Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review

Abstract

BackgroundStroke is a leading cause of mortality and morbidity and access to timely rehabilitation can reduce morbidity and help patients to return to normal life. Telerehabilitation can deliver rehabilitation services with the use of technology to increase patient options, deliver services more efficiently and overcome geographical barriers to healthcare access. Despite its popularity, there is conflicting evidence for its effectiveness. Therefore, the aim of this systematic review was to update the current evidence base on the effectiveness of telerehabilitation for stroke.MethodsA systematic search of databases (Medline Ovid; Embase; Emcare; Scopus; The Cochrane Library; PEDro; OTSeeker) was conducted in April 2018 (updated in October 2018). This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and methodology registered with PROSPERO (CRD42018090445). A modified McMaster critical appraisal tool for quantitative studies was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis was conducted.ResultsOut of 1868 studies, 13 randomised controlled trials met the inclusion criteria. A diverse range of interventions were delivered through a variety of telerehabilitation systems and the effectiveness measured through a myriad of outcome measures. Summarised findings from the heterogeneous evidence base indicate that telerehabilitation may have a positive impact on a range of primary and secondary outcomes. However, despite these positive findings, the current evidence lacks clarity and uniformity in terms of intervention parameters and measurement of outcomes, which limits broader application of these results.DiscussionTelerehabilitation, as an alternate form of rehabilitation for people with stroke, shows potential. However, due to methodological and practical concerns, an unequivocal recommendation cannot be made. Findings from this review may inform future policies and practices regarding the use of telerehabilitation for stroke patients.

Implementation of telerehabilitation in response to COVID-19: Lessons learnt from neurorehabilitation clinical practice and education

“…For example, a 2020 Cochrane systematic review and metaanalysis found that telerehabilitation is as effective as in-person rehabilitation for people with stroke (Laver et al, 2020), with similar findings seen in other populations (Di Tella et al, 2020;Ownsworth et al, 2018). Telerehabilitation has been shown to have positive impacts on activities of daily living, healthrelated quality of life, and depressive symptoms in people with neurological disabilities (Appleby et al, 2019;Laver et al, 2020;Ownsworth et al, 2018). Preliminary evidence suggests that telerehabilitation may be more cost-effective than in-person interventions (Caughlin et al, 2020;Housley et al, 2016;Lloréns et al, 2015).…”

Remote Assessment of Post-Stroke Elbow Function Using Internet-Based Telerobotics: A Proof-of-Concept Study

“…Most studies investigating assessment have attempted to implement video conferencing systems between clinicians in a health center and patients in a remote location such as their home ( 5 ). However, these attempts are still far from in-person assessments; for example, all of the assessments lack any physical interaction between clinician and patient ( 6 , 7 ). Since one of the major targets of rehabilitation is to improve the patient's physical impairments, i.e., plegia, weakness, and spasticity, a clinician needs to assess the impairments by conducting in-person physical exams that involve physical interaction.…”

“…Since one of the major targets of rehabilitation is to improve the patient's physical impairments, i.e., plegia, weakness, and spasticity, a clinician needs to assess the impairments by conducting in-person physical exams that involve physical interaction. Without such interaction, the clinician's assessment ability is limited, and the assessment accuracy is degraded ( 3 , 6 , 8 ).…”

The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness

“…Covid-19 is going to expose the continuing absence of any systematic organisation of rehabilitation outside regional specialist services, who will only see a minority of all patients. Most Covid-19 inpatients will need pulmonary rehabilitation, but in addition some or many patients may need rehabilitation for: 6,8,9,45,46 Rehabilitation is of course adapting to new circumstances, for example using telerehabilitation, 47,48 but the long-standing complete separation of services, with minimal personal contacts between separate services that are almost always in separate management structures, has not allowed much reorganisation and redeployment of resources.…”