The added value of telemedicine services for physical rehabilitation

Despite the huge potential of telemedicine services (increasing accessibility of care, increasing quality of care and lowering of healthcare costs), its implementation in daily clinical practice is very limited and most services fade away after a project or pilot phase. The aim of this thesis has been to contribute to knowledge concerning the added value of telemedicine services for physical rehabilitation. For this, two state of the art evaluation studies of telemedicine services for physical rehabilitation (chapter 2 and 3) have been performed and in addition, the actual use of these telemedicine services and its association between actual use and clinical benefit have been addressed (chapter 5 and 6). Results of this thesis show that telemedicine services have potential to comply with the increased demand of care in the field of rehabilitation and other fields. To provide concrete guidelines to other researchers active in the field of evaluation of telemedicine services the “DeChant” framework [4] is refined into a new stage approach framework focusing on four different aspects 1] evaluation objective, 2] evaluation context, 3] evaluation design and 4] evaluation endpoints. Actual use is an aspect that is hugely underexposed given that it is significantly related to clinical outcome and the measure that reflects real adoption of telemedicine by its end users. In addition, based on the knowledge that actual use of telemedicine decreases over time, it is important that new tools and techniques will be developed that improve actual use. It is hypothesized that this can be realized on one hand by enhancing technologies, such as using ambulant technology that allows objective monitoring and feedback and gaming technology but also by addressing implementation strategies such as implementation intentions