Description of tele-rehabilitation and tele-prehabilitation services

P. Frigerio,¹ L. Marin^2-5 | ¹Health Professions Manager Health and Social Care Professions Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; ²Laboratory for Rehabilitation and Orthopedic Surgery, Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; ³Laboratory of Adapted Motor Activity, Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Italy; ⁴Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Czech Republic; ⁵Department of Rehabilitation, “Città di Pavia” Healthcare Institute, Pavia, Italy

Telemedicine – encompassing tele-consultation, tele-monitoring, and tele-rehabilitation – has definitively moved beyond the "emergency fix" phase of the pandemic to establish itself as a structural pillar of the Ministerial Decree 77/2022 (DM 77). We are no longer facing an optional methodological choice, but rather an essential delivery method to meet a "mass market" need: in Italy, 44.9% of the population (over 27 million people) requires rehabilitation services, a figure higher than the European average that reflects the country’s relentless demographic aging. The regulatory framework and resources are ready. The Ministry of Health has charted the course, and the PNRR has provided the funds to digitalize the National Health Service (SSN). Organizational guidelines exist with defined workflows that mandate the provision of technological equipment by Health Authorities, treated like any other medical device. However, a question arises: why is the system not taking off? While scientific literature has extensively explored the clinical aspects, a recent scoping review highlights that the true unresolved bottlenecks are economic costs and organizational factors. This is where we must intervene, moving from isolated pilot projects to structured, scalable, and equitable services. In this context, the paradigm shift must extend to Prehabilitation (Prehab). Prehab is a proactive approach to surgery that transforms the "limbo" between diagnosis and the procedure into an active treatment window. This multidisciplinary intervention prepares the patient for surgical stress by "training" them as if for a marathon, focusing on three key levels:

• Physical activity: personalized programs to boost aerobic and endurance capacity.
• Nutritional optimization: increasing protein intake and stimulating muscle growth.
• Psychological support: mitigating the anxiety associated with the waiting period.

The clinical evidence is striking: in frail oncology patients, this path can reduce post-operative complications from 50% to 13.3%. Remote or hybrid models offer extraordinary advantages for those forced into "health migration" toward distant specialized centers: true proximity lies in bringing hospital excellence directly to the patient's home via platforms and devices. The final challenge is managerial. The success of this transition depends on innovative procurement, moving beyond the purchase of individual "devices" to embrace integrated services that are interoperable with the Electronic Health Record (FSE 2.0). Only then can we guarantee a sustainable healthcare model, measurable in terms of Value-Based Healthcare and capable of ensuring real continuity of care between the hospital and the community.