Implementation and Adoption of Telerehabilitation for Treating Mild Traumatic Brain Injury.
Kody R Campbell, Jennifer L Wilhelm, Natalie C Pettigrew and 3 others
PMID 35666882WHAT IT FOUND
Tele-rehabilitation for mild traumatic brain injury was safe and feasible, but symptoms improved less than with in-person care.
The remote program removed hands-on cervical therapy, supervised aerobic exercise, and challenging balance tasks, which likely limited recovery compared to the full in-person protocol.
Key findings
01Tele-rehabilitation was safe and feasible, with high session attendance and no adverse events, though home exercise adherence was lower than in-person care.
02Symptom reduction was smaller in the tele-rehabilitation group compared to in-person care, with moderate effect sizes versus large effect sizes.
03The tele-rehabilitation protocol was diluted, removing manual therapy, supervised aerobic testing, and eyes-closed or foam-surface balance exercises due to safety and equipment limits.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The tele-rehabilitation group was very small (17 participants) compared to the in-person group (56), limiting statistical power. The study was not randomized and had no control group, so differences in outcomes could be due to other factors. The tele-rehabilitation protocol was intentionally 'diluted' (removing manual therapy and high-risk balance exercises), so the results reflect a modified program, not a direct comparison of the same treatment delivered remotely. Home exercise adherence was lower in the tele-rehabilitation group, which may have contributed to smaller symptom improvements, but it is unclear if this was due to less exercise being done or less accurate reporting. There were no objective measures of balance or gait in the tele-rehabilitation group due to equipment and space constraints. The groups differed in sex distribution, with the tele-rehabilitation group having significantly more males, which may affect symptom presentation and recovery.
Declared interests
The authors report no conflicts of interest. The study was funded by the U.S. Government (Non-P.H.S.).
The easy way to misread this
Do not conclude that tele-rehabilitation is equally effective as in-person care for mild traumatic brain injury. The smaller symptom improvement in the remote group likely resulted from the removal of key treatment components (manual therapy, supervised aerobic exercise, and challenging balance tasks), not just the delivery method. A fully equivalent remote protocol might yield different results, but this study tested a modified, less comprehensive version.