Re-assembling primary care therapies with virtual technologies: An Actor Network Theory Analysis of Pandemic Telerehabilitation (Preprint)

BACKGROUND The COVID-19 pandemic triggered an abrupt transition to virtual rehabilitation across physiotherapy, occupational therapy, and respiratory therapy. While telerehabilitation research has documented feasibility and patient satisfaction, less is known about how professionals navigated the destabilization and reassembly of care practices during this transformation. Existing literature frames virtual care as a technical substitution for in-person services, overlooking the deeper reconfiguration of the socio-technical networks that organize therapeutic work. OBJECTIVE Applying actor-network theory (ANT), we examined how rehabilitation professionals reconfigured their practices through technology during the first year of the pandemic. We explored how digital tools, domestic spaces, and new sensory practices reshaped therapeutic presence, professional identity, and the environments in which care was enacted. METHODS We conducted a secondary analysis of longitudinal diary-interview data collected from 16 Canadian rehabilitation professionals (occupational therapists, physiotherapists, and respiratory therapists) working in community-based primary care in Ontario and Manitoba (2020-2021). Participants recorded audio diaries over 12 weeks and completed two follow-up interviews. Analysis followed an interpretive approach informed by Science and Technology Studies, tracing how human and technological actors were enrolled, adapted, and redefined within emerging care assemblages. RESULTS Three interconnected processes characterized the reconfiguration of rehabilitation: (1) technology as active participant, where digital platforms mediated rather than merely transmitted therapeutic reasoning and clinical decision-making; (2) reconfiguration of therapeutic presence, as sensory attention and embodiment were redistributed across screens, sounds, and new forms of spatial choreography; and (3) enrollment of domestic spaces as clinical environments, as clinicians' and patients' homes became sites of care shaped by new ethical, material, and relational dynamics. These processes reveal that virtual rehabilitation constituted a new form of care co-produced by humans, technologies, and spaces rather than a digitized replication of traditional practice. CONCLUSIONS The pandemic exposed rehabilitation as a socio-technical practice sustained through the coordination of multiple actors rather than professional expertise alone. Virtual care redefined therapeutic presence when traditional boundaries between clinical and domestic, human and technological, were blurred. Recognizing virtual care as a distinct modality underscores the need to integrate technology-mediated competencies into rehabilitation education and practice. Future research should incorporate patient perspectives and direct observation to trace how these care networks evolve.