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

Abstract

[Abstract] Objective: To assess equity in telehealth interventions in physiotherapy research using the PROGRESS plus framework.

Methods: We searched the PEDro, CENTRAL, and PubMed databases from January 2020 to December 2023 for randomized controlled trials evaluating the effectiveness of telehealth in physiotherapy. We selected, extracted, and assessed the characteristics and the PROGRESS factors. The PROGRESS Plus is a framework of factors that influence health outcomes. Telehealth studies were classified as equity-focused and oriented. Data were analyzed descriptively for the characteristics and the PROGRESS factors. We provided a hypothesis-testing approach to describe the three social gradient hypotheses.

Results: We included 94 telehealth equity trials (n = 45 telehealth equity-focused; n = 49 telehealth equity-oriented). Telehealth equity-focused trials demonstrated favorable outcomes in 28 studies (62%), primarily addressing factors such as place of residence, race/ethnicity, and vulnerable populations. Telehealth equity-oriented showed favorable benefits in 15 cases (30%), while 33 trials (67%) incorporated more than one PROGRESS-Plus factor. Most trials showed no social gradients (86%), while few (12%) demonstrated a reduction in health inequities.

Conclusion: Robust evidence for equity-focused telehealth interventions in physiotherapy is uncertain; reported benefits vary, with some studies reporting similar outcomes and others favoring telehealth. Most telehealth equity-oriented trials no differential effects, although they provided some evidence of benefits specifically for disadvantaged populations. Telehealth equity studies often fail to systematically integrate PROGRESS factors throughout the entire research lifecycle.