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Meta-Analysis
. 2018 Oct 26;20(10):e10867.
doi: 10.2196/10867.

Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis

Huidi Tchero  1 , Maturin Tabue Teguo  2   3   4   5 , Annie Lannuzel  6 , Emmanuel Rusch  7
Affiliations
Meta-Analysis

Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis

Huidi Tchero et al. J Med Internet Res. .

Abstract

Background: Telerehabilitation is an emerging technology through which medical rehabilitation care can be provided from a distance.

Objective: This systematic review and meta-analysis aims to investigate the efficacy of telerehabilitation in poststroke patients.

Methods: Eligible randomized controlled trials (RCTs) were identified by searching MEDLINE, Cochrane Central, and Web of Science databases. Continuous data were extracted for relevant outcomes and analyzed using the RevMan software as the standardized mean difference (SMD) and 95% CI in a fixed-effect meta-analysis model.

Results: We included 15 studies (1339 patients) in our systematic review, while only 12 were included in the pooled analysis. The combined effect estimate showed no significant differences between the telerehabilitation and control groups in terms of the Barthel Index (SMD -0.05, 95% CI -0.18 to 0.08), Berg Balance Scale (SMD -0.04, 95% CI -0.34 to 0.26), Fugl-Meyer Upper Extremity (SMD 0.50, 95% CI -0.09 to 1.09), and Stroke Impact Scale (mobility subscale; SMD 0.18, 95% CI -0.13 to 0.48]) scores. Moreover, the majority of included studies showed that both groups were comparable in terms of health-related quality of life (of stroke survivors), Caregiver Strain Index, and patients' satisfaction with care. One study showed that the cost of telerehabilitation was lower than usual care by US $867.

Conclusions: Telerehabilitation can be a suitable alternative to usual rehabilitation care in poststroke patients, especially in remote or underserved areas. Larger studies are needed to evaluate the health-related quality of life and cost-effectiveness with the ongoing improvements in telerehabilitation networks.

Keywords: meta-analysis; mobile phone; rehabilitation; stroke; telemedicine.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the study selection process. RCT: randomized controlled trial.
Figure 2
Figure 2
Risk of bias assessment summary according to the Cochrane risk of bias tool: Red, green, and yellow colours indicates high, low, and unclear risk of bias, respectively.
Figure 3
Figure 3
The pooled standardized mean difference between the telerehabilitation and control groups in terms of Barthel Index and Berg Balance Scale scores.
Figure 4
Figure 4
The pooled standardized mean difference between the telerehabilitation and control groups in terms of Fugl-Meyer Upper Extremity, Action Research Arm Test, and Stroke Impact Scale (mobility) scores.
See this image and copyright information in PMC

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