Exploring Digital Rehabilitation: Perspectives of Rwandan Service Users and Professionals.

Access to rehabilitation services

Twenty-seven clients and six rehabilitation professionals (primarily physiotherapists) participated in interviews conducted during September and October 2022. The interviews aimed to assess Rwanda’s current rehabilitation landscape and explore participants’ experiences with digital rehabilitation.

This study was the first in Rwanda under the DIRECT project. Both rehabilitation professionals and clients were interviewed at different locations in Kigali and Musanze (e.g., in Figure 1). All the professionals interviewed participated in our pilot study exploring Physitrack, our partner’s digital rehabilitation solution. Other participants included current rehabilitation clients, those using Physitrack, and those needing but lacking access to services. Rehabilitation was most often sought for musculoskeletal issues like low back pain, injuries from accidents (traffic or otherwise), and conditions resulting from childbirth. For some, this meant less participation in housework, employment, or job seeking.

While opinions varied on rehabilitation services’ accessibility, most clients felt they were inaccessible. The barriers to accessing rehabilitation services included:

• The uneven distribution of rehabilitation professionals causing long wait times, as a small number of professionals serve many patients in district and provincial hospitals.
• Travel distance. Long travel distances to access rehabilitation services, especially in remote areas.
• Getting a referral. Obtaining referrals for rehabilitation services from lower-level health facilities to district and provincial hospitals was challenging.
• Conflicting diagnoses by medical professionals. This results in extended visits to healthcare facilities without adequate care.
• The cost. The cost is high, particularly for people requiring specialized, long-term care. Not all people have access to government-sponsored community-based health insurance (CBHI), and even when available, coverage is not comprehensive. Physical therapy is the only rehabilitation covered, and the number of annual sessions is capped. Private clinics often require 100% out-of-pocket payment because they do not accept CBHI.
• Lack of assistive devices/equipment needed for some exercises.
• Lack of information. Insufficient information about rehabilitation services is a significant problem, particularly in underserved, remote regions.

Although access was difficult and professionals are few, most clients valued the care they received. Clients felt reassured by the professionals and comfortable discussing their challenges.

Participants’ experiences with Physitrack

Both professionals and 14 of the 27 clients who used Physitrack (Grodon et al., 2024; “Physitrack® – The World Leader in Remote Patient Engagement and Telehealth”, n.d.) reported positive experiences, noting its user-friendliness in comparison to a prior system. Therapists can use Physitrack’s extensive exercise library to create and share personalized exercise plans with their clients. It offers home exercise programs through its mobile application (PhysiApp) and a clinician portal. Physitrack offers patient education materials, tracks patient-reported outcomes, and enables remote monitoring and communication (Grodon et al., 2024; “Physitrack® – The World Leader in Remote Patient Engagement and Telehealth”, n.d.).

A trial solution implemented by professionals during the Covid-19 pandemic failed because it needed users to have email, which was a barrier for many of their clients. Interviewees reported using Physitrack for periods ranging from one week to four months. Neither clients nor professionals had prior experience with digital rehabilitation technology. Most respondents’ experience with digital rehabilitation was limited to using WhatsApp to share instructions and watching exercise videos on YouTube.

While people are often reluctant to embrace new technologies, their views shift once they understand the personal advantages. Those in need of rehabilitation, upon learning of Physitrack, were eager to use it due to its remote rehabilitation features and exercise library.

Other benefits mentioned included:

• Fewer in-person appointments with professionals meant lower transportation costs.
• It saves time; you can exercise at your leisure and manage other tasks as your schedule allows.
• Clients recovered faster because home exercise was easier, improving their overall health. Clients occasionally struggled to recall their exercise plans following appointments, a problem mitigated by Physitrack.

Unlike before, when conditions deteriorated between sessions, professionals observed continuous progress with Physitrack because it improved clients’ commitment to their exercise plans. Professionals also mentioned these additional benefits:

• Access to a vast library of exercises for different body parts increased their knowledge.
• Improvements in their productivity and ability to serve clients more efficiently.
• Monitoring client app usage and progress was easier.
• More effective client guidance and better exercise programs led to improved client interaction.
• The system allowed creation of customized exercises for severe cases lacking pre-made templates.

Many respondents cited inconsistent internet access as a major hurdle, making it hard to download and stream exercise videos. This probably explains the lack of remote video sessions and limited app communication. Professionals typically used WhatsApp or local calls to answer client questions and for follow up. A lack of compatible devices and mobile phones prevented some clients from using Physitrack.

Improving access to rehabilitation services

Professionals are optimistic about the growth of Rwanda’s health and rehabilitation services but recognize that significant work remains. The Ministry of Health is digitizing health services and holding ongoing consultations to secure more resources and develop targeted rehabilitation policies.

During their brief experience with Physitrack, respondents recognized its potential to improve access to and delivery of rehabilitation services throughout Rwanda. According to a physiotherapy department head, increased use of systems such as Physitrack by professionals would simplify her work and allow for greater focus on developing her management skills and expertise. A major benefit in Rwanda is the near-total internet connectivity within its healthcare facilities. Broader public internet access and digital literacy training are necessary, however. This also includes providing healthcare institutions with the necessary equipment.

To complement the digitalization of health services and digital skills training, public outreach initiatives and enabling health policies are needed from the Ministry of Health. Suggestions included: 1) Facilitating early interventions for disorders or disabilities by having relevant professionals present at birth. 2) Raising awareness about the rights of people with disabilities and the significance of rehabilitation, and 3) Increasing the number of rehabilitation professionals at all levels of the public health system.

Addressing the third point requires legislation and the creation of specific rehabilitation policies, such as:

• A tendering committee for assistive devices and other equipment.
• Creating more specialised rehabilitation centres comparable to provincial or district hospitals.
• Incentivizing digital rehabilitation in the healthcare policy by offering reimbursements and addressing professionals’ financial concerns.

Read more

• Start of research activities in Rwanda and preliminary discussions about research collaboration in Kenya
• An overview of the first year’s activities and future project plans
• Initial research activities in Kenya