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Telerehabilitation and Smartphone Apps in Physiotherapy

Original Editor - Oriana Catenazzi, Alicia Rebellato, Hannah Meredith, Aaron Kirk, Martin Fitheridge, Marco Zavagni as part of Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice Project
Top Contributors - Oriana Catenazzi, Alicia Rebellato, Aaron Kirk, Hannah Meredith, Marco Zavagni, Martin Fitheridge, Kim Jackson, İbrahim Seker, Vidya Acharya, 127.0.0.1, Admin, Tarina van der Stockt, Alexandra Stead, Tony Lowe and Michelle Lee

Introduction

The rapid evolution of technology has allowed health professionals to begin to adapt to these changes and deliver healthcare in a new, remote fashion. More recently, mobile health (mHealth) has been integrated, which refers to the concept of using mobile devices, such as phones, tablets and smartphones in both medicine and public health[1]. mHealth is seen as an enabler of change worldwide because of its high reach and low-cost solutions[1]. The change towards technology-based practice and more specifically smartphone-based applications is an extremely relevant area for health professionals to effectively communicate and treat a variety of patient groups. Therapeutic compliance has been a topic of clinical concern since the 1970s due to the widespread nature of non-compliance with therapy and rehabilitation programmes[2]. It can be proposed that these recent advances in technology can help improve therapeutic outcomes. 

Specific to physiotherapy home exercise programmes, smartphone applications provide a new and emerging way to deliver physiotherapy that promotes active participation from both the physiotherapist and patient throughout the course of treatment.

Overview of Telerehabilitation

Definition and Scope of Telerehabilitation

In recent years, technology has revolutionised all aspects of medical rehabilitation, from developments in the provision of cutting edge treatments to the actual delivery of the specific interventions[3]. Telerehabilitation refers to the use of information and communication technologies (ICT) to provide rehabilitation services to people remotely in their home or other environments[3]. Such services include therapeutic interventions, remote monitoring of progress, education, consultation, training and a means of networking for people with disabilities[4].

Patient Empowerment and Accessibility

Using technology to deliver rehabilitation services has many benefits for not only the clinician but also the patients themselves. It provides the patient with a sense of personal autonomy and empowerment, enabling them to take control in the management of their condition[3]. In essence they are becoming an active partner rather than a passive participant in their care. It enables access to care for individuals in remote areas or for those who have mobility issues associated with physical impairment, access to transport and socioeconomic factors[4]. In addition, it cuts down the associated travel costs and time spent travelling for both the healthcare provider and the patient[5]. Research has found that the rehabilitation needs for individuals with long-term conditions such as stroke, traumatic brain injury (TBI ) and other neurological disorders are often unmet in the patient’s local community[4][6].

Continuity of Care and Functional Outcomes

As telerehabilitation expands, patient continuity of care improves. It enables clinicians to remotely engage and deliver patient care outside of the medical setting, thus eliminating the issue of distance between clinician and patient[3]. This opportunity to continue rehabilitation within the patient’s own social and vocational environment should lead to greater functional outcomes[7].

Demographic Drivers and the Shift Toward Self-Management

The shift in the global demographics towards an increasing elderly population brings with it an associated increase in chronic health conditions[8]. This highlights the need for changes to be made in the delivery of rehabilitation services with the incorporation of self-management strategies and technology. In 2022, people aged 65 and over already made up 19% of the UK population, with projections now extending to 27% by 2072[9].

Predicted growth in the elderly population in the UK
(National Statistics 2012)

Growing numbers of elderly people have an impact on the National Health Service (NHS), incurring considerable health costs due to the growing demand for treatments[10]. It is hoped that by integrating telehealth measures, these costs will be reduced. Shambushankar et al. (2025) found a significant improvement in patient outcomes when using telerehabilitation with a 90% reduction in cost in comparison to in-patient rehabilitation[11].

Generally, most systematic reviews that have been carried out investigating the efficacy of telerehabilitation report the patient’s perspective on its use as a positive experience with significant clinical outcomes[12][13]. The hope for the future is to continue to develop and use new, innovative technologies that will transform current practice and make telerehabilitation an integral part of healthcare[4].

Progression of Technology

Early Developments in Telerehabilitation

Telerehabilitation for physical disorders has been short-lived. The problems that arose for this type of rehabilitation stemmed from the difficulties it imposed on the so-called “hands-on” therapies, particularly physiotherapy and occupational therapy[4]. However, as technology has progressed in healthcare, the possibilities for effective telerehabilitation in therapies such as these have improved.

Progression of technology in telerehabilitation

Early research into telerehabilitation was introduced with small pilot studies. In some of the first projects, clinicians used the telephone to provide follow up and to administer self-assessment measures[14]. From this, telerehabilitation continued to progress into the 1980s with pre-recorded video material for client use and interaction[15].

Eventually, live interactive video conferencing was introduced[16]. The potential uses for video conferencing in healthcare and telerehabilitation became apparent in the 1990s with many projects being carried out in physiotherapy. In a randomised control trial (RCT) by Russell and colleagues (2011)[17], the efficacy of this internet-based telerehabilitation system was assessed versus conventional physiotherapy in the provision of outpatient rehabilitation to patients who had received total knee replacement (TKR). Comparable results were reported with the two rehabilitation methods and patients were satisfied with the telerehabilitation treatment provided[17]. Additionally, a systematic review and meta-analysis of RCTs demonstrated that telerehabilitation after TKR provides functional outcomes and range of motion comparable to face-to-face rehabilitation, while offering a more cost-effective alternative for patients[18].

Monitoring In Telerehabilitation

The use of videoconferencing allows for the provision of consultations, diagnostic assessments and delivery of treatment interventions as well as providing verbal and visual interaction between participants[19]. However, problems lay initially in the inability to measure participant’s physical performance as clinicians can only see the patient in limited perspectives; for example, in physiotherapy, these would include measures such as range of motion and gait. This was soon overcome by measurement tools that were able to objectively quantify participant’s physical performance[20]. By integrating skeletal motion capture with plantar pressure sensor data, Mészáros et al.[21] enable the recording of home-based exercise sessions, thereby providing clinicians with a 3D virtual environment for asynchronous review. Additionally, developments continued to be made using remote therapeutic monitoring (RTM) such as vital signs, blood glucose, or electrocardiogram tracings, using wearable or implanted sensors for within the home which further enhanced the benefits of these new innovative technologies of telerehabilitation[22]. These developments provided a means of home-based exercise monitoring by the patient and the rehab professional while also enabling the professional to track patient compliance to specific exercise programmes[19].

Immersive Technologies: Virtual Reality and Exergaming in Physical Therapy

Virtual environments are another technological method introduced to healthcare. Virtual reality (VR) combines computer-generated immersive environments with motion tracking and interactive feedback to facilitate exergaming, transforming traditional physical exertion into highly engaging simulated experiences[23] [24]. It enables healthcare professionals to design environments which can be used in areas such as surgery, physical rehabilitation and education and training. In terms of physiotherapy, a comprehensive umbrella review by Marcomini et al.[25] demonstrates that virtual reality (VR) interventions significantly improve balance, functional mobility, and respiratory outcomes, particularly in chronic conditions like stroke and Chronic obstructive pulmonary disease (COPD). Additionally, this technology enhances patient motivation and engagement whilst effectively mitigating psychological symptoms such as anxiety and pain. A systematic review including 19 primary studies by Yosafat et al. [23]demonstrated that VR-based exercise can promote moderate-intensity cardiovascular responses and improve outcomes such as VO₂max, VO₂peak, heart rate, and functional capacity.

The Rise of Mobile Health (mHealth) and Smartphone Applications

In recent years, smartphones have revolutionised communication within the medical setting. This modernisation is allowing the opportunity to provide medical support when and where people need it.  Recently, it has been reported that half of smartphone owners use their devices to get health information[26], with nearly two-thirds of smartphone users actually using health related applications (apps)[27]. There are a wide range of mobile apps available for healthcare professionals, medical students, patients and the general public [28].

mHealth Applications in Clinical Practice

In the innovation of mobile technology, mHealth in particular is helping with chronic disease management, empowering the elderly, reminding people to take medication at the right time, undergo scheduled exercise, extending service to underserved areas and improving health outcomes[29]. There is currently a vast range of mobile apps, interactive tools and podcasts that cater to an array of healthcare conditions and disabilities both formal and informal, recognised and promoted by the NHS[30]. In 2024, there were an estimated 54,546 health-related apps available[31]. Those formal in nature allow patients to record and send health measures and send them electronically to physicians and/or specialists. According to the systematic review findings, the greatest facilitator in the adoption of eHealth interventions is the enhancement of healthcare quality and clinical management, whilst the most critical barriers are financial constraints and disruptions to the workflows of healthcare professionals[32]. Commercial and clinical data demonstrate that up to 71% of users disengage within the first 90 days, with the sharpest decline occurring in the initial weeks. This widespread attrition is primarily driven by technical instability, burdensome manual tracking, and a critical absence of clinician-led, human-in-the-loop interaction, underscoring that technical availability must be matched with sustained engagement strategies to achieve true rehabilitative success[33].

As such the National Delivery Plan 2012 documented that by deploying technology in healthcare it “provides an opportunity to treat patients in new ways and helps manage rising costs and demand”[34]. Theoretically, this allows for greater access to healthcare provisions, availability of care and supports self management and prevention in routine care, thereby reducing unnecessary admissions therefore speeding up the treatment of patients requiring medical intervention) and helps to reduce healthcare costs in an ageing population[35].

Currently, a number of generic healthcare apps are available for download to cater for many different acute and chronic conditions, having been approved by either the NHS or the private sector. Furthermore, many function as self-assessment, screening, and testing tools, as well as symptom checkers, goal setters, and treatment or exercise logs. Others provide collections of support videos and advice.

Using Smartphone Applications in Physiotherapy

Telerehabilitation via smartphone applications includes many factors that have an impact on the patient’s ability to respond and agree to treatment in the form of home exercise programmes (HEPs), as well as the potential for healthcare and physiotherapy smartphone applications to deepen the patient-physiotherapist relationship and improve overall rehabilitation of the patient in a musculoskeletal setting[36]. 

In an outpatient setting, a HEP is tailored to an individual patient and targets their specific problems, as identified by the Physiotherapist. This exercise schedule, modified with repetitions, sets and/or additional strengthening/ endurance components, is to be performed by the patient in their home environment between treatment sessions with the Physiotherapist[37]. Continuation of training at home ensures that a patient will begin to improve and that their progress can be monitored throughout time. The continued tailoring of the HEP from each session by the physiotherapist must be complemented by the patient’s continued determination and trust in their shifting programme[38]. The understanding and commitment between both the patient and their physiotherapist to achieve both short-term and long-term goals indicates a better outcome for the patient once they are back to (or potentially better than) their baseline. However, various reports monitoring patient compliance with and to a HEP show non-adherence rates to be as low as approximately 70- 80%[39][40][41].

In addition to factors and models described above such as goal setting, self-efficacy, intrinsic and extrinsic motivation (self-determination theory) and the transtheoretical model there are other circumstances which can affect the ability of patients to respond positively to a home exercise programme. While demographics such as age and gender have been shown to have little effect on these rates[39], there are a few factors that have been discovered and discussed in the research that may affect compliance such as:

  • Low levels of physical activity at baseline
  • Anxiety, depression and pain
  • Poor social support
  • Greater perceived barriers to exercise
  • Poor understanding about their condition
  • Difficult to commit to the time needed to exercise
  • High cost of treatment


Identification of these modifiable barriers enables physiotherapists, working alongside the multidisciplinary team, to implement targeted strategies to support patient engagement, promote self-efficacy, and optimise rehabilitation outcomes. Failure to address such barriers contributes to persistently low adherence rates and represents a significant impediment to full functional recovery.

Data Protection

With the increasing number of smartphone applications and rapid progression of telerehabilitation services available worldwide, it is important that the physiotherapist is aware of the quality and protection that the software offers. In the UK, compliance with the Data Protection Act[42] is a minimum standard to protect your information and rights. The following table describes key rules so that information is:

(Scottish Government 2015)
(Scottish Government 2015)


Many applications provide a global sample of physiotherapy home exercise programmes available through smartphone applications. Under the ‘terms and conditions’ and ‘privacy policy’ section of each application, they specifically describe data protection as well as liability concerns for using their software[42]. Importantly, they all describe in some form that the company is not to be held liable for any health concerns that have occurred while using the application[43]. The physiotherapist must ensure that they are adequately insured [44]. This is extremely important for all applications, but specifically PhysioAdvisor[45], as the patient can utilise resources to assist with self-diagnosis and have independent control over creating their own exercise program. It is important for both patients and physiotherapists to make themselves aware of the terms and conditions when using external applications[42].

Cost Effectiveness

The common occurrence of patients’ failing to attend scheduled appointments results in loss of revenue, underutilisation of the healthcare system as well as prolonged waiting lists[46][47]. A smartphone application is a potential method to prevent cancellations through effective reminder systems. Each application costs a small renewable fee which is based on the number of physiotherapists and or clinics that require a subscription . Important to note is that therapeutic non-compliance has been associated with excess urgent care visits, hospitalisations and higher treatment costs[48]. These applications can be seen as an investment for the clinic or hospital to help increase efficiency, reduce cancellations and prevent future health care demand[46]. While these applications provide an exciting new outlet for physiotherapy to proceed towards in the future, there are some barriers and limitations to the successful implementation of these new technologies. Through a discussion and understanding of these obstacles, further research can be directed at ways to improve and adapt technologies to suit the current needs of healthcare.

Summary

With the ever enhancing realm of technology and mHeath applications, the future generation of physiotherapists must be aware of the evolving changes in technology to make physiotherapy an interactive environment with the patient. This will support an increase in motivation and facilitate participation in a home exercise programme. As one review discovered, non-compliance remains a major issue in improving healthcare outcomes despite many studies highlighting this ongoing issue over the years[2]. The new face of physiotherapy applications can facilitate patient adherence by creating an interactive exercise environment that promotes self-efficacy and behaviour change through enhanced communication, goal setting and progress reporting means. As this wiki has highlighted, there are many links that can be made between the models of behaviour change and some of the smartphone applications discussed here, however due to wide variation in terms of study designs and applications, it is difficult to pinpoint potential influences of mobile-phone based strategies on physical activity behaviour[49]. Additionally, the effectiveness of smartphone applications to improve health behaviours is an emerging field of research[50].

Government highlights for our way forward, we need to improve sustainability and value by establishing a baseline, and developing consistent outcome measures and indicators to track the impact of telehealth and telecare on working practices, productivity and resource use[34]. Future research is necessary to focus on these novel physiotherapy applications and the effect on patient behaviour change and patient experience. Research should also target physiotherapy programmes administered via these applications to identify any advances in rehabilitation and home exercise programmes.

References

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