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Meta-Analysis
. 2013 Dec 16;2013(12):CD010255.
doi: 10.1002/14651858.CD010255.pub2.

Telerehabilitation services for stroke

Kate E Laver  1 , Daniel Schoene, Maria Crotty, Stacey George, Natasha A Lannin, Catherine Sherrington
Affiliations
Meta-Analysis

Telerehabilitation services for stroke

Kate E Laver et al. Cochrane Database Syst Rev. .

Update in

  • Telerehabilitation services for stroke.
    Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Laver KE, et al. Cochrane Database Syst Rev. 2020 Jan 31;1(1):CD010255. doi: 10.1002/14651858.CD010255.pub3. Cochrane Database Syst Rev. 2020. PMID: 32002991 Free PMC article.

Abstract

Background: Telerehabilitation is an alternative way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face.

Objectives: To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self care and domestic life and improved mobility, health-related quality of life, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions.

Search methods: We searched the Cochrane Stroke Group Trials Register (November 2012), the Cochrane Effective Practice and Organization of Care Group Trials Register (November 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 11, 2012), MEDLINE (1950 to November 2012), EMBASE (1980 to November 2012) and eight additional databases. We searched trial registries, conference proceedings and reference lists.

Selection criteria: Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation.

Data collection and analysis: Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information.

Main results: We included in the review 10 trials involving a total of 933 participants. The studies were generally small, and reporting quality was often inadequate, particularly in relation to blinding of outcome assessors and concealment of allocation. Selective outcome reporting was apparent in several studies. Study interventions and comparisons varied, meaning that in most cases, it was inappropriate to pool studies. Intervention approaches included upper limb training, lower limb and mobility retraining, case management and caregiver support. Most studies were conducted with people in the chronic phase following stroke.

Primary outcome: no statistically significant results for independence in activities of daily living (based on two studies with 661 participants) were noted when a case management intervention was evaluated.

Secondary outcomes: no statistically significant results for upper limb function (based on two studies with 46 participants) were observed when a computer programme was used to remotely retrain upper limb function. Evidence was insufficient to draw conclusions on the effects of the intervention on mobility, health-related quality of life or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation. No studies reported on the occurrence of adverse events within the studies.

Authors' conclusions: We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Analysis 1.1
Analysis 1.1
Comparison 1 Independence in activities of daily living: postintervention, Outcome 1 Independence in activities of daily living.
Analysis 2.1
Analysis 2.1
Comparison 2 Upper limb function: postintervention, Outcome 1 Upper limb function.
See this image and copyright information in PMC

References

References to studies included in this review

    1. Boter H, for the HESTIA Study Group. Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients. Stroke 2004;35:2867‐72. - PubMed
    1. Carey J, Durfee W, Bhatt E, Nagpal A, Weinstein S, Anderson K, et al. Comparison of finger tracking versus simple movement training via telerehabilitation to alter hand function and cortical reorganization after stroke. Neurorehabilitation and Neural Repair 2007;21(3):216‐32. - PubMed
    1. Chumbler N, Quigley P, Li X, Morey M, Rose D, Sanford J, et al. Effects of telerehabilitation on physical function and disability for stroke patients. Stroke 2012;43:2168‐74. - PubMed
    1. Deng H, Durfee W, Nuckley D, Rheude B, Severson A, Skluzacek K, et al. Complex versus simple ankle movement training in stroke using telerehabilitation: a randomized controlled trial. Physical Therapy 2012;92(2):197‐209. - PMC - PubMed
    1. Forducey P, Glueckauf R, Bergquist T, Maheu M, Yutsis M. Telehealth for persons with severe functional disabilities and their caregivers: facilitating self‐care management in the home setting. Psychological Services 2012;9(2):144‐62. - PMC - PubMed

References to studies excluded from this review

    1. Adie K, James M. Does telephone follow‐up improve blood pressure after minor stroke or TIA?. Age and Ageing 2010;39:598‐603. - PubMed
    1. Bergquist T, Yutsis M. The effect of cognitive rehabilitation delivered via instant messaging on functional independence in persons with ABI. Brain Injury 2012;26(4‐5):700‐1.
    1. Burton C, Gibbon B. Expanding the role of the stroke nurse: a pragmatic clinical trial. Journal of Advanced Nursing 2005;52(6):640‐50. - PubMed
    1. Eide L, Schanke A. Examining computerized working memory training as a supplement to cognitive rehabilitation for patients with an acquired brain injury. Brain Injury 2012;26(4‐5):749‐50.
    1. Gillham S, Endacott R. Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial. Clinical Rehabilitation 2010;24(9):822‐30. - PubMed

References to ongoing studies

    1. Eames S, Hoffman T, Worrall L, Read S, Wong A. Randomised controlled trial of a post‐discharge education and support package for clients with stroke and their carers. International Journal of Stroke 2011;6(Suppl 1):8.
    1. Graven C, Brock K, Hill K, Cotton S, Joubert L. Does a focus on participation and personal goal achievement have an impact on depression in the first year after stroke?. Neurorehabilitation and Neural Repair 2012;26:755.
    1. Miller I, Bishop D, Epstein‐Lubow G. Reduction in post‐stroke depressive symptoms among patients and caregivers: theFITT study. American Journal of Geriatric Psychiatry 2010;18(3(Suppl 1)):S61‐2.
    1. Alberts J, Wolf S. Rehabilitation of the stroke hand at home (HAPPI). ClinicalTrials.gov (http://clinicaltrials.gov/show/NCT01144715)2010.
    1. Uswatte G. Home‐based automated therapy of arm function after stroke via tele‐rehabilitation. ClinicalTrials.gov (clinicaltrials.gov/ct2/results?term=NCT01157195)2010.

Additional references

    1. American Speech‐Language‐Hearing Association. Speech‐language pathologists providing clinical services via telepractice: position statement. www.asha.org/policy2005.
    1. American Telemedicine Association. A blueprint for telerehabilitation guidelines. Telemedicine and e‐Health 2011;17:662‐5. - PubMed
    1. Australasian Rehabilitation Outcomes Centre. The AROC Annual Report: the state of rehabilitation in Australia in 2010. http://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@aroc/documents....
    1. Brennan D, Mawson S, Brownsell S. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation and self management. In: Gaggioli A editor(s). Advanced Technologies in Rehabilitation. Amsterdam: IOS Press, 2009:231‐48. - PubMed
    1. Brochard S, Robertson J, Medee B, Remy‐Neris O. What's new in new technologies for upper extremity rehabilitation?. Current Opinion in Neurology 2010;23:683‐7. - PubMed