ROSIA (Remote Rehabilitation Service for Isolated Areas): A Digital Innovation Framework for Value-Based Integrated Tele-rehabilitation

Background: Globally, there is an urgent need to scale up rehabilitation services to meet growing demand to address health inequities, particularly in remote and isolated areas. Digital technologies, particularly tele-rehabilitation, offers a promising solution to bridge this gap by enhancing patient access, outcomes, and cost-effectiveness. The ROSIA (Remote Rehabilitation Services for Isolated Areas) project, a pre-commercial procurement (PCP) initiative funded by the European Commission, has spent 4.5 years driving market innovation and delivering digital solutions that foster an integrated ecosystem for remote rehabilitation, ultimately enhancing patient outcomes.

 

Approach: ROSIA project involved 12 partners across five countries – Ireland, Spain, Portugal, Netherlands, Denmark. With an aim develop a scalable, value-based model of care and promoting supported self-management of rehabilitation and grounded in a tailored integrated care model designed to optimise both quality of care and clinical resource utilisation. The PCP framework mandated an iterative three-phase approach.

Phase 1 focused on comprehensive co-creation and design with patients, clinicians, and technical partners.

 Phase 2 saw the development and prototyping of innovative digital solutions.

Phase 3 advanced the field testing of two solutions, and recently concluded and with patient groups from the National Rehabilitation Hospital (NRH) in Ireland, Servicio Aragonés de Salud in Spain, and Centro Hospitalar e Universitário de Coimbra in Portugal.

 

RAISE and REHABILIFY platforms targeted outpatients undergoing rehabilitation programmes; and an example from NRH were patients with an acquired brain or spinal cord injury. For assessing the ‘system usability’ of these platforms the System Usability Scale (SUS) - a validated 10-item questionnaire with 5-point Likert scale; was disseminated to patients and clinical teams. The SUS tool was one of three tools identified as measurable indicators towards KPI’s (Key Performance Indicators) and set as a quantifiable deliverable for both solutions providers to compete.

Results: With percentage changes ranging from 48.5% to 60.93%; the initial findings from the SUS data collated from patients across all three sites; show a substantial improvement in patient-related behaviours; including adherence, perceived autonomy, and ease of self-management. The consistent achievement across NRH, SALUD Aragón, and CHUC indicates a project-wide success in promoting greater patient engagement and self-care compared to the estimated baseline. However, for clinical teams across the regions the results from SALUD Aragón showed a 0% satisfaction rate: with NRH in Ireland reporting only 12.5% and both falling short of the 25% target.

 

Implications: ROSIA’s innovation set out to addresses global challenges in health equity and the need to scale up rehabilitation services to strengthen value-based integrated care targeting geographically isolated populations. ROSIA’s Phase three pilot sought to bridge the gap from hospital to home; and validate an innovative and user-friendly tele-rehabilitation platform supporting continuous care for patients at home. Despite positive feedback from patient groups, significant challenges were reported from clinical teams,; and related to platform usability, technical support, and organizational factors. These, and other KPI's may limited the solution's perceived value and acceptance among the healthcare professionals and exploitation of a solution/s. Further analysis is required to understand wider ‘validation’ hurdles on tech-driven telerehabilitation innovation.