Meanings of digital rehabilitation: A reflexive thematic analysis on group interviews

Tiitinen Sanni⁽¹⁾, Korniloff Katariina⁽¹⁾, Riquelme Inmaculada⁽³⁾, Lällä Kaisa^(1,2)

⁽¹⁾ Jamk University of Applied Sciences, Institute of Rehabilitation, Jyväskylä, Finland

⁽²⁾ University of Jyväskylä, Faculty of Sport and Health Sciences, Jyväskylä, Finland

⁽³⁾ University of the Balearic Islands, Department of Nursing and Physiotherapy, Palma, Spain

Abstract

Background: The development of digital technologies has offered new ways to provide rehabilitation services, and the COVID-19 pandemic at the latest accelerated the introduction of digitality into rehabilitation. However, there is not a shared understanding of the terminology related to digitality within the field of rehabilitation.

Objectives: The paper aims at providing a data-driven, broad understanding about the variety of meanings for digital rehabilitation within the professional field of rehabilitation in Finland.

Data: The data consisted of three group interviews conducted in Finland online via Zoom in September 2021 as part of a larger international research project focusing on digital rehabilitation. The interviewees were students, teachers, and practitioners of rehabilitation (mainly from the fields of physiotherapy and occupational therapy), and they had some experience on digital rehabilitation. The groups included 10 interviewees in total.

Methodology: We utilized social constructionism as our theoretical framework and reflexive thematic analysis as our method with which we approached the data inductively.

Results: Based on our qualitative analysis, we described the following four themes: (1) digital rehabilitation as an inescapable part of today’s digital world, (2) digital rehabilitation as fundamentally the same than before digitalization, (3) digital rehabilitation as a mix of established methods and new prospects, and (4) digital rehabilitation as a constantly developing and radically new thing. Thus, very different and potentially tensioned meanings were constructed for digital rehabilitation during the group interviews.

Conclusions: The results highlight the importance of open and multi-perspective discussion about the different meanings of digital rehabilitation. This is essential so that scholars and practitioners will not end up talking about digital rehabilitation and implicitly linking it to different meanings.

Keywords

digital rehabilitation; group interviews; rehabilitation; social constructionism; thematic analysis

1. Introduction

Within the past decades, the development of digital technologies has offered new ways for delivering rehabilitation services. The COVID-19 pandemic at the latest showed the potential (Wittmeier et al. 2022) and accelerated the delivery (Heiskanen et al. 2021) of digital rehabilitation services. For example, in Finland more than half of speech and language therapists as well as psychotherapists used digital devices to carry out rehabilitation remotely with all or most of their clients during the COVID-19 pandemic (Heiskanen et al., 2021). However, using remote rehabilitation was less common among physiotherapists and occupational therapists. Only 15 percent of physiotherapists and 36 percent of occupational therapists were using remote rehabilitation with all or most of their clients (Heiskanen et al. 2021; for physiotherapists’ perspective see also Hellstén et al., 2022).

Although rehabilitation services are increasingly delivered in digital form, the terminology remains very diverse. For example, over 35 terms referring to psychological interventions delivered via the internet have been identified (e.g., digital health, E-mental health, Internet-delivered therapy, and online intervention) (Smoktunowicz et al., 2020). Some of the concepts are defined in relation to the remote nature of providing rehabilitation services with the help of digital technologies (e.g., tele-rehabilitation, Heiskanen et al., 2021 and digital practice, Dantas et al., 2020); some of them cover the use of digital technologies in rehabilitation more widely (e.g., eRehabilitation, Brouns et al., 2018). The terminology also varies both between and within professional fields. In occupational therapy, the term “telehealth” is commonly used (Cason et al., 2021) but in physical therapy terms like “telerehabilitation” (e.g., Seron et al., 2021), “digital physical therapist practice” and “telehealth” (e.g., Lee, 2020) as well as “remote rehabilitation” (e.g., Rintala et al., 2019) are common. In this paper, we have chosen to utilize the wide term digital rehabilitation defined as the use of digital technologies as a part of the rehabilitation process aiming to optimize functioning and reduce disability of individuals with health conditions in interaction with their environment (adapted from World Health Organization, 2023).

No matter what terms are used, previous literature has provided comprehensive knowledge on different aspects of digital technologies in rehabilitation. First, previous research has focused on the effectiveness of telerehabilitation compared to traditional rehabilitation (e.g., Suso-Martí et al., 2021). Second, the experiences of digitally delivered rehabilitation have been investigated from different perspectives: the professionals’ and clients’ (e.g., Johnsson & Bulkeley, 2021) as well as the clients’ partners (e.g., Dinesen et al., 2019). Third, previous literature has reported some factors influencing the uptake of eRehabilitation (e.g., Brouns et. al., 2018; Heiskanen et al., 2021). However, as studies typically start with definitions that stem from the researchers’ and research-based understandings, we lack knowledge on the different meanings that are related to the use of digital technologies within the professional field of rehabilitation. With these meanings we refer to the various connotations and interpretations that are recognizable and available for the phenomenon of digital rehabilitation through language-use in social situations (see Burr, 2015).

Because there is not a shared understanding of the terminology, there is a tangible risk that scholars and practitioners use the different concepts interchangeably or keep inventing new concepts. If we do not have a comprehensive understanding of the different meanings that can be related to the phenomenon of digital rehabilitation, we are not able to enhance shared understanding of the terminology in a sustainable way. In addition, understanding the meanings is essential since the ways in which we talk about digital rehabilitation also constructs the social reality around us: it affects the possibilities and risks that we can observe, describe, and consider in action (see Burr, 2015).

The aim of this qualitative study is to provide a data-driven, broad understanding about the variety of meanings for digital rehabilitation within the professional field of rehabilitation in Finland. The research questions were: (1) What kinds of meanings are constructed for digital rehabilitation among professionals, teachers, and students of rehabilitation in a group interview, and (2) what kinds of roles are these different meanings of digital rehabilitation implying for rehabilitation professionals?

2. Data

The data consists of three group interviews conducted in Finland online via Zoom in September 2021. Each group was interviewed once. Two of the groups had three and one had four interviewees, totaling 10 interviewees. Interviews were part of the international “Competences for the new era of user-driven digital rehabilitation” (DIRENE) -project conducted between 2020–2023. Voluntary participants were recruited by both personal emails and more general online advertisements to relevant people (e.g., students and teachers of courses related to digital rehabilitation). The researchers also asked their networks for help in circulating the recruitment advertisement. The aim was to recruit rehabilitation professionals, teachers, and students with some experience on digital rehabilitation. In the recruiting process, targeted emails were used to ensure interviewees from different education levels (from vocational and secondary education to higher education and universities) and having participants from different areas in Finland. The backgrounds of participants are presented in Table 1. The anonymity of the interviewees has been ensured by using pseudonyms and by presenting just rough background information. The ethical guidelines by the Finnish National Board on Research Integrity (2019) were followed in the research.

Two female researchers participated in all three groups interviews. Senior researcher (Doctor of Health Sciences) KK acted as a facilitator and senior researcher (Doctor of Social Sciences) ST as an assistant. Both had prior experience in conducting qualitative interviews. Project manager KL was present in the first interview. The researchers presented themselves briefly at the beginning of each interview, describing their educational background, occupation, and role during the interview. Since the interviewees were recruited among groups of people who were known to have potentially relevant experiences, some of them were acquaintances of KL and KK.

As the group interviews were part of an international project with an interest for also comparative analysis between different countries, the interviews utilized a pre-planned structure and questions that were kept as similar as possible. The structure included the following steps: 1) checking the technical aspects (i.e., everyone can hear each other), 2) presentation of the facilitator and the assistant, 3) presentation of the purpose of the group interview (to identify education needs, barriers, facilitators, and attitudes related to digital rehabilitation), 4) instructions for the interview (e.g., there are no correct or incorrect answers; one does not need to agree with others but others’ views and experiences should be listened to respectfully), 5) discussion based on interview questions, and 6) wrap up (e.g., thank you to participants and more information about the project if asked for). The interviewees did not know the specific interview questions beforehand.

The questions included the following topics: knowledge, insights and experiences about digital rehabilitation, education and training on digital rehabilitation tools, views about educational needs in digital rehabilitation, as well as barriers and facilitators of using digital rehabilitation. The interview questions were phrased in relation to the term digital rehabilitation, and one of the questions even dealt explicitly with the understandings that the interviewees have about the term. However, the interviewers did not share their own definition for the term but encouraged the interviewees to discuss the topic widely. The interview questions were presented by the facilitator (KK) and posted on chat by the assistant (ST). Besides posing questions, the researchers took few turns of talk during the interviews. The participants coordinated their turn-taking fluently and discussed each topic commenting also on others’ talks.

Starting from the step 5 in the structure – discussion based on the interview questions –, the group interviews were video-recorded utilizing Zoom’s internal recording tool. One of the recordings lasted approximately 1 hour, and two of them approximately 1 hour and 15 minutes. The assistant (ST) also wrote notes about the discussion during the interviews. The recordings were transcribed verbatim by ST with the help of Word’s dictation tool.

3. Methodology

We utilized social constructionism as our theoretical framework and thus, started with the following assumptions: 1) One objectively right and stable meaning for digital rehabilitation does not exist. 2) Different meanings for digital rehabilitation, as all phenomena in the social world, are constructed through language when it is being talked about. 3) These meanings – and more generally all the ways in which we understand and define the world – are dependent on the historical and cultural context. 4) The meanings build the grounds for what kinds of actions and perceptions are (un)acceptable, desirable etc. (See Burr, 2015.)

As our method, we utilized reflexive thematic analysis (Braun & Clarke, 2006, 2019, 2022). Reflexive thematic analysis is a profoundly qualitative method in which the subjective interpretation of the researcher is seen as an essential analytic tool. Themes are seen as “patterns of shared meaning underpinned or united by a core concept” (Braun & Clarke, 2019) – not just summaries of topics talked during an interview. The idea is that the themes do not just emerge from the data – as if they were there waiting to be found by the researcher –, but the researcher is seen as having an active role in organically and iteratively generating the themes. This role also requires the researcher to be reflective and transparent in relation to the analytic process and its underlying assumptions. (Braun & Clarke, 2006, 2019, 2021, 2022.)

We approached the data inductively, and the analysis proceeded through the following (partly overlapping) steps described by Braun and Clark (2006) for reflexive thematic analysis: First, we systematically coded the whole data corpus from the perspective of the question of how digital rehabilitation was described in the data. We paid special attention to the attributes utilized by the interviewees and accounts they gave, and aimed at reaching also latent themes, i.e., the ideas and assumptions behind the surface level of the interviewees’ talk. Second, we grouped the different codes to create preliminary themes. Third, we went through the codes and data extracts, and revised the themes with the aims of coherence within each theme and clear differences between the different themes. Fourth, we finalized the names of the themes and selected the most illustrative data extracts also considering the representation of different interviewees in the report. (Braun & Clarke, 2006.) Figure 1 illustrates the steps in the iterative process. Throughout the process, the codes and themes were managed with Excel sheets. ST conducted the analyses, and the themes were commented by KK and KL. The data was analyzed in the original language, i.e., in Finnish, but the extracts will be presented in English.

Figure 1 Analytic process

4. Analysis

During the interviews, it became apparent, as expected, that the interviewees did not have a single, straightforward definition for the term digital rehabilitation. However, they were still able to have the interview discussion using the vague term and at the same time, they constructed various meanings for it.

In this section, we present four themes that describe the different meanings of digital rehabilitation constructed by the interviewees. The four themes are: (1) digital rehabilitation as an inescapable part of today’s digital world, (2) digital rehabilitation as fundamentally the same than before digitalization, (3) digital rehabilitation as a mix of established methods and new prospects, and (4) digital rehabilitation as a constantly developing and radically new thing. We present the themes in this order, starting from the ones where digital rehabilitation is constructed primarily in line with digitalization and as merely an incremental change to rehabilitation; then we move on to the themes where digital rehabilitation is constructed as a more significant change to the field of rehabilitation. Table 2 summarized the analyses.

4.1 Digital rehabilitation as an inescapable part of today’s digital world

The first theme presents digital rehabilitation as an inescapable part of today’s digital world. Within this theme, digitality was described as a natural part of modern rehabilitation, something that was inescapably already here and now. When asked about the educational needs of today’s rehabilitation work, one interviewee put it like this:

”Well, at least the thing that the digitality cannot be a separate matter there (in the education), as it should somehow cut through everything, because it is the present, this moment. And how does it become strongly cross-cutting. That is already strongly a present need.” (G2, Lena)

Digital rehabilitation was constructed in close linkage with a universally digital society where so many things already happen digitally that the field of rehabilitation cannot overlook it.

”… are we anymore able in a way to even think about rehabilitation without the digital dimension? As our customers and the society revolves so much around digital services. So, I feel somehow that we in the rehabilitation must go to the same world, too, so that we are present there and are there in people’s lives.” (G3, Rita)

Furthermore, digital rehabilitation was seen as part of the digital society also in its negative sense: the same challenges that are related to digitality in general creep into the field of rehabilitation when it gets digitalized. If we witness digital exclusion in society, there is a risk of witnessing it also in digital rehabilitation if everyone does not have the needed digital devices; if we witness making obsolete robots, there is a risk of seeing them coming also to digital rehabilitation.

“…but also those ethical solutions, as digitality is in any case the kind of a matter which has two sides. Like nevertheless we are starting, or we are talking the whole time more about digital exclusion. So that some people do not have the possibility to use those devices. ((…)) But then we perhaps go back to (the idea) that when all the basics, all the ethical matters, are fine, I mean everyone has the right to participate in the face-to-face (rehabilitation) and it definitively works and is a valid thing, then. But you know the ethical matters indeed need to be reflected upon too.” (G2, Lena)

“…I feel that this kind of digital rehabilitation is absolutely useful, but at least in the field of welfare technology, when some robots are introduced and presented, and they have a heavy price tag. But when one asks what can be done with it, “well this can guide a person from one place to another” or something like that. In my opinion, we don’t perhaps find very meaningful work or tasks which the robot would be able to do in the end. So, sometimes I get the feeling that we are in such a strong phase of development that we are kind of like getting technological devices just for the technology’s sake.” (G1, Ella)

When it comes to the rehabilitation as a profession, within this theme the interviewees constructed the needs of new skills and support from the technological viewpoint. The same technological devices utilized in other areas of mundane and working lives become useful also in rehabilitation practices. In other words, rehabilitation is constructed as equivalent to e.g., the field of education in relation to how digitality affects it. Also, one element of this theme was that Covid-19 was presented as an undeniable boost to digital rehabilitation in the same way that it was to other areas of life.

“So, I don’t have other proper competences or degrees in relation to this (digital rehabilitation), but last year when this Covid-19 pandemic started, I immediately had to start doing all my (rehabilitation) work remotely. ((…)) So, we needed to introduce the remote solutions very quickly. And if I hadn’t had the experience of blended teaching [[in higher education]], where remote teaching was used a lot, I would have been in more trouble.” (G3, Sara)

“…one could perhaps have regional and then clearly nationwide coaches ((…)) so that one would have an expert to also the rarer buttons, to whom you could call and get the help, for instance, when you are meeting with a client. That would be essential. Otherwise, it won’t work.” (G1, Anna)

4.2 Digital rehabilitation as fundamentally the same than before digitalization

The second theme presents digital rehabilitation as a fundamentally similar practice than rehabilitation has been before digitalization. The rehabilitation part is foregrounded in digital rehabilitation, and digitality is described as a mere tool to do things that would be done in any case. In addition, the tools are given very low criteria; for example, phone calls and emails to rehabilitation clients pass as digital rehabilitation.

“Well, it keeps running through my mind, too, that the digital devices are nevertheless tools with which we might get done the same things than what we have wanted to do with the clients also earlier. They (the tools) are not an absolute value, but they could give us in a way more methods, tools, for all the actors within rehabilitation.” (G1, Ella)

“If we think about the field of digital rehabilitation, my first contact to that has been somewhere at the end of 1990s. ((…)) At that time, it wasn’t used much. Other than mainly when passing information and in phone calls and in emails, and in these kinds of things, the digital rehabilitation was observable”. (G3, Rita)

Within this theme, digital rehabilitation is approached as a tool that not only prioritizes rehabilitation over the digital tools, but also is required to do so. Digitalizing is not allowed to change any core practices of rehabilitation: the services need to be as easy to use, as affordable, and most importantly, as client centered as earlier.

“And then usability (is one thing). So that when they (digital devices) are easy to use, then also as it is easy, one ends up trying them out and one gets the good opportunities and all the information about what one is able to do with them.” (G2, Kati)

”…in practice do we stop to think about every client that is this now a right thing for their process and does it promote their rehabilitation, life management, supporting functional capacity. Or is it just the kind of package deal so that we now have this technology ((…)) So it’s a kind of eternal question for me that how do we make sure in the everyday practice that we are doing client centered work.” (G1, Heta)

When digitality is constructed as a mere tool, it is presented as having the same fundamental obstacles as other rehabilitation tools: the digital tools will not reach people who do not want to get rehabilitation services, nor will they change the clients’ nature.

”So, some may have more difficulties in finding the time when they are able to focus on doing (the exercises on an online platform) and the others are very conscientious by nature and do what is asked for and keep notes. It depends a little, but it was like this of course even before these digital things, too. Perhaps then it was just easier to say that “I didn’t”, or “yes I have done these”. (G3, Tomi)

With regard to the rehabilitation profession, technological matters and rehabilitation was constructed as essentially different areas of expertise. The professionals of rehabilitation were presented as having a unique perspective which should be considered, e.g., when designing digital tools for rehabilitation.

“L: We come back again to the matter that one must be able to discuss with the programmers about the needs of social and health care. ((laughs))

P: I can tell you it’s not easy.

L: Exactly what I’ve been saying, too.

P: Yes. I don’t understand at all what they are saying, although they speak Finnish. And they don’t understand what I’m saying, although I speak Finnish.” (G2, Lena & Pia)

4.3  Digital rehabilitation as a mix of established methods and new prospects

The third theme constructed digital rehabilitation as a mix of established methods and new prospects. The concept of digital rehabilitation was presented as not yet fixed. Nevertheless, the ways in which the interviewees negotiated about the definitions and referred to the various methods constructed an image of some established methods that are self-evidently part of the phenomenon surrounded by other methods waiting to be fully discovered and recognized as part of it.

“…((in the laboratory of the educational institution)), there are a lot of that kind of tools which I understand that could be understood precisely as being part of this digital practice. So, it is by no means always remote rehabilitation or remote coaching which is one part and has become now through Covid-19. But our therapy equipment has developed to be very versatile, and we can introduce EEG also in the therapy encounters and so on.” (G1, Anna)

“Well in my job, rehabilitation means precisely the kind of happening in real-time. I mean those video-mediated encounters. ((…)) And surely that’s also perhaps a little like digital rehabilitation when we have made these kinds of instructions on our websites.” (G2, Mika)

“But it (remote rehabilitation) surely is not yet even in the kind of the core of digital rehabilitation. What I would like to see, what doesn’t happen yet in practice, is precisely that we would be able to monitor more in real time ((…)) Here, I see the potential of digital rehabilitation when the digitality means more than filling in a preliminary information form online, but it could be precisely these wearable meters.” (G3, Tomi)

Within this theme, digital rehabilitation was described as a method that cannot replace face-to-face rehabilitation, but nevertheless is able to deliver the goods and perhaps even something more. Thus, digital rehabilitation gets constructed as a parallel option to the standard form of real time face-to-face rehabilitation. Furthermore, the rehabilitation professionals are described as actively ensuring that clients’ needs are considered when choosing between the options. In the same way as in the previous theme, the digital services are seen as essentially similar rehabilitation. The descriptions of advantages compared to face-to-face rehabilitation cover rather practical matters such as, enhanced flexibility and accessibility. If there are some more positive effects, they are described to be nice surprises.

“…we encounter a lot this (thought) that remote rehabilitation will for some reason replace present rehabilitation. It will definitely not (do that), and it must not (do that). At all events, we should not forget present rehabilitation and meeting with the clients. But we need to see it exactly as giving us the extra elements so that we are able to respond to our clients’ needs in better and more modern ways – this is also one advantage in my opinion.” (G2, Piia)

”And what has been a positive and inspiring thing for me in these groups for elderly people, is that the old stager therapists have felt that remote rehabilitation might have been a bit more effective even. Perhaps not in the sense that one could not have done the same exercises in present therapy. But in the sense that remote rehabilitation has provided the experience of becoming capable to operate also video mediated.” (G1, Heta)

4.4  Digital rehabilitation as a constantly developing and radically new thing

The fourth theme described digital rehabilitation as a field which is in the state of constant development, and which radically changes rehabilitation practices and rehabilitation as a profession. The constant development was described in relation to the technological devices and digital solutions as well as rehabilitation practices and structures. The theme entwined the current state of rehabilitation and the (yet unknown) future.

“…when we are now educating digital skills for those who are in working life, it’s a little bit late already. As we should be all the time thinking about what more we will need after a couple of years ((…)) they (future professionals) should have knowledge in innovating the future and that kind of seeing the future and what is coming there next.” (G2, Piia)

When the other themes approached digital rehabilitation as a tool that requires merely new digital skills from professionals, this theme presented the changes as more significant, even radical. Digital rehabilitation was described to require whole new thinking, give endless new opportunities, and change the role dynamics of professionals and clients. The new skills needed from the rehabilitation professionals were not only related to technical and practical matters, but also to fundamental matters such as, contents, pedagogy, and interaction. The same work is not only done with new tools, but the tools give opportunities and require approaching the whole profession from a new angle.

“…the therapists need massive support to this digital leap. And the thing that it’s not self-evident, no matter how many years you have been working, it changes the work practices so essentially and radically, the way in which we operate remotely. Or how the tablet computer is included in the therapy session with a child and so on.” (G1, Heta)

“I think that service design is one skill we would need strongly ((…)) So that we would precisely think in new ways about how we could provide rehabilitation, it requires totally different thoughts compared to what we have now traditionally used to think about perhaps at this phase, how the rehabilitation is seen at the moment.” (G2, Lena)

“…one must be really excited and motivated to manage to implement it. To go through the process of how I will take over the remote solution in the first place. ((…)) but also the process of what it means to me as a professional, how it is changing my work. ((…)) So, one is not able to provide one’s therapy as it is in a remote form, but one must go through the fundamental thoughts about how one works and to change one’s way of working to be more coaching, which might feel as too challenging for many.” (G3, Rita)

5. Conclusions and Discussion

The unique contribution of our analysis has been to present a variety of different meanings constructed for digital rehabilitation. These meanings can be seen as forming a continuum ranging from digital rehabilitation constructed as an inescapable part of today’s digital world towards digital rehabilitation representing a constantly developing and radically new thing in the field of rehabilitation.By focusing on the meanings, we have been able to tease out what are currently (some of the) culturally available ways to talk about digital rehabilitation in Finland. As the wide variety of different concepts related to digital rehabilitation already has suggested, our analysis further highlights that one shared understanding of what digital rehabilitation is and what are its implications does not exist.

Our results also show the potential tensions between the meanings: if digital rehabilitation is constructed as a mere tool to do familiar things, it is rather far away from seeing it as something radically new. In our data, the meanings were sometimes constructed explicitly but very often also implicitly. Hence, the tensions between different meanings might remain under surface. Then, the risk is that scholars as well as practitioners end up talking about digital rehabilitation but link it to very different meanings and all this remains implicit.

Previous studies have also discussed similar matters that were touched upon in our data. First, when digital rehabilitation was constructed in our data as a mix of established methods and new prospects or as a constantly developing and radically new thing, optimistic expectations of digitality were at the center. This kind of optimism and focus on new opportunities has also been described in previous studies in relation to digital services in health care (Valokivi et al., 2023). Second, when digital rehabilitation was constructed as an inescapable part of today’s digital world, the potential negative sides were also highlighted. Critical perspectives have been presented also in previous studies, for example, by pointing out that the impact of increased digitalization, especially in the services for elderly and other vulnerable groups, has not been fully considered (Fernández Da Silva et al., 2022; Valokivi et al., 2023). In contrast to previous studies, although the positive and negative aspects of digital rehabilitation were part of the themes in our study, our analysis highlights the radicality of the change as a core element in constructing the relationship between rehabilitation and digitality.

Furthermore, our analysis described that the role of the rehabilitation professionals is constructed as different within each theme: On the one hand, the professionals are described as needing just new digital skills and technological support. On the other hand, digital rehabilitation can be seen as pushing the professionals to reflect their own profession and work practices in a completely new way. The potentially changing role of rehabilitation professionals has been previously described, for example, in a qualitative case study on a telerehabilitation program (Dineden et al., 2019). As the program encouraged the clients to be more involved in making personal decisions related to their own rehabilitation process, the professionals were also seen in a new role as coaches who were encouraging clients to keep on focusing on their own rehabilitation. (Dinesen et al., 2019).

There were some limitations and strengths in this research. First, the data set was rather small, and the interviewees were a rather homogenous group in relation to their educational backgrounds (mainly in physiotherapy and occupational therapy) which might have affected the variety of meanings constructed in the data. On the other hand, a strength of the data was that the interviews were rich in relation to the studied phenomenon (which was narrow in its focus) (see Braun & Clarke, 2021, 2022) and the interviewees included people with different positions in the field of rehabilitation. Second limitation is related to the use of the data. The interviews were not collected for reflexive thematic analysis; if they had been, the interviews could have been arranged to be less structured. However, this was found not to be a big problem since the interviewees treated interview questions as opening topics of talk and commented on each other’s turns. Furthermore, because we utilized reflexive thematic analysis, the saturation of the data was not relevant for the purposes of this paper. Instead, validity was sought through the depth of analysis. (Braun & Clarke, 2021.) In addition, as we utilized social constructionist approach to data (i.e., the researchers were not seeking correct meanings by the interviewees), the transcripts or analyses were not returned to the participants for correction.

Since this paper focused on meanings constructed in the discussions between rehabilitation students, teachers, and practitioners, future studies should cover rehabilitation clients’ perspectives. Also, it would be useful to have similar analyses on policy documents related to digital rehabilitation to get a fuller picture on the societal context for constructing the different meanings.

The implication of our results is that it is important to have open and multi-perspective discussion about the different meanings of digital rehabilitation. In relation to digital health more generally, there have been critical and reflexive discussions already for several years (Arigo et al., 2019); now the field of rehabilitation needs to follow. Our results give one structured starting point for such discussions.

Acknowledgements

Following members of the DIRENE project has contributed to designing the study protocol and supported the data gathering process: Christian Grüneberg, Angela Arntz, Marietta Handgraaf, Franziska Weber, Anita Kidritsch, Mario Heller, Andreas Jakl, Jakob Doppler, Evanthia Sakellari, Christina Athanasopoulou, Inmaculada Riquelme Agulló, María de la Paz Martínez Bueso, Iosune Salinas Bueno, Olga Velasco Roldán, Elisa Bosch Donate and Kari-Pekka Murtonen.

Funding sources

This work has been done as a part of the DIRENE-project (2020-1-FI01-KA226-HE-092634) which was funded by the Erasmus + Programme Key Action 2: Strategic Partnerships. The European Commission is not responsible for the content of this publication. More information about the Erasmus+ programme: www.oph.fi/erasmusplus.

Corresponding Author

Sanni Tiitinen

Jamk University of Applied Sciences, Institute of Rehabilitation

Piippukatu 2, 40100 Jyväskylä

Email address: firstname.lastname@jamk.fi

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URN: http://urn.fi/urn:nbn:fi:jamk-issn-2954-1069-12