Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke—A Scoping Review

Abstract

Objectives The COVID-19 pandemic has seen a rapid shift to telehealth delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke. Methods Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weightbearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another and results synthesized narratively. Results Seven studies (two randomized trials, one mixed-methods and four pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment and two (29%) studies only included participants who walked independently. Adherence (reported in three studies) and satisfaction (reported in four studies) was good, and no serious adverse events (data from four studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance and in-person exercise prescription. However, there is limited high quality evidence of efficacy. Conclusions We identified strategies used in research to date which can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services. Impact The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers, and optimize safety and adherence for telehealth interventions involving activities in weightbearing or standing positions.

How Many Hours of Device Wear Time Are Required to Accurately Measure Physical Activity Post Stroke?

“…With the continuing development of device-based technologies, longer monitoring periods (e.g., 24 h or devices worn for the entire day) may become the norm. Telerehabilitation using digital communication technology is an approach that allows safe remote monitoring of physical activity post-stroke by clinicians [36]. Clinicians could set targets for their patients and remotely review progress via a device app or platform and provide feedback and review goals with the patient via telephone or video conferencing without the need for face-to-face consultation.…”

Remote physical therapy during COVID-19 pandemic: guidelines in the Brazilian context

“…27 As with face-toface care at the clinic, this involves preparatory actions such as creating contingency plans for any event. 37 It is important to consider, for example, whether the patient will be able to safely perform all necessary activities during the consultation. Before consultation, it is important to consider how these risks can be mitigated.…”

The Impact of the COVID-19 Pandemic on Physical Activity, Function, and Quality of Life

“…Care delivered via telehealth shows similar outcomes to traditional pulmonary rehabilitation. 47 Evidence for other groups such as stroke is more limited 48,49 ; however, a large number of trials have evaluated the feasibility of using telehealth to deliver exercise, with more underway. [50][51][52][53][54] It is essential that mechanisms to support the delivery of physical activity interventions via telehealth to older people are considered and that the effectiveness of telehealth interventions are rigorously evaluated.…”