Successful cases of telerehabilitation processes and medical consultations carried out through telemedicine platforms are presented in the study by Finak et al [8], highlighting the application of remote communication technologies for physical rehabilitation, occupational therapy, and chronic pain management [9], particularly for rural populations [10,11]. In addition, the following aspects were analyzed:

In this aspect, a review was conducted to understand how the type of technology used and the characteristics of the population influence the effectiveness of telemedicine and telerehabilitation interventions [19]. Effective components in different clinical contexts were analyzed, aiming to optimize technologies to maximize their benefits in medical practice [20].

Regarding access and coverage of telemedicine services in rural and remote areas, significant challenges were identified, which have been addressed through various telecommunication technologies. Key factors in choosing appropriate technology in contexts with limited communication infrastructure, such as rural areas [21], include the scarcity of terrestrial networks and the need for sustainable solutions. The use of technologies such as Very Small Aperture Terminals (VSAT) [22] is justified by their availability and adaptability to local needs, highlighting cost-effectiveness and broad coverage, especially in rural areas. Furthermore, in extremely remote locations such as Maewo Island [23], satellite technology emerges as the most viable solution [24].

For mobile networks in telemedicine, efforts focus on integrating patients and health care professionals through advanced ICT such as 5G, which offers high bandwidth and the capacity to quickly transmit large medical files [25], enabling timely and informed decision-making about patient health [26]. In addition, the future scalability of 5G and its ability to easily upgrade to new technologies are key advantages. The adaptation to available communication infrastructure, along with diverse technological options such as Code Division Multiple Access (CDMA 2000 1X) [27] and Global System for Mobile Communications (GSMC) [28,29], enhances availability and connection stability in both urban and rural environments, complemented by the use of ad hoc mobile networks such as Mobile Ad Hoc Networks (MANET) and Mobile Internet Protocol (Mobile IP) [30].

Worldwide Interoperability for Microwave Access (WiMAX) is another useful technology for covering large distances while providing adequate bandwidth for telemedicine applications, such as the transmission of high-resolution medical images and video [31].

Fiber optic infrastructure and radio networks also enhance access. In the study by Baena and Bríñez [32], a high-speed backbone network is shown to enable the creation of a faster and more robust telemedicine network, compared to other technologies such as satellite connections or radio links. In another case, radiofrequency-based solutions [33] connect a hospital with rural health posts in remote areas using a radio link.

In summary, the technologies used in telemedicine are diverse and vary according to the specific needs of each environment. WiMAX stands out for its high bandwidth and its ability to prioritize critical data. Studies presented in Niyato et al [34], Tchao et al [35], and Aliyu et al [36] further highlight these advantages. The use of portable devices and long-range communication protocols is also important. In the study by Pramanik et al [37], Long Range (LoRa) technology is selected for its broadband wireless access capabilities and security features, facilitating effective transmission of medical data.

Wireless Body Area Networks (WBAN) combined with cloud computing enable remote patient monitoring and real-time health data analysis. An example of remote health monitoring can be found in Suleiman and Adinoyi [38].

A description of how 5G technology, artificial intelligence, machine learning, and the Internet of Medical Things (IoMT) are transforming health care delivery is provided in the study by Latha et al [39]. In addition, WBAN technology [40] and cloud computing are used to create a telemedicine framework, as shown in the study by Park et al [40]. Finally, LTE-Advanced (LTE-A) can also be selected for its higher bandwidth, lower latency, better coverage, increased capacity, and improved quality of service, as highlighted in Kress and Leeuwen [41].

To analyze the health care access issues in this region of Colombia, it is essential to consider the years of armed conflict experienced in the Department of Caquetá. This context has hindered progress in various sectors, such as infrastructure, education, and health, limiting access to essential basic services. These deficiencies, recognized as unsatisfied basic needs, not only contradict the Sustainable Development Goals but also widen socioeconomic and territorial inequality gaps in the region.

In the Department of Caquetá, medium-complexity health services are centralized in Florencia, the department’s capital. In some municipalities, specialist services (such as gynecology, cardiology, internal medicine, and pediatrics) are only offered through mobile health brigades. Outside the capital, municipalities only provide low-complexity health services, which results in an uneven distribution of specialists across the department. In addition, there is insufficient supply, high demand, long waiting times for appointments managed by health entities, and geographical limitations.

The San Rafael Hospital in San Vicente del Caguán has recently opened a Comprehensive Rehabilitation Center, offering physical therapy, occupational therapy, and speech therapy, making it the only municipality outside Florencia with these 3 rehabilitation services available.

San Vicente del Caguán covers an area of 28,300 km² and has a population of approximately 54,575 inhabitants, where 51.3% of the population lives in rural areas, according to 2024 projections by Departamento Administrativo Nacional de Estadística [42]. The municipality is made up of 287 rural settlements distributed across 14 police inspection zones within the municipal territory. The primary access routes are dirt roads (unpaved), which significantly complicate the journey of rural patients traveling from their villages to San Rafael Hospital for various health care procedures.

In addition, there is no internet access at health service points in the region. However, a significant number of inhabitants own mobile phones, which they use for telephone calls and, when possible, access mobile data services in communal zones where coverage is available.

Considering these regional conditions, the proposed telerehabilitation system, based on broadcasting therapy content (physical therapy, occupational therapy, and speech therapy) through an asynchronous computer-based format, offers a viable solution to expand health care service coverage to rural areas served by San Rafael Hospital. This model would also overcome geographical barriers and internet access limitations, improving health care delivery in the region.

A video is an audiovisual content format that combines visual and audio elements to facilitate the understanding of a message and enhance information retention [43-45]. Videos can vary in format, duration, and purpose and are widely used across different industries, including education, entertainment, advertising, and health care, particularly in telerehabilitation where digital platforms have shown effectiveness [46,47].

Based on these criteria, teletherapy is developed as a care modality that uses ICTs, including mobile apps and video-based content, to deliver remote therapeutic rehabilitation services [46].

When supporting the use of videos in teletherapy, it is necessary to consider the following aspects: the positive impacts that are reflected in the improvement of the understanding of exercises, by providing a visual representation, allow patients to observe precise movements, postures, and appropriate techniques, which reduces the likelihood of errors and increases the accuracy in the execution of exercises [46]. In turn, adherence to rehabilitation treatment is another aspect that is strengthened with the use of videos.

Another significant impact is the reduction of the patients’ dependence on the therapist. Video-based interventions and visual feedback allow patients to perform exercises more independently, providing a constant guide that they can review as many times as necessary [48]. In Latin America, several studies have also demonstrated significant positive impacts. Video-based therapeutic interventions for rehabilitation resulted in significant improvements in mobility and pain reduction [49]. Technology-based rehabilitation interventions for poststroke patients helped improve motor coordination and reduce recovery time [50]. Technology-assisted rehabilitation programs have reported improvements in aerobic capacity and reduction of fatigue in patients with chronic conditions [51]. Rehabilitation programs have shown faster recoveries and pain reduction in postsurgical hip replacement patients [52].

The design of rehabilitation videos requires a methodical approach to ensure that audiovisual content is accurate, understandable, and accessible to all patients. Studies have highlighted [53] the importance of a systematic approach to creating educational videos for rehabilitation.

The need for a structured process for the design of audiovisual content has been emphasized in rehabilitation research [53], highlighting the importance of conducting pilot tests and collecting patient feedback to improve the quality of the videos, an iterative approach that makes it possible to adjust the content to make it more effective and accessible.

Finally, it is important to take into account that the methods or processes that guide the design of videos in telerehabilitation should consider the following recommendations: having the collaboration of multidisciplinary professionals [53], the duration of the video should be short enough to maintain the patient’s attention, but long enough to cover all important aspects of the exercise or technique [46], including clear and descriptive visual elements, as effective visual communication is essential in digital health interventions [54], to address the diversity of patients’ needs, the videos must be adaptable and customizable [51], the creation of videos must be an iterative process that includes evaluation and continuous feedback from patients and health care professionals, as demonstrated in recent systematic reviews [55], and it is important to consider options for downloading videos in areas with limited internet access [42].

The following are the 3 components of the model, consisting of the telecommunications infrastructure, the mobile app, and the design of audiovisual content with its mode of operation. The teletherapy services implemented support the telerehabilitation services for physiotherapy, occupational therapy, and speech therapy.

The solution has 3 components: a telecommunications component supported by a wireless network based on radiofrequency solutions (long-range and high-bandwidth radio links) and Wi-Fi technologies (802.11a, 802.11b, 800.11n, 802.11ac, and 802ax), which enable the interconnection of a hospital with prioritized and remote health posts far from the municipal or urban center. A software platform (Progressive Web Application [PWA]; Google), user-friendly and interactive, is complemented by the creation of audiovisual content (videos and animations) that are stored in a cloud repository or are synchronously and programmatically loaded with a rehabilitation therapy plan onto the patient’s mobile device. This solution can be available for direct access to the cloud or located at remote or rural centers for loading onto the patient’s mobile device to be used later at home. The platform allows the administration and configuration of therapies that will be scheduled for patients according to their medical history, needs, and clinical records.

Figure 1 shows the general configuration of the telecommunications system.

The network is made up of a radio link that guarantees access to rehabilitation services in the telemedicine modality to connect the E.S.E. Hospital San Rafael with remote health centers with difficult access to serve the communities of Los Pozos and Tres Esquinas. The network is composed of several components described below.

E.S.E. Hospital San Rafael in San Vicente del Caguán: from this point, the telerehabilitation service is coordinated, bringing together specialists, training patients referred to teletherapy, and providing follow-up through tele-expertise to patients by connecting doctors and nurses through the radio link. These professionals are responsible for maintaining direct contact with patients once they start follow-up when they come to the center for their check-ups. Finally, monitoring is carried out via telemonitoring and synchronous and asynchronous teleconsultation.

The system has 2 signal relay hops at Lince Hill and Cerro Neiva. This configuration allows communication coverage to reach the remote areas.

Figure 2 shows the installed infrastructure at each of the described points. Figure 2A shows the antenna installed at Hospital San Rafael. Figure 2B presents the configuration at Lince Hill, which maintains a direct line with the hospital. Figure 2C shows the configuration at Cerro Neiva, which maintains a link with Lince Hill. From Cerro Neiva, the highest point in the configuration, communication is established with Tres Esquinas and Los Pozos, as shown in the configuration in Figure 2D for each point.

The software system of the solution follows a layered architecture that ensures separation of responsibilities. The presentation layer consists of 2 apps. The first one, HSRehabiAPP, shown in Figure 3, is a mobile app designed for online and computer-based use, where users can access their assigned therapies, obtain exercise instructions, prepare evidence, monitor their progress, and securely communicate with the assigned health care professional.

A critical aspect in the design of the mobile app is its offline functionality. This is particularly important considering that most patients are in rural areas with little or no internet connectivity. Data synchronization is fully automated and takes place whenever patients have a connection, using a publish-subscribe model that optimizes data transfer.

The second app, HSRehabiWEB (Figure 4), is a web app where health care professionals manage the catalog of videos and exercises, configure therapies, register their patients, and monitor their progress. This app serves as the control center of the solution.

The application layer consists of an application programming interface, which provides access points to the application logic (Backend). The application layer is deployed on the AWS platform (Amazon) to ensure adequate quality of service. The data layer, also deployed on AWS, implements a relational model in a PostgreSQL database (Amazon).

A pilot test was carried out between the San Rafael Hospital in San Vicente del Caguán and the centers of Pocos and Tres Esquinas in rural areas, to evaluate the implementation and effectiveness of the telerehabilitation model based on asynchronous transmission of audiovisual content in the municipality of San Vicente del Caguán, Colombia. The test included 7 patients in the telerehabilitation program, which covered physical, occupational, and speech therapies. The criteria observed considered functional tests, usability criteria, and content evaluation.

Table 1 summarizes the demographic, clinical, and geographic characteristics of the patients in the trial.

Table 2 presents the criteria evaluated during the tests of the telerehabilitation model and its app, organized by number, specific criterion, and corresponding description. The evaluation covered 3 main areas: functional testing, usability testing, and audiovisual content assessment. Functional testing verified key aspects related to the usability, accessibility, and functionality of the app. Usability testing focused on identifying strengths and opportunities for improvement in the user experience by analyzing different aspects of user interaction with the app. Additionally, the audiovisual content evaluation examined the quality and effectiveness of the multimedia materials used in the telerehabilitation model to ensure that patients could perform the exercises properly and safely.

This study was approved by the Research Ethics Committee of Universidad Distrital Francisco José de Caldas. All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its subsequent amendments. Written informed consent was obtained from all participants included in the study (or from their legal guardians in the case of minors) prior to their participation. Participants were provided with detailed information regarding the nature and objectives of the telerehabilitation model, the procedures involved, the potential risks and benefits, and their right to withdraw from the study at any time without penalty. All participants were given sufficient time to consider their participation and had the opportunity to ask questions before signing the informed consent forms.

Patient data, including demographic information, medical records, therapy videos, and evaluation results, were securely stored in encrypted digital formats with access restricted exclusively to authorized members of the research team. The mobile app (HSRehabiAPP) and the web platform (HSRehabiWEB) were designed with security measures aimed at protecting personal health information, in compliance with Colombian data protection regulations (Law 1581 of 2012 on personal data protection). Video recordings used for therapy sessions were stored on secure servers and were accessible only to the assigned health care professionals and the corresponding patient. Participants were informed about data storage, access, and usage procedures through the informed consent process.

Additional ethical considerations were adopted to ensure adequate protection of these participants. In the case of the older adult participant, cognitive capacity to provide informed consent was assessed prior to enrollment in the study. For the minor participant, both parental informed consent and child assent were obtained, and therapy sessions were adapted according to the child’s age and conducted under parental supervision. Given the rural and potentially socioeconomically vulnerable condition of participants from Los Pozos and Tres Esquinas, measures were taken to ensure that participation was entirely voluntary and that individuals did not feel coerced to participate due to limited access to alternative rehabilitation services.

Anonymized participant data will not be made publicly available due to the small sample size and the potential risk of reidentification, particularly considering the specific rural and clinical context of the participants. Aggregate results and findings are presented in this publication in a manner that protects the individual confidentiality of participants.