What does “tele” do to rehabilitation? Thematic analysis of therapists’ and families’ experiences of pediatric telerehabilitation

Pediatric telerehabilitation has become increasingly common with the advent of simple video-conferencing technologies and following the COVID-19 pandemic. This research aimed to ascertain the impact of the technology-facilitated shift in therapy format from in-person to remote (at home) settings, as experienced and described by families and therapists. Two focus groups were conducted, one with 10 families who received telerehabilitation and another with 14 therapists who provided these services for children in care at two rehabilitation institutions. A six-phase inductive thematic analysis was conducted. Three themes were generated, describing the dynamic processes set in motion when remote rehabilitation was introduced: (1) reconstructing conventional therapy, (2) deconstructing conventional therapy, and (3) home as a new therapeutic opportunity. Inspired by actor–network-theory, we contend that “technology”, and “home” are added as actors when the pediatric therapeutic alliance is conducted remotely. This new therapeutic alliance network has the intended consequences of rehabilitating function and skills, but it also impacts the relationships, roles, and self-perceptions of all participants (unintended consequences). A deeper understanding of these changes facilitates a rethinking of pediatric telerehabilitation’s goals and toolboxes. Practically, we suggest a remapping of roles, goals, and relationships in the light of the new therapeutic opportunities offered by telerehabilitation. New technologies that are introduced into the pediatric rehabilitation therapeutic network will likely affect the participants’ positions, actions, and meanings.The results of the presented analyses clarify the unintended consequences on roles and relationships, making them more transparent to all rehabilitation participants.In order to reconstruct conventional pediatric rehabilitation settings at home, the family needs to be willing and able to provide an intimate and enabling setting.All participants need to invest time in establishing and reinforcing connections between the children, families, and therapists to accommodate their changing roles in the network. New technologies that are introduced into the pediatric rehabilitation therapeutic network will likely affect the participants’ positions, actions, and meanings. The results of the presented analyses clarify the unintended consequences on roles and relationships, making them more transparent to all rehabilitation participants. In order to reconstruct conventional pediatric rehabilitation settings at home, the family needs to be willing and able to provide an intimate and enabling setting. All participants need to invest time in establishing and reinforcing connections between the children, families, and therapists to accommodate their changing roles in the network.