An Exploration of the Acceptance of Telerehabilitation in Saudi Arabia: Physiotherapists' and Patients' Perspectives

Abstract

Background: Providing long-term treatment and monitoring for patients, especially those with neurological conditions, requires resources which are not always available. Consequently, finding innovative solutions that can ease the financial and physical burden of chronic conditions is essential. Telerehabilitation offers a potential solution to this challenge, and it was widely used during the COVID-19 pandemic, when face-to-face rehabilitation services could not be provided. However, despite its clinical effectiveness, previous studies suggest that its application may be impeded by users’ concerns, and an inadequate understanding of the practical implications of the discipline. The number of people with chronic disabilities in the Kingdom of Saudi Arabia (KSA) exceeds one million, and these patients require regular sessions with physiotherapists; however, accessing rehabilitation services can be difficult and costly, especially for those in rural or remote areas. Although telerehabilitation was used in the Saudi healthcare system before the pandemic, no formal framework to support its implementation exists and the potential barriers to its wider adoption in the country have not been clearly identified. As a result, this study explores the acceptance of telerehabilitation among physiotherapists and patients with neurological conditions in KSA and proposes a potential strategy for its nationwide implementation which takes account of the country’s large geographic area and its socio-religious context.

Methods: This study adopts a pragmatic philosophical paradigm and employs the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) models to identify the factors which influence Saudi physiotherapists’ and patients’ acceptance of telerehabilitation. It also utilises Q methodology to gather and analyse the data, introducing a novel online approach to data collection in response to the limits on face-to-face engagement as a result of the pandemic.

Results and discussion: The physiotherapist participants viewed telerehabilitation as beneficial, particularly for patients in rural or isolated areas, but they expressed concerns about data security, and the lack of training and technical support. The use of Q methodology enabled them to be categorised into three attitude-based groups: Advocates, who supported telerehabilitation for its cost-effectiveness; Pragmatists, who were open to healthcare technology but emphasised the need for better patient understanding of the uses of telerehabilitation; and Hesitants, who were uncertain and concerned about missing important clinical information. The patients with MS had varied perspectives, appreciating potential benefits, such as cost savings, but expressing concerns about data security and highlighting the lack of support from family and friends as a potential barrier. These patients were also categorised into three groups: Supporters, who recognised telerehabilitation's benefits but had concerns about a lack of suitable space at home and would prefer to be treated by a physiotherapist of the same gender; Rationalists, who accepted telerehabilitation's potential benefits but who thought more resources were required in order to accept it; and Resisters, who questioned its effectiveness over face-to-face rehabilitation. Barriers to telerehabilitation acceptance included the lack of facilitating conditions, such as training, guidelines, and equipment, individual differences such as age, gender knowledge, digital literacy, and medical conditions, and social influence, such as lack of support and encouragement from physiotherapists and family and friends to use telerehabilitation. These findings informed the development of a logic model for a strategy to implement telerehabilitation in KSA, which considers religious and cultural beliefs in KSA, and addresses the barriers identified above. The model sets out the desired outcomes, necessary inputs, and activities for physiotherapists, patients and healthcare services. It also lists the short-term, medium-term, and long-term outputs, the assumptions on which the model is based, and the external factors which might affect its implementation, including the rapid rate of social change in KSA.

Conclusion: This study fills a gap in the literature by examining users' perceptions of telerehabilitation in KSA and identifying the barriers to its acceptance among two key stakeholders groups. The logic model contributes to society by outlining a strategy for the implementation of telerehabilitation in KSA, and, potentially, in other countries which share its cultural and religious values. The study also contributes to Q methodology by demonstrating an innovative method for online data collection and evaluating its effectiveness. In addition, the use of Q methodology in combination with the TAM and UTAUT models provides a methodology to assess user acceptance of healthcare technologies which could be used in other contexts. As such, the findings of this study are of immediate value to policy makers and healthcare providers in KSA, but they also have wider implications. Future research in the Saudi context should focus on the feasibility of the proposed strategy, including cost-benefit analyses and practical trials, and exploring perceptions in other rehabilitation fields, such as occupational and speech therapy.