Telerehabilitation service impact on physical function and adherence compared to face‐to‐face rehabilitation in patients with stroke: A systematic review and meta‐analysis

Abstract

PurposeThe purposes of this systematic review and meta‐analysis were to: 1) appraise the available evidence of telerehabilitation program effects on functional outcomes, adherence and patient satisfaction compared to face‐to‐face programs after stroke, and 2) provide direction for future outcome measure selection and development for clinical research purposes.MethodsMEDLINE, CINAHL, Embase, Scopus, Proquest Theses and Dissertations, PEDro, and Clinical Trials.gov were searched for studies published in English from 1964 to the end of April 2022. A total of 6,450 studies were identified, 13 were included in the systematic review and 10 with at least 3 reported similar outcomes were included the meta‐analysis. Methodological quality of results was evaluated using the PEDro checklist.ResultsTelerehabilitation demonstrated equivalency in outcomes across several domains and was favored compared to conventional face‐to‐face alone or when paired with semi supervised physical therapy on Wolf Motor Function performance score (mean difference [MD] 1.68 points, 95% CI 0.21 to 3.17) and time score (MD 2.07 seconds, 95% CI ‐4.04 to –0.098, Q test=30.27, p<0.001, I2=93%), and Functional Mobility Assessment in the upper extremities (MD 3.32 points, 95% CI 0.91 to 5.74, Q test=5.60, p=0.23, I2=29%alone or when paired with semi‐supervised physical therapy). The Barthel Index participation measures of function demonstrated improvement (MD 4.18 points, 95% CI, 1.78 to 6.57, Q test=3.56, p=0.31, I2 =16%). Over half of summarized study ratings were determined to be of low to moderate quality (PEDro score 6.54 ± 2.11 points). Adherence varied in available studies from 75%‐100%. Satisfaction levels of telerehabilitation were highly variable.ConclusionsTelerehabilitation can improve functional outcomes and promote therapy adherence post‐stroke function. Therapy protocols and functional assessments need substantial refinement and standardization to improve interpretation and clinical outcomes.This article is protected by copyright. All rights reserved.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

“…A Cochrane Review involving studies up to June 2019 indicated no difference between telerehabilitation and in-person rehabilitation regarding activities of daily living based on low certainty evidence. 44 Several SRs pointed to the comparable outcomes of telerehabilitation when compared to in-person traditional rehabilitation on upper extremity function and balance 45 , 46 with strong evidence for balance 47 as well as equivalency in some other outcomes such as Barthel Index 48 and ADL. 49 Guidelines 50 can be consulted for details of providing rehabilitation to individuals with stroke using telecommunication technologies.…”

Telerehabilitation for Stroke: A Personalized Multi-Domain Approach in a Pilot Study

“…Various VR systems can be used for TR application, which appears to be comparable to conventional in-person rehabilitation in improving motor function [21], especially for upper-extremity and balance recovery among stroke survivors in the chronic stage [18]. This occurs in various functional domains [22,23], also resulting in improvements in cognitive deficits [23], especially for executive function impairments [24], and in patients with post-stroke aphasia [25,26]. In this study, a model for integrated TR was devised with the aim of offering a holistic and patient-centered approach to stroke rehabilitation.…”

Characterization of an Algorithm for Autonomous, Closed-Loop Neuromodulation During Motor Rehabilitation

“… 10 Telerehabilitation solutions promote therapy adherence after neurological injury and demonstrate equivalent or better outcomes when compared to conventional face-to-face therapy. 11 Additionally, telerehabilitation increases engagement and permits longer courses of rehabilitation, which has been shown to produce additional recovery. 12 , 13 Take-home systems, such as RePlay, have been developed to support high-repetition motor rehabilitation and could be readily combined with strategies to improve VNS stimulation timing.…”