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Purpose. To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities. Method. Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale. Results. Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, rehabilitation for speech-language impairments, and rehabilitation for varied clienteles. Clinical outcomes were generally improved following a telerehabilitation intervention and were at least similar to or better than an alternative intervention. Clinical process outcomes, such as attendance and compliance, were high with telerehabilitation although few comparisons are made to alternative interventions. Consultation time tended to be longer with telerehabilitation. Satisfaction with telerehabilitation was consistently high, although it was higher for patients than therapists. Few studies examined healthcare utilization measures and those that did reported mixed findings with respect to adverse events, use of emergency rooms and doctor visits. Only five of the studies examined costs. There is some preliminary evidence of potential cost savings for the healthcare facility. Conclusions. While evidence is mounting concerning the efficacy and effectiveness of telerehabilitation, high-quality evidence regarding impact on resource allocation and costs is still needed to support clinical and policy decision-making. [ABSTRACT FROM AUTHOR]

Introduction Virtual reality (VR) can promote functional rehabilitation of arm movements through environments allowing the practice of a variety of tasks while providing feedback [1] . We evaluated an affordable VR system for arm rehabilitation, developed by Jintronix Inc and based on the Microsoft Kinect, that provides three unilateral and two bilateral activities, each with ten difficulty levels. Objectives Our objectives were to (1) determine which activities and levels of difficulty are appropriate for rehabilitation of arm movements in stroke patients with different degrees of motor impairment; and (2) determine the ease of use and subjective experience of patients using the VR arm rehabilitation system. Methods Clinicians each supervised two to four stroke patients who participated in three 20-minute sessions with the Jintronix system. We determined the highest level of difficulty attained by patients in each activity with a performance score of at least 50%. Arm impairment was assessed using the upper extremity section of the Chedoke-McMaster Scale (CM) [2] . Patients and clinicians completed a questionnaire on the usability of the Jintronix system, based on the technology acceptance model (FD Davis [3] ). Results Fifteen clinicians supervised a total of 40 stroke patients. Over 80% of the clinicians and patients provided positive feedback in terms of ease of use and VR experience. For each activity of the Jintronix system, results indicated a positive correlation between the CM score and the maximal difficulty level reached by stroke patients. Discussion Our data demonstrate the feasibility of using an affordable VR arm rehabilitation system in a clinical setting and provide clinical guidelines for the selection of impairment-specific difficulty levels. [ABSTRACT FROM AUTHOR]