Barriers to telerehabilitation practice among physiotherapists in Tunis, Tunisia

Introduction

Telerehabilitation (TR) offers opportunities to improve access to care, but its implementation remains limited. Identifying barriers to TR practice is essential to support its integration. This study aimed to identify the main barriers to TR practice among physiotherapists in Tunis.

Methods

A cross-sectional study was conducted in March 2023 with a representative sample of physiotherapists practicing in the private sector in the Greater Tunis region (governorates of Tunis, Ariana, Manouba, and Ben Arous). Data were collected using a standardized face-to-face questionnaire with a specific section on perceived barriers to TR practice. Data analysis was descriptive.

Results

A total of 200 physiotherapists were included, 86.5% of whom were women, with a median age of 32 years (IQR [29–36]). The percentage of participants who had previously practiced TR was 29% (58/200). These participants were asked about barriers encountered. The main reported barrier was the absence of physical contact with patients (56.9%). Other frequently cited barriers included communication difficulties between physiotherapists and patients (22.4%), technical complexity of tools used (15.5%), and lack of infrastructure adapted to TR (10.3%).

Conclusions

The absence of physical contact was the main barrier to TR practice among physiotherapists. Other barriers were primarily technical and organizational. Promoting TR integration in Tunisia requires strengthening training and providing adequate technical and logistical support, while emphasizing its role as a complementary approach to in-person care.

Key messages

• The top barrier to telerehabilitation among Tunisian physiotherapists is lack of physical contact (56.9%), emphasizing the need for a hybrid TR + in-person care model.

• Technical complexity and poor infrastructure limit TR adoption in Tunisia; boosting training and logistical support is key to broader implementation.