Telerehabilitation Approaches for Stroke Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials

Chen, Jing; Jin, Wei; Zhang, Xiaoxiao; Xu, Wei; Liu, Xiao‐Nan; Ren, Chuancheng

doi:10.1016/j.jstrokecerebrovasdis.2015.09.014

Cited by 173 publications

(141 citation statements)

References 51 publications

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“…Effective therapist-facing software is as important as the patient-facing program 43 and performed well in this pilot study. Video-based techniques may be a key component to effective telerehabilitation 44 and were a central feature of the system under study. Although the sample size in this pilot study was modest, good compliance with therapy was found in patients with gait velocity < 0.4 m/sec (i.e., mobility limited to the home) or MMSE score as low as 23 (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Telehealth methods may be useful to improve outcomes, particularly given decreasing lengths of stay for inpatient stroke care 46,47 , and moderate evidence exists for equivalence to conventional rehabilitation 44 . The current study supports the feasibility and utility of a home-based system to effectively deliver telerehabilitation, improve patient education, screen for complications of stroke, and provide patients at home with a means for interaction with medical personnel.…”

Section: Discussionmentioning

confidence: 99%

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A Home-Based Telerehabilitation Program for Patients With Stroke

Dodakian

McKenzie

et al. 2017

Neurorehabil Neural Repair

141

126

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Background Though rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit due to access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods Patients were 3–24 months post-stroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of one structured hour focused on individualized exercises and games, stroke education, and an hour of free-play. Results Enrollees (n=12) had baseline Fugl-Meyer (FM) score of 39±12 (mean±SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607±9,934 per subject. Arm motor status showed significant gains (FM change 4.8±3.8 points, p=0.0015), with half of subjects exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age (r=−0.92, p<0.0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge (p=0.0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later (r=0.88, p=0.0001). In-person blood pressure values closely matched those obtained via this system (r=0.99, p<0.0001). Conclusions This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Home-Based Telerehabilitation Program for Patients With Stroke

Dodakian

McKenzie

et al. 2017

Neurorehabil Neural Repair

141

126

View full text Add to dashboard Cite

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“…The results of these yielded ambiguous results. [21][22][23][24][25] In particular, the results from two systematic reviews, 24,25 which were both negative, may be problematic to interpret largely due to the variability in treatment contrasts. Interventions provided in the included studies, 7 and 10, respectively, were delivered by virtual reality, phone, and internet-based therapies.…”

Section: Section 2: Organization Of Telestroke Services For Ongoing Smentioning

confidence: 99%

Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017

Blacquiere

Lindsay

Foley

et al. 2017

International Journal of Stroke

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Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. The 2016 update of the Canadian Stroke Best Practice Recommendations Telestroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. These recommendations focus on the use of telemedicine technologies to rapidly identify and treat appropriate patients with acute thrombolytic therapies in hospitals without stroke specialized expertise; select patients who require to immediate transfer to stroke centers for Endovascular Therapy; and for the patients who remain in community hospitals to facilitate their care on a stroke unit and provide remote access to stroke prevention and rehabilitation services. While these latter areas of Telestroke application are newer, they are rapidly developing, with new opportunities that are yet unrealized. Virtual rehabilitation therapies offer patients the opportunity to participate in rehabilitation therapies, supervised by physical and occupational therapists. While not without its limitations (e.g., access to telecommunications in remote areas, fragmentation of care), the evidence-to-date sets the foundation for improving access to care and management for patients during both the acute phase and now through post stroke recovery.

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“…The most important contribution of all the studies performed on stroke rehabilitation is that they emphasize certain clinically important aspects for proper rehabilitation programs. They have confirmed the importance of focused personal care, mobility training, team work, and education of patients and families [22,23].…”

Section: Outcome Of Rehabilitationmentioning

confidence: 67%