Implementation characteristics and outcomes of virtual rehabilitation programs for individuals with spinal cord injury (SCI)

This is a scoping review that will explore the implementation characteristics and outcomes of the virtual rehabilitation programs for individuals with spinal cord injury (SCI). Spinal cord injury (SCI) is a debilitating condition which can be traumatic or nontraumatic in origin and can lead to complete or partial sensory and/or motor paralysis of the body below the level of injury (Nas et al., 2015). In Canada, the estimated prevalence of SCI is approximately 86000 including both traumatic and nontraumatic injury (Noonan et al., 2012), of which 44000 (51%) are traumatic and 42000 (49%) are nontraumatic in origin (Noonan et al., 2012). Of these individuals, 56% are living with paraplegia and 44% are living with tetraplegia (Noonan et al., 2012). The individuals living with SCI often develop many acute and long term secondary complications which include pressure sores/ulcers, urinary infections, bladder and bowel incontinence, autonomic dysreflexia, and respiratory infections which affects these individuals not only physically, but also mentally, socially, and economically and this can cause depression, loss of independence, and reduced quality of life in these individuals (Sezer et al., 2015, Pilusa et al., 2019, Lee et al., 2021, Thorogood et al., 2023). These secondary health conditions are the leading cause of re-hospitalization and increased mortality in individuals with SCI (Sezer et al., 2015, Pilusa et al., 2019). Therefore, it becomes important to prevent or reduce these secondary health conditions in these individuals and this is often overwhelming to the individuals and their caregivers as this process involves early diagnosis, treatment, and rehabilitation which requires multidisciplinary healthcare services (Lee et al., 2021, Touchett et al., 2022). Many individuals have difficulty accessing needed healthcare services due to remote locations and financial and time constraints (Touchett et al., 2022). Also, during the covid-19 pandemic, it became almost impossible for these individuals to access healthcare services as they are immunocompromised and often develop infections very easily and quickly, and the services were also restricted and disrupted during pandemic times (Swarnakar et al., 2023). During the pandemic, tele health or tele medicine emerged as a safe and promising alternative to deliver in-person healthcare services (Touchett et al., 2022, Swarnakar et al., 2023). Rehabilitation services using telephone or video conferencing (i.e., tele-rehabilitation) is helpful to overcome barriers to accessing SCI care and needs to be considered and explored further. Tele-rehabilitation allows individuals to access healthcare through devices (such as a computer or iPad) from convenient locations. Moreover, the global pandemic augmented the use of virtual rehabilitation (Touchett et al., 2022) which is reported to be safe, feasible, and effective in improving self-care and mobility in individuals with SCI (Coulter et al., 2017, Sweet et al., 2017, Swarnakar et al., 2023). A scoping review was done in 2023 to describe and compare the models of telehealth services for community-dwelling adults with SCI. However, there is no evidence available about the implementation characteristics and outcomes of virtual rehabilitation programs for individuals with SCI. Therefore, the objective of this scoping review is to explore the implementation characteristics and outcomes of virtual rehabilitation programs for individuals with SCI. Research question: What literature exists to describe the implementation characteristics and outcomes of the interventions used for virtual rehabilitation of individuals with SCI?

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