Exploring equity in telehealth interventions in physiotherapy: A meta-epidemiological study

Area of Science:

• Physiotherapy research
• Health equity
• Telehealth interventions

Background:

• Telehealth interventions are increasingly used in physiotherapy.
• Assessing equity in these interventions is crucial for equitable healthcare delivery.
• The PROGRESS Plus framework offers a method to evaluate factors influencing health outcomes.

Purpose of the Study:

• To evaluate the equity of telehealth interventions in physiotherapy research.
• To apply the PROGRESS Plus framework to analyze equity considerations in telehealth physiotherapy trials.
• To identify trends and gaps in research addressing health equity through telehealth.

Main Methods:

• A systematic search of PEDro, CENTRAL, and PubMed databases was conducted for randomized controlled trials from January 2020 to December 2023.
• 94 telehealth physiotherapy trials were included and assessed using the PROGRESS Plus framework.
• Studies were categorized as equity-focused or equity-oriented, with descriptive analysis of characteristics and PROGRESS factors.

Main Results:

• Of 94 trials, 45 were equity-focused and 49 were equity-oriented.
• Equity-focused trials showed favorable outcomes in 62% of cases, addressing factors like residence and race/ethnicity.
• Most trials (86%) showed no social gradients, with only 12% demonstrating a reduction in health inequities.

Conclusions:

• The evidence for equity-focused telehealth physiotherapy interventions remains uncertain, with varied reported benefits.
• Equity-oriented trials showed limited differential effects but some benefits for disadvantaged populations.
• Telehealth equity studies often lack systematic integration of PROGRESS factors across the research lifecycle.