Digitally enabled flexible implementation of medical rehabilitation for adolescents with scoliosis: a non-inferiority study

Background
Digitalization is becoming increasingly important in healthcare, including rehabilitation. In response, the German Pension Insurance (Deutsche Rentenversicherung) has developed a framework for piloting a digitally flexible model of medical rehabilitation. This research project builds directly on that initiative. Participants in the intervention group will complete the first and fourth weeks of the four-week rehabilitation program as inpatients, while the second and third weeks will be delivered remotely from home. Therapy in the home setting will be provided through both synchronous videoconferencing sessions and asynchronous digital resources, such as instructional videos hosted on an online platform. The study is being conducted in collaboration with the Asklepios Katharina Schroth Klinik Bad Sobernheim. The primary objective of the project is to evaluate whether the digitally flexible rehabilitation model is non-inferior to conventional inpatient rehabilitation.
Methods
A cluster-randomized, controlled non-inferiority trial will be conducted. Eligible participants are adolescents aged 14–17 years with scoliosis who have previously completed at least one rehabilitation program at the Asklepios Katharina Schroth Klinik Bad Sobernheim. The primary outcome of the non-inferiority trial is the change in spinal rotation, measured using a scoliometer. In addition, qualitative interviews and therapy diaries will be used to identify facilitators and barriers to the implementation of the digitally flexible rehabilitation program. A cross-sectional study involving adolescents undergoing rehabilitation for the first time will assess their general willingness to participate in a digitally flexible rehabilitation program and explore the motivations underlying their preferences. The findings will inform sustainability workshops in which the potential expansion of the model to additional indications and patient groups will be discussed. Furthermore, the costs of the digitally flexible rehabilitation model will be compared with those of conventional inpatient rehabilitation.