Telerehabilitation in Stroke: a systematic review

Citation: Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. Journal of Stroke and Cerebrovascular Diseases. 2018;27(9):2306-2318.

BACKGROUND. Telerehabilitation, with the use of telecommunication devices (telephone, videoconference), can be valuable in meeting the rehabilitation needs of stroke survivors, especially in rural settings.

PURPOSE. This updated systematic review aimed to investigate the effect of telerehabilitation on motor deficits, higher cortical dysfunction and depression in individuals with stroke.

METHODS. Pubmed & Cochrane were searched from 1980 to 2017 using ‘telerehabilitation’ and ‘stroke’ as main keywords. Studies with randomized controlled trials, pilot or feasibility trials including an intervention group (telerehabilitation) and a control group (usual or no care) were assessed using PRISMA checklist.  Motor deficits were measured using barthel index, berg balance scale, functional independence measure, fugl-myer assessment, wolf motor function, timed-up-go, nine-peg, action research arm, walking speed, ashworth scale & quality of life assessments. Higher cortical dysfunction was measured using aphasia and visuo-spacial neglect, and depression by center for epidemiologic studies depression scale and  patient health questionnaire-9. Other measures included cost, caregiver strain (caregiver’s strain index), satisfaction (satisfaction with stroke care questionnaire), and cognition (mini-mental state exam).

RESULTS. 22 publications met the inclusion criteria. Tele-rehabilitation interventions focused on motor recovery (n=18), depression (n=2) and higher cortical dysfunction (n=2). Duration of the intervention(s) ranged from 2 to 24 weeks with sample size in the intervention group ranging between 5 and 51. Overall, tele-rehabilitation interventions were associated with significant improvements in recovery from motor deficits, higher cortical dysfunction and depression in the intervention groups in all 22 studies but significant differences between intervention versus control groups were reported in 8 out of 22 studies in favor of tele-rehabilitation group.  Cost-effectiveness of tele-rehabilitation showed that the in-clinic intervention resulted in more expenses than the telerehabilitation program (654.72 $ per person).

CONCLUSION & INTERPRETATION. Telerehabilitation for motor, higher cortical deficits and depression appears to be as effective as in-person therapies if not better. This review is limited by the sample size and study design of included studies, and an inconsistent duration of the interventions (2-24weeks).