OpenTeleRehab

According to the WHO, globally, an estimated 2.4 billion people are currently living with a health condition that may benefit from rehabilitation. This represents one in three people worldwide. Currently, the need for rehabilitation is largely unmet. In some low-income countries, more than 50% of people do not receive the rehabilitation services they require. The need for rehabilitation worldwide is predicted to increase due to changes in the health and characteristics of the population. For example, people are living longer, but with more chronic disease and disability. Emergencies including conflicts, disasters and outbreaks create enormous surges in rehabilitation needs while also disrupting services and have the greatest impact on the most vulnerable populations and the weakest health systems. The current rehabilitation service delivery model - operating within a fixed framework – is not meeting and will not meet those needs.

Telerehabilitation, the use of Information and Communication Technologies (ICTs) to provide rehabilitation services to people at a distance in their environments, can contribute to the process of rehabilitation, as noted in the landmark resolution on “Strengthening rehabilitation in health systems” adopted at the World Health Assembly in 2023.

Humanity & Inclusion is working on improving access to rehabilitation through an innovative service delivery model that combines the existing delivery setup in a given context with the use of telerehabilitation in low- and middle-income countries and emergencies.

OpenTeleRehab is an innovative, open source, multidisciplinary telerehabilitation software, recognized as Digital Public Good.

OpenTeleRehab connects rehabilitation professionals with service users to improve access to rehabilitation services and contribute to universal health coverage by facilitating discharge, transition of care and community-based follow-up. OpenTeleRehab allows its users to access tailormade rehabilitation treatment plans adapted to a variety of health conditions.

OpenTeleRehab Modules

OpenTeleRehab is a combination of 3 different modules that interact with each other.

- Admin Web Portal: The Admin Portal is for organizational administrators who manage the therapists and provide the library content to support therapists to create treatment plans for patients. The portal enables administrators to manage all content related to other modules. It should allow bulk uploads of content to be used and be as flexible as possible to support the related apps. Access to the portal is further customized based on the user's role which can be any of the following: Global Admin, Country Admin and Service Admin.

- Therapist web portal: The Therapist Portal allows therapists to manage their patients and facilitate the creation of treatment plans. The portal allows a therapist to create their own exercises, education materials and questionnaires for their patient and also copy existing content available in the library. The therapists can also monitor the rehabilitation progress of patients and make direct contact via message, voice, and video calls. The portal supports patient information management and appointment management.

- Patient Mobile App: The patient Mobile App is designed to allow patients to access the treatment plan designed by the therapist. It displays the scheduled activities for the day. The activities are shown as easy to read cards that include exercises with pictures and instructions, questionnaires
and feedback forms, and education and information materials that the
patient can access. It also supports chat and call features that allow
the patients to be in contact with their therapists. Patients can also
manage their appointments with their therapist.

A satellite open access web app, OpenTeleRehab Library, allows the
public to access, review and contribute to a global telerehabilitation
clinical library of contents (Exercises, Information and Education
Materials and Questionnaires).

Our solution serves children, adult or older person to become as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. Most particularly, it supports underserved communities with the greatest unmet rehabilitation needs – including persons with disabilities, refugees, internally displaced persons, rural communities, and survivors of conflict and disasters who would otherwise have limited or no access to rehabilitation services due to financial, attitudinal and geographical barriers.

Recent scientific evidence suggest that telerehabilitation would have at least similar effects to traditional rehabilitation on long-term pain, on short and long-term physical function and on short and long-term quality of life (Dias et al. 2021). The advantages of telerehabilitation are numerous, such as limiting travel, reducing health care related costs, bringing expertise closer to users in the community and promote continuity of care, enhance data collection, reporting, analysis and dissemination of rehabilitation programs - therfore contributing to Health System Strengthening and Universal Health Coverage.

Telerehabilitation can particularly helpful in contexts where
rehabilitation is not available at primary health care level or in the
aftermath of emergencies or disasters.

As Nobel Prize winner, Humanity & Inclusion  together with local partners including rehabilitation service providers and professional associations, organizations of people with disabilities, and relevant authorities have been improving access to high-quality, affordable and sustainable rehabilitation services to help people with disabilities, injuries, trauma or other health conditions reach and maintain a maximum level of functioning for more than 40 years and across more than 50 countries.

Since 2016, HI has been researching and testing the use of information and communication technologies in remote service provision, particularly for low- and middle-income countries and complex situations. Based on our findings, we are working on improving access to rehabilitation services through an innovative service delivery model that combines the existing delivery setup in a given context with the use of digital technologies.

More specifically, HI conducted a study, “Barriers and levers for the use of telerehabilitation through experimentation in three countries”. The aim of this study was to identify, through quantitative and qualitative data, the barriers and levers for the use of telerehabilitation by professionals and beneficiaries, based on experiences in three countries (Haiti, Madagascar and Colombia). The barriers and levers were classified according to human factors, technological factors and organizational factors. Consecutively, HI developed a guideline “Designing and Implementing telerehabilitation interventions” and OpenTeleRehab, designed and developed following the Principles for Digital Development and included significant time and resource to collectively design the software using human-centered design and agile approaches. The software is today recognized as a Digital Public Good and piloted in 4 countries across Asia and Africa, where additional evidence is being collected, including acceptability and feasibility studies.

OpenTeleRehab was officially launched in September 2021 and recognized as a Digital Public Good in 2022. The software is currently being piloted in 4 countries (Cambodia, Vietnam, Rwanda and Benin) and benefited 665 users in total.

In each location, the pilot focuses on ensuring acceptability and feasibility in the local context, bringing the necessary adjustments and demonstrating effectiveness of the intervention so as to support and prepare for growth stage.

OpenTeleRehab would welcome:

- Critical opinions, strategic advice and technical guidance about pathways to scale and strengthening of business model.
- Networking opportunities in the Information and Communication Technologies for Development and Digital Health.
- Financial support and funding opportunities

OpenTeleRehab is an innovative telerehabilitation software uniquely
tailored to address the specific needs of low- and middle-income
countries (LMICs) and emergency situations.

- Holistic Approach to Health Conditions: OpenTeleRehab prioritizes health conditions prevalent in LMICs and emergencies, ensuring that its resources and features are aligned with the most pressing healthcare needs in these contexts. It focuses on conditions such as musculoskeletal injuries, stroke rehabilitation, and post-traumatic recovery, among others.

- Enhanced Accessibility Features: OpenTeleRehab incorporates offline mode and SMS capability for users living in remote areas with poor connectivity. It ensure that individuals in resource-constrained settings can still benefit from rehabilitation services.

- Localization and Cultural Sensitivity: OpenTeleRehab recognizes the importance of cultural context and offers localization in various languages and dialects. By providing content in local languages, it facilitates quicker acceptance and adoption within communities, especially in emergency situations where time is critical.

- Integration with Health Information Systems: OpenTeleRehab is designed to strengthen existing health systems by potentially integrating with other health information systems. This possible integration streamlines data management, enhances coordination among healthcare providers, and contributes to the overall efficiency and effectiveness of healthcare delivery.

- Commitment to Accessibility Standards: OpenTeleRehab complies with the Web Content Accessibility Guidelines (WCAG) at level A/AA. This commitment ensures that the software is usable by individuals with disabilities, promoting inclusivity and equitable access to rehabilitation services.

- Scalable Architecture for Sustainability: Leveraging a microservices architecture, OpenTeleRehab ensures scalability, flexibility, and sustainability. This design facilitates localization efforts, technology transfer to different settings, and long-term maintenance and updates, ultimately maximizing the software's impact and sustainability.

- Decentralized Management : The software includes a dedicated administration application, empowering decentralized management of users and settings. This feature alleviates the burden on limited healthcare workforces, allowing for efficient and effective management of rehabilitation programs across diverse settings and scenarios.

Our impact goals for OpenTeleRehab are centered around improving access to high-quality, affordable rehabilitation services, enhancing health functional outcomes, and strengthening healthcare systems in low- and middle-income countries (LMICs) and emergency situations.

- Increase Access to Rehabilitation Services: We aim to expand access to rehabilitation services for individuals in LMICs and emergency settings, particularly those with limited mobility or resources. Our goal is to reach underserved populations who may face barriers to accessing traditional rehabilitation facilities due to geographical, financial, or infrastructural constraints.

- Improve Health Functional Outcomes: Our objective is to improve health functional outcomes for patients by providing timely and effective rehabilitation interventions. We focus on reducing disability, enhancing functional abilities, and improving overall participation, independance, quality of life of people with rehabilitation needs.

- Strengthen Healthcare Systems: We strive to strengthen healthcare systems by integrating OpenTeleRehab into existing infrastructure and promoting collaboration among rehabilitation service providers. By enhancing coordination, data management, and resource allocation, we aim to improve the efficiency, effectiveness, and sustainability of rehabilitation services within broader healthcare systems.

Measuring Progress:

- Service Utilization: We track the number of users accessing OpenTeleRehab and the adherence to the treatment plans. Increasing utilization and adherence indicates access to rehabilitation services and can demonstrate the effectiveness of OpenTeleRehab in reaching target populations.

- Clinical Outcomes: We systematically monitor outcomes such as pain level and functional objectives achievement among patients using OpenTeleRehab. Available Validated patient-reported outcomes measures can help us evaluate the impact of our interventions.

- User Satisfaction and Feedback: As part our our project, we systematically collect the satisfaction levels of the users. High satisfaction levels can indicate the relevance of our solution in addressing rehabilitation challenges.

OpenTeleRehab is a software combining different modules:

Admin Portal and Therapist Portal These are web applications. The frontend is developed using ReactJS and Google Material Design. The backend of the portals is developed separately and follow a micro-services architecture that allows all three modules to connect to these micro-services independently. These micro-services use technologies like Laravel framework, Restful APIs, Identity and Access Management systems and other open-sourced third-party systems that can easily be integrated as a micro-service using Restful APIs.

Patient Mobile App The mobile app was developed using ReactNative and Google Material Design. Chosen technologies are all rooted in free Open Source projects and the components are popular and widely used in Android and iOS. Choosing ReactNative means that the system can be developed and compiled for both iOS and Android instead of being built separately.

Technology stacks:
- Operating System and webserver: Ubuntu
- Programming language and framework: Laravel
– PHP - Databases: MySQL
- Identity and authentication management: Keycloak
- Hosting: Amazon Web Services – supporting Kubernetes and Docker

Additional technical information can be found on our Wiki Space.

- Full-time staff (HQ):
- Part-time staff (project): 4
- Contractors: 5

4.5 years

Diversity, equity, and inclusion is built into the HI mission and identity as the leading international aid organization promoting the rights of persons with disabilities and the inclusion of persons with disabilities across all levels of society. With hundreds of active projects in more than 50 low- and middle-income countries worldwide, HI raises awareness on disability inclusion among the public; engages with local, national, and multinational authorities to develop and implement disability inclusive policies; and collaborates with local partners in implementing initiatives that create opportunities for persons with disabilities to get vital health care, get an education, earn a livelihood, and advocate on their own behalf.

HI has developed a number of institutional policies which provide an essential reference framework for our statutory mission. These policies apply first and foremost to HI staff. However, they also include provisions that apply to the other stakeholders in our activities, especially our public, private or associative partners, and companies that provide us with goods and services.

The list and content of each policy can be found here: https://www.hi.org/en/institutional-policies  

It includes:

- HI’s policy on Disability, Gender and Age. This policy sets forth HI’s different levels of commitment with regard to Disability, Gender & Age, and the changes to be made in how the organization works, including with its partners. These commitments apply to the whole HI network and are to be taken into account at operational, technical and advocacy levels, and notably in technical and operational strategies and programming policies.

- Be Hinclusive, an internal project aiming at making HI an organization recognized for its inclusiveness in terms of employment of persons with disabilities

The business model of OpenTeleRehab revolves around providing valuable telerehabilitation services to populations in low- and middle-income countries (LMICs) and emergency situations, focusing on impact and accessibility rather than traditional revenue generation.

Key Customers and Beneficiaries:

- Rehabilitation professionals: We offer a platform that enables rehabilitation professionals to deliver rehabilitation services remotely, reaching underserved populations in LMICs and emergency settings.
- Patients: Our services directly benefit patients by providing access to high-quality rehabilitation care regardless of geographical constraints or limited resources.
- Health Systems: OpenTeleRehab can strengthen health systems by integrating with existing infrastructure and contributing to improved rehabilitation service delivery and patient outcomes.

Products and Services:

- Telerehabilitation Software: We provide a comprehensive telerehabilitation software platform.
- Localization and Customization: OpenTeleRehab can be localized in various languages and customized to suit the specific needs and contexts of different regions and communities.

Provision of product and services:

- Open Licensing Strategy: We adopt an open licensing strategy, allowing widespread adoption and modification of the platform. This approach
fosters collaboration, innovation, and community engagement, ultimately
maximizing the reach and impact of OpenTeleRehab.
- Partnerships: We establish partnerships with healthcare organizations, NGOs, and governmental agencies to facilitate the implementation and
scaling of the platform in diverse settings.
- Capacity Building: We invest in capacity building to empower local rehabilitation service providers with the knowledge and skills needed to
leverage telerehabilitation effectively.

Value proposition:

- Accessibility: OpenTeleRehab addresses the critical need for accessible

rehabilitation services in underserved communities, where traditional
rehabilitation infrastructure may be lacking.
- Quality Care: By providing remote monitoring capabilities, we ensure patients receive high-quality beyond the traditional physical rehabilitation services.
- Efficiency and Cost-Effectiveness: Our platform enables rehabilitation providers to deliver care remotely, reducing the need for travel and minimizing operational costs, thus increasing efficiency and affordability.

In summary, OpenTeleRehab's business model focuses on delivering value through accessible, high-quality telerehabilitation services to populations in need, leveraging an open licensing strategy to promote widespread adoption and collaboration.

Our current revenue model primarily relies on cost recovery through grants from donors. This approach has allowed us to distribute running costs across several projects, benefiting from economies of scale.

Initial software development was made possible through an opportunistic grant, which provided the necessary resources to kickstart the project. To minimize ongoing expenses, we've opted for competitive third-party service providers for hosting and maintenance, keeping software running costs at a minimum.

Human resources are sustained through a combination of project institutional funding and our own funds generated from mass marketing efforts.

Aligned with our social mission, we prioritize measuring revenue in terms of positive social value rather than solely economic value.

To achieve long-term financial sustainability, we are transitioning towards a hybrid revenue model that encompasses:

- Software as a Service (SaaS): Offering OpenTeleRehab as a subscription-based service to organizations and institutions, ensuring ongoing revenue streams.
- Technical Assistance: Providing consultancy services and technical support to governments, healthcare institutions, and NGOs implementing tele-rehabilitation programs, generating revenue through service contracts.
- In-kind Contributions from the Open Source Community: Leveraging the power of open-source development, we anticipate contributions from the community, reducing development costs and enhancing the software's features and functionalities.