Tele-rehabilitation in rural Nepal: a systematic review of effectiveness, barriers, and strategic directions for digital health equity

Access to rehabilitation services in many low-and middle-income countries (LMICs) is still very unequal, especially for people living in rural or remote areas. Distance, cost, weak infrastructure, and limited digital access make it difficult for patients to receive the care they need. Tele-rehabilitation, which means providing rehabilitation support through online or digital tools, has the potential to reduce these gaps. This review brings together current evidence on how well tele-rehabilitation works in LMICs, with special attention to rural Nepal. Using the PRISMA 2020 guidelines, this study focused on major databases from 2010 to 2024 and selected 28 relevant studies, including clinical trials, cohort studies, and qualitative research. Overall, the results show that tele-rehabilitation can provide benefits similar to traditional in-person care, especially for stroke, musculoskeletal problems, and neurodevelopmental conditions. Several challenges were identified, such as weak internet networks, low digital skills, limited access for women, and lack of supportive policies. At the same time, important strengths were also seen, including increasing mobile phone use, blended service models, culturally tailored applications, and support from community-based digital helpers. Using behavioral science models-such as TAM, HBM, and DOI-the review shows that people are more likely to use tele-rehabilitation when they feel it is useful, easy to manage, supported by their community, and when they can clearly see the benefits. For Nepal, integrating tele-rehabilitation into the national e-health plan, improving digital access, and designing services that fit local needs will be crucial. Finally, results highlights that tele-rehabilitation, when guided by practical theories and local realities, can play a major role in improving fair access to rehabilitation care in rural LMICs.