Implementation considerations for a telerehabilitation system to improve patients’ adherence to home-based physical exercises: a qualitative study

Physiotherapists often prescribe home exercise programmes (HEP) to aid in the recovery of their clients with disabilities, which are often poorly adhered to by clients, and can lead to poor clinical outcomes. To improve HEP adherence, our team has proposed a gamification-based telerehabilitation system, which integrates gaming elements (e.g., challenges, rewards, and interactive features) with remote monitoring and guidance from physiotherapists. The purpose of this study was to explore the attitudes, preferences, and experiences of both clients and physiotherapists with gamification-based telerehabilitation solutions as a means to improve clients' adherence to HEP. A qualitative study using semi-structured interviews was conducted with clients who underwent physical therapy within the past 2 years (<i>n</i> = 8), and physiotherapists (<i>n</i> = 8). The interviews explored attitudes, preferences, and/or experiences related to using technology to support clients' and physical therapists' needs. An inductive thematic analysis was used to analyse the data. Four main themes were identified: (1) Virtual and in-person rehabilitation programmes, (2) Adherence to HEP, (3) Users' preferences towards the technology, and (4) Technology consideration for HEP application. The findings from clients and physiotherapists highlight important design and implementation considerations for a remote gamification system aiming to improve adherence to HEP.