A systematic review of the evidence for telerehabilitation in the facilitation of physical activity participation and management of long-term morbidities in cancer survivors
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Background: Advances in the oncological field have resulted in a rapidly growing population of cancer survivors. Post-cancer treatment, many individuals have reported the development of persistent physical, emotional and/or cognitive issues and a reduction in physical activity levels. Increases in the utilization of technological devices has enabled the provision of telerehabilitation-based interventions to increase physical activity participation for the management of long-term morbidities within this population. The current evidence-base indicates that telerehabilitation interventions are effective; however, a systematic review is necessary to determine whether it can be established as a more effective alternative to conventional care. Objective: The primary aim of this systematic review was to evaluate the evidence-base pertaining to the use of telerehabilitation in the facilitation of physical activity participation and the management of long-term morbidities in cancer survivors; and establish whether it was more effective than conventional care. Search Strategy: A pre-determined set of key words were utilized. The searches were completed in April-June 2017 on the following databases: Health and Technology Assessment, MEDLINE, CINAHL, PubMed, PEDro, Google Scholar, Cochrane, The Knowledge Network and Science Direct. Selection Criteria: All quantitative study designs that fulfilled a pre-determined inclusion criteria and compared post-cancer treatment telerehabilitation interventions with conventional management in the facilitation of physical activity and management of long-term morbidities in cancer survivors were accepted. Data Collection and Analysis: Two reviewers independently extracted data and assessed the methodological quality of all studies using the Cochrane Collaboration’s Risk of Bias Tool. Studies were graded across seven domains as being ‘low’, ‘high’, or ‘unclear’ risk of bias with supporting judgements. Results: Eight articles graded as ‘high’ or ‘unclear’ for performance bias were selected for inclusion in this systematic review. Of the selected studies, four found significant differences in physical activity levels between the intervention arm and control group. Five studies also iv found significant improvements in quality of life. Results of studies varied in outcomes for psychological factors and no real differences were found cancer-related fatigue and pain. None of the studies reported data on cost-effectiveness. Conclusion: A definitive conclusion regarding the increased effectiveness of telerehabilitation interventions in the facilitation of physical activity participation and management of long-term morbidities among cancer survivors could not be drawn due to variability of outcome measures and results. However, the majority of studies demonstrated that telerehabilitation was more effective than conventional management in improving physical activity participation and quality of life within this population. This promising trend indicates that telerehabilitation-based physical activity interventions can be utilized as a more effective alternative to conventional care in the near future; however, additional research is required in the various modalities of telerehabilitation and its cost-effectiveness.