Researchers: Naomi Gefen^1,2, Tal Krasovsky^3,4, Maurit Beeri¹, Jana Landa^4,5, Tamar Weiss^1,3, Efrat Shadmi³

Background: Remote therapy has the potential to save families of youngsters receiving in-person rehabilitation significant time and financial resources. Evidence supporting remote rehabilitation has grown, and during COVID-19, remote services at Sheba and ALYN Medical Centers demonstrated feasibility and satisfaction. Nevertheless, most services quickly reverted to in-person care.

Objectives: To investigate a hybrid program of outpatient rehabilitation (OPR) and telerehabilitation’s potential to maintain therapeutic benefits. We developed, implemented, and evaluated a process by: (a) identifying facilitators and barriers to adoption; (b) developing a hybrid program equivalent to conventional therapy; (c) comparing hybrid and in-person rehabilitation in terms of adherence, therapeutic alliance, perceived quality of care, functional and cost effectiveness; and (d) generating best practice recommendations.

Method: Focus groups with participants who used remote therapy during COVID were analyzed. Conventional OPR was documented for a year, and a two-month hybrid program was offered. Adherence, alliance, and quality of care were examined monthly. Surveys, interviews, and focus groups were conducted of participants who used hybrid services, those who declined the service and a small group of telerehabilitation experts.

Findings: Focus groups highlighted barriers, facilitators, and implications for participant roles and identity. Uptake of hybrid rehabilitation was low among both families and therapists. For those who participated, high adherence and therapeutic alliance were identified with no difference in functional gains compared with standard care. However, both therapists and families generally perceived that remote therapy was inferior to in-person care.

Conclusions: Given current infrastructure and family and therapist acceptance issues, hybrid rehabilitation does not yet appear to justify altering existing care models.

Recommendations: Greater adoption will require better virtual platforms, substantial technical support, caregiver and staff education, financial accessibility and tailored approaches addressing therapist- and family-specific acceptance.

Research end date: 12/2025