Influence of Core-Stability Exercises Guided by a Telerehabilitation App on Trunk Performance, Balance and Gait Performance in Chronic Stroke Survivors: A Preliminary Randomized Controlled Trial

Abstract

Stroke is one of the main causes of disability. Telerehabilitation could face the growing demand and a good strategy for post-stroke rehabilitation. The aim of this study is to examine the possible effects of therapeutic exercises performed by an App on trunk control, balance, and gait in stroke survivors. A preliminary 12-week randomized controlled trial was developed. Thirty chronic stroke survivors were randomly allocated into two groups. Both groups performed conventional physiotherapy, in addition to, the experimental group (EG) had access to a telerehabilitation App to guide home-based core-stability exercises (CSE). Trunk performance was measured with the Spanish-Trunk Impairment Scale (S-TIS 2.0) and Spanish-Function in Sitting Test. Balance and gait were measured with Spanish-Postural Assessment Scale for Stroke patient, Berg Balance Scale and an accelerometer system. In EG was observed an improvement of 2.76 points in S-TIS 2.0 (p = 0.001). Small differences were observed in balance and gait. Adherence to the use of the App was low. CSE guided by a telerehabilitation App, combined with conventional physiotherapy, seem to improve trunk function and sitting balance in chronic post-stroke. Active participation in the rehabilitation process should be increased among stroke survivors. Further confirmatory studies are necessary with a large sample size.

Mobile health applications for improving physical function, physical activity, and quality of life in stroke survivors: a systematic review

“…The literature search identified 975 studies after the duplicate articles were manually removed. Screening of 53 full-text studies revealed 11 studies that fulfilled the inclusion criteria [34][35][36][37][38][39][40][41][42][43][44]. No relevant articles were identified in the additional manual search.…”

“…Extracted data are presented in Tables 1 and 2. Five studies were conducted in Europe (United Kingdom, Spain, the Netherlands, and Israel) [34,38,40,42,44] and three in Asia (South Korea and the Philippines) [36,37,39]. Other studies were conducted in North America (the United States) [41], South America (Chile) [35], and Africa (Ghana) [43].…”

“…Other single issues related to methodological quality was random allocation [37], concealed allocation [39,44], baseline comparability [37], adequate follow-up (> 85%) [38], and reporting of point measures and measures of variability [37]. For two non-RCTs and four uncontrolled clinical trials, low external validity was observed where the source population was not adequately reported.…”

“…Individual studies used different main inclusion criteria for eligibility to participate in an mHealth intervention study. These were defined with measurements of upper extremity impairments [37], ability to move wrist and fingers [36,39,40], functional ambulation classification (FAC) score between 3 and 5 points [38,42], able to use a mobile app independently [41], independent walk with or without using an aid or orthosis [34], balance (e.g., Berg Balance Scale < 50 points out of 56) [35], the level of ADL (e.g., modified Rankin score of 1 to 4) [43], or a score equal to or less than 10 in the Trunk Impairment Scale (TIS) [44]. Hence, measurements of impairment levels varied across studies; however, overall synthesis indicated that most participants had either mild or moderate symptoms of stroke (Table 1).…”

“…The training volume ranged between one single session and 12 weeks (median of 5 weeks). Seven (63.6%) out of 11 studies used a smartphone-based mHealth solution in their interventions [34,35,37,38,[41][42][43][44], of which three studies used apps in a combination with other devices such as inertial movement unit (IMU) sensors [35], tablet [37], and pedometer [38]. Three (27.3%) studies used a tablet-based mHealth solution only [36,39,40] and one (9.1%) study used either an app or a tablet [44].…”