programs.

Orthopedic and Musculoskeletal Conditions, findings remain mixed, remotely supervised exercise-based programs may improve adherence, yet effects on strength, range of motion, and functional performance appear more variable across studies.

Safety, Acceptability, and Retention

The safety profile of telerehabilitation is generally favorable. Recent reviews (2025) report low rates of adverse events directly attributable to remote interventions. Most documented challenges relate to privacy concerns, technical difficulties, or the absence of real-time supervision in situations where acute risk may arise. Patient acceptability and satisfaction tend to be high, and retention rates are comparable to those observed in conventional in-person rehabilitation when adequate technical support and clear instructions are provided. Nevertheless, adverse event reporting remains inconsistently structured, underscoring the need for improved standardization in documentation and monitoring practices.3

Practical and Implementation Considerations

The implementation of tele-OT requires careful attention to several interrelated components:

Platforms and Technology

The selection of digital platforms-secure videoconferencing systems, exercise applications, and remote monitoring devices-must comply with data protection regulations and align with the digital literacy levels of patients and their families. Recent toolkits and guidelines, provide structured templates for remote assessment, informed consent procedures, and emergency response protocols.4

Clinical Protocols and Outcome Measures

The standardization of outcome measures (e.g., COPM - Canadian Occupational Performance Measure, Barthel Index, FIM, and pediatric-specific scales) enhances cross-study comparability and supports reliable monitoring of clinical progress. Clinical protocols should delineate explicit criteria for patient selection (i.e., identifying individuals appropriately suited for tele-OT), recommended session frequency, the role and responsibilities of caregivers, and escalation pathways in the event of emerging complications.

Professional Training

Occupational therapy practitioners require targeted training in both technological competencies and the adaptation of therapeutic interventions for remote delivery (e.g., conducting environmental assessments of the home setting, implementing task-oriented occupational therapy strategies at a distance). Additional competencies include remote communication skills and risk management. Professional organizations increasingly advocate for the integration of telehealth training within university curricula and continuing professional development programs.

Ethics and Equity

The adoption of tele-OT raises significant ethical considerations. Variations in technological access, digital literacy, connectivity costs, and socioeconomic disparities can introduce barriers to care and potentially exacerbate existing inequities in access to rehabilitation services. Rapid equity-focused reviews note that disadvantaged groups-such as older adults with limited financial resources, individuals in rural or underserved areas, and populations with low digital proficiency-may derive disproportionately fewer benefits from tele-OT. To mitigate these disparities, interventions should incorporate compensatory strategies, including the provision of necessary equipment, user-friendly digital training, and hybrid care models that combine in-person home visits with remote sessions.5

Limitations of the Evidence and Research Gaps

Methodological heterogeneity, substantial variability across studies-regarding intervention design, outcome measures, and methodological quality-limits the ability to draw definitive conclusions for many clinical areas.

Lack of long-term follow-up most available evidence focuses on shortto medium-term outcomes; long-term effects and real-world transferability remain insufficiently examined and require extended follow-up periods.

Underreporting of adverse events and ethical concerns, although existing data suggest a favorable safety profile, reporting standards for adverse events, technical failures, and ethical issues remain inconsistent, hindering accurate risk assessment.

Recommendations for Occupational Therapy Practice6

o Clinicians should consider an initial hybrid model, reserving tele-OT for patients who demonstrate acceptability, low clinical risk, and adequate home conditions during the initial assessment. Explicit escalation protocols should guide transitions to in-person care when necessary.

o The use of validated functional instruments (e.g., COPM, Barthel Index, FIM) is essential for enabling comparability across settings and ensuring consistent monitoring of clinical progress.

o Telehealth competencies should be embedded in professional education and supported through ongoing technical assistance for both clinicians and patients.

o Clinicians should systematically document adverse events, technical issues, and patient satisfaction metrics, using these data to guide continuous quality improvement.

Structured Recommendations for Effective and Safe Implementation of Tele-Rehabilitation in Occupational Therapy

Implementation should be guided by a structured, multidimensional framework tailored to the individual's clinical context. Recommendations can be organized across three levels: clinical, organizational, and system-level (health policy).7

1. Rigorous Patient Selection for Tele-OT

Tele-rehabilitation is particularly appropriate for:

* individuals with mild to moderate motor impairments;

* patients with stable cognitive functioning;

* individuals who have reliable family or caregiver support;

* patients with secure internet access and appropriate digital equipment.

Patients who are not ideal candidates include:

* individuals with severe cognitive impairments;

* patients with medical instability;

* individuals at high risk of falls when unsupervised.

An initial face-to-face evaluation is recommended, followed by a structured determination of tele-OT suitability.

2. Adaptation of Interventions to the Home Environment Remote interventions should be:

* ecologically valid, reflecting the patient's real living environment;

* task-oriented, focusing on functional activities such as bathing, cooking, dressing, and mobility;

* progressively structured;

* demonstrable and monitorable via video.

Task-oriented occupational therapy is preferred over isolated exercise routines due to its ecological relevance and functional transferability.

3. Standardizing Assessment and Progress Monitoring

Recommended instruments include:

* COPM (Canadian Occupational Performance Measure) - considered standard for tele-OT;

* Barthel Index;

* Functional Independence Measure (FIM);

* pediatric-specific scales (e.g., PEDI, WeeFIM).

Assessments should be conducted:

* at baseline,

* at 4-6 weeks,

* at program completion.

4. Active Involvement of Family Members and Caregivers Family members act as co-therapists, supporting:

* correct and safe execution of activities

* risk prevention;

* adherence to the therapeutic plan.

Dedicated caregiver training sessions, separate from patient sessions, are strongly recommended.

5. Remote Safety and Risk Prevention

Safety procedures should include:

* providing a structured home safety guide;

* verifying the workspace (furniture, flooring, lighting, hazards);

* establishing an emergency protocol;

* avoiding high-risk activities without physical supervision.

Recommendations for Medical Institutions and Rehabilitation Centers 1. Development of Clear Tele-OT Protocols Institutions should establish comprehensive protocols that include:

* explicit inclusion and exclusion criteria;

* standardized categories of interventions;* specifications regarding duration, frequency, and therapeutic objectives;

* structured plans for assessment and reporting.

2. Continuous Professional Development for Therapists Essential competencies include:

* remote occupational assessment skills;

* effective therapeutic communication in online formats;

* data security and confidentiality practices;

* the ability to adapt interventions to real-life home environments.

Tele-OT should be incorporated into university curricula as well as postgraduate and continuing education programs.

3. Integration of Hybrid Models of Care

An optimal model includes:

* an initial face-to-face assessment;

* a mixed intervention format (online sessions supplemented by periodic in-person visits);

* a final in-clinic re-evaluation.

This model provides:

* increased efficiency,

* enhanced safety,

* maximum flexibility for patients and clinicians.

Recommendations for Health Policy and Management

1. Reducing Digital Inequalities

Recommended strategies include:

* device loan programs;

* subsidized internet access;

* community-based tele-rehabilitation centers;

* digital literacy training for older adults.

2. Legislative Regulation and Reimbursement for Tele-OT

It is necessary to ensure:

* official recognition of tele-OT services;

* inclusion of these services within reimbursement systems;

* clear professional responsibility and accountability standards.

3. Quality Monitoring and Cost-Effectiveness Evaluation

Recommended actions include:

* annual audits of tele-OT interventions;

* analysis of dropout and retention rates;

* evaluation of costs relative to functional outcomes;

* systematic incorporation of patient feedback.

Conclusions

Tele-rehabilitation represents a valuable component of occupational therapy in the context of accelerating digitalization. Growing evidence supports its effectiveness in selected areas-particularly post-stroke recovery-and highlights its potential to expand access to rehabilitation services. While the occupational therapy-specific literature is encouraging, heterogeneity in study designs, methodological limitations, and concerns related to equity continue to limit broad, unqualified recommendations.

Successful implementation requires standardized protocols, robust professional training, stringent data protection practices, and active policy measures aimed at reducing digital disparities. Future research should prioritize well-designed pragmatic randomized controlled trials, long-term outcome evaluations, and comprehensive cost-effectiveness studies to support sustainable policy and practice development.

Tele-rehabilitation in occupational therapy demands a carefully structured approach grounded in rigorous patient selection, standardized assessment, specialized therapist training, active family involvement, and targeted efforts to reduce digital inequities. When implemented effectively, it has the potential to become a durable, safe, and efficient component of contemporary rehabilitation.

References

References:

American Occupational Therapy Association, (2018), Telehealth in Occupational Therapy, American Journal of Occupational Therapy.

Feldhacker, Diana R.; Jewell, Vanessa D.; LeSage, Sadie Jung; Collins Haley; Lohman, Helene; Russell, Marion, (2022), Telehealth Interventions Within the Scope of Occupational Therapy Practice: A Systematic Review, The American Journal of Occupational Therapy, Vol. 76.

Jaswal, S., Lo J., Howe A., Hao Y., Zhu S., Sithamparanathan G., Nowrouzi-Kia B., (2024), The Era of Technology in Healthcare-An Evaluation of Telerehabilitation on Client Outcomes: A Systematic Review and Meta-analysis. Journal of Occupational Rehabilitation, Canada.

Laver, K.E., et al., (2020), Telerehabilitation services for stroke. Cochrane Database of Systematic Reviews, USA.

Shnitzer, H., Chan, A., et al., (2025), The safety of telerehabilitation: A systematic review. JMIR Rehabilitation and Assistive Technologies, Vol. 121, Toronto.

Veras, M., et al., (2025), A rapid review of ethical and equity dimensions in telerehabilitation. International Journal of Environmental Research and Public Health, Basel, Switzerland.

Footnote

1 American Occupational Therapy Association, Telehealth in Occupational Therapy, American Journal of Occupational Therapy, 2018, p. 18.

2 K.E. Laver, et al. Telerehabilitation services for stroke. Cochrane Database of Systematic Reviews, USA, 2020, p. 122.

3 M. Veras, et al., A rapid review of ethical and equity dimensions in telerehabilitation. International Journal of Environmental Research and Public Health, Basel, Switzerland, 2025, p. 1900.

4 S. Jaswal. J. Lo, A. Howe, Y. Hao, S. Zhu, G. Sithamparanathan, B. Nowrouzi-Kia, The Era of Technology in Healthcare-An Evaluation of Telerehabilitation on Client Outcomes: A Systematic Review and Meta-analysis. Journal of Occupational Rehabilitation, 2024, p. 783-799.

5 Diana R. Feldhacker; Vanessa D. Jewell; Sadie Jung LeSage; Haley Collins; Helene Lohman; Marion Russell, Telehealth Interventions Within the Scope of Occupational Therapy Practice: A Systematic Review, The American Journal of Occupational Therapy, Vol. 76, 2022.

6 M. Veras, et al., A rapid review of ethical and equity dimensions in telerehabilitation. International Journal of Environmental Research and Public Health, Basel, Switzerland, 2025, p. 1901.

7 H. Shnitzer, A. Chan et al., The safety of telerehabilitation: A systematic review. JMIR Rehabilitation and Assistive Technologies, Vol. 121, Toronto, 2025, p. 2.