Provider perspectives on safety of telerehabilitation and risks of nonphysical harm for neurological conditions: a qualitative descriptive study

Safety in telerehabilitation, especially regarding nonphysical harm, remains underexplored. This study examines providers’ perspectives on the risks, challenges, and strategies to enhance safety in telerehabilitation for individuals with neurological conditions. Using a qualitative descriptive approach, we invited 25 outpatient telerehabilitation providers, leaders and learners from a large academic rehabilitation hospital in four focus groups and three interviews to share their experiences about safety in their telerehabilitation practice. Discussions were audio-recorded, transcribed, and analyzed using an inductive thematic approach. Three overarching themes emerged: (1) Despite their neurological complexity, patients in this study were largely safe, comfortable, and confident participating in telerehabilitation at home. (2) Providers themselves may be vulnerable to under-recognized nonphysical harm, reflected in three sub-themes: persistent worry about patient safety, moral and ethical distress over perceived care inequities, and blurred professional boundaries. (3) Strategies to mitigate harm included recognizing and addressing provider nonphysical harm as essential to advancing to safety and wellness, with opportunities such as standardized education, peer support, and effective patient triage. As virtual care expands, understanding the risks of nonphysical harm to telerehabilitation providers is critical as part of a broader, more inclusive approach to safety and wellness. Safety in telerehabilitation needs to be reconceptualized to include nonphysical harm experienced by providers, as part of a broader commitment to safety and wellness.Standardized, intentional education and peer support are critical to reducing moral distress and patient safety-related anxiety among telerehabilitation providers.Clear triage protocols and professional boundaries help safeguard provider well-being while promoting safe and equitable telerehabilitation delivery. Safety in telerehabilitation needs to be reconceptualized to include nonphysical harm experienced by providers, as part of a broader commitment to safety and wellness. Standardized, intentional education and peer support are critical to reducing moral distress and patient safety-related anxiety among telerehabilitation providers. Clear triage protocols and professional boundaries help safeguard provider well-being while promoting safe and equitable telerehabilitation delivery.