Abstract
Objective
To study the effectiveness of technology-based distance physical rehabilitation interventions
on physical functioning in stroke.
Data Sources
A systematic literature search was conducted in 6 databases from January 2000 to May 2018.
Study Selection
Inclusion criteria applied the patient, intervention, comparison, outcome, study design
framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation
interventions; (C) any comparison without the use of technology; (O) physical functioning;
(S) randomized controlled trials (RCTs). The search identified in total 693 studies,
and the screening of 162 full-text studies revealed 13 eligible studies.
Data Extraction
The studies were screened using the Preferred Reporting Items for Systematic Reviews
and Meta-analysis guidelines and assessed for methodological quality and quality of
evidence. Meta-analysis was performed if applicable.
Data Synthesis
A total of 13 studies were included, and online video monitoring was the most used
technology. Seven outcomes of physical functioning were identified—activities of daily
living (ADL), upper extremity functioning, lower extremity functioning, balance, walking,
physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based
distance physical rehabilitation had a similar effect on ADL (standard mean difference
0.06; 95% confidence interval: −0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and
other treatment). Similar results were obtained for other outcomes, except inconsistent
findings were noted for walking. Methodological quality of the studies and quality
of evidence were considered low.
Conclusions
The findings suggest that the effectiveness of technology-based distance physical
rehabilitation interventions on physical functioning might be similar compared to
traditional treatments in stroke. Further research should be performed to confirm
the effectiveness of technology-based distance physical rehabilitation interventions
for improving physical functioning of persons with stroke.
Keywords
List of abbreviations:
ADL (activities of daily living), BBS (Berg Balance Scale), GRADE (Grading of Recommendations, Assessment, Development and Evaluation), ICF (International Classification of Functioning, Disability and Health), LLFDI (Late-Life Function and Disability Instrument), PICOS (patient, intervention, comparison, outcome, study design), RCT (randomized controlled trial), SIS (Stroke Impact Scale), SMD (standard mean difference)To read this article in full you will need to make a payment
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References
- Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.Lancet. 2014; 383: 245-255
- Heart disease and stroke statistics--2014 update: a report from the American Heart Association.Circulation. 2014; 129: e28-e292
- Stroke risk estimation across nine European countries in the MORGAM project.Heart. 2010; 96: 1997-2004
- Relative risks for stroke by age, sex, and population based on follow-up of 18 European populations in the MORGAM project.Stroke. 2009; 40: 2319-2326
- Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American heart association.Stroke. 2010; 41: 2402-2448
- Relationships between long-term stroke disability, handicap and health-related quality of life.Age Ageing. 2006; 35: 273-279
- Quality of life after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS).Stroke. 2004; 35: 2340-2345
- Rethinking the continuum of stroke rehabilitation.Arch Phys Med Rehabil. 2014; 95: 595-596
- Time to rethink long-term rehabilitation management of stroke patients.Top Stroke Rehabil. 2012; 19: 457-462
- Auckland Stroke Outcomes Study: part 2: cognition and functional outcomes 5 years poststroke.Neurology. 2010; 75: 1608-1616
- Robot-assisted therapy in stroke rehabilitation.J Stroke. 2013; 15: 174-181
- Virtual reality for stroke rehabilitation.Cochrane Database Syst Rev. 2015; 12: CD008349
- Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery.Top Stroke Rehabil. 2007; 14: 52-61
- Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature.J Rehabil Res Dev. 2012; 49: 479-496
- Bridging the gap between robotic technology and health care.Biomed Signal Process Control. 2014; 10: 65-78
- Rehabilitation and health care robotics.in: Siciliano B. Khatib O. Springer handbook of robotics. Springer, Berlin, Heidelberg2008: 1223-1251
- Telerehabilitation services for stroke.Cochrane Database Syst Rev. 2013; 12: CD010255
- Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials.J Stroke Cerebrovasc Dis. 2015; 24: 2660-2668
- Telerehabilitation in stroke care-a systematic review.J Telemed Telecare. 2011; 17: 1-6
- Towards a common language for functioning, disability and health: ICF.(Available at:) (Accessed October 15, 2017)
- Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.Syst Rev. 2015; 4: 1
- Understanding interobserver agreement: the kappa statistic.Fam Med. 2005; 37: 360-363
- 2015 updated method guideline for systematic reviews in the cochrane back and neck group.Spine. 2015; 40: 1660-1673
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.Br Med J. 2008; 336: 924-926
- Understanding GRADE: an introduction.J Evid Based Med. 2013; 6: 50-54
- How to GRADE the quality of the evidence. Cochrane consumers and communication group.(Available at:) (Accessed October 15, 2017)
- Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information.Disabil Rehabil. 2019; 41: 574-583
- International Classification of Functioning, Disability and Health checklist.(Available at:) (Accessed October 15, 2017)
- Higgins J.P. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011 (Available at:) (Accessed October 15, 2017)
- A power primer.Psychol Bull. 1992; 112: 155-159
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.Br Med J. 2011; 343: d4002
- A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial.Arch Phys Med Rehabil. 2003; 84: 1486-1491
- Domiciliary VR-based therapy for functional recovery and cortical reorganization: randomized controlled trial in participants at the chronic stage post stroke.J Med Internet Res. 2017; 5: e15
- Effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia.Am J Phys Med Rehabil. 2017; 96: 152-160
- Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial.Stroke. 2012; 43: 2168-2174
- Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial.Clin Rehabil. 2017; 31: 1068-1077
- Bidirectional and multi-user telerehabilitation system: clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities.Sensors. 2014; 14: 12451-12466
- Effects of community exercise therapy on metabolic, brain, physical, and cognitive function following stroke: a randomized controlled pilot trial.Neurorehabil Neural Repair. 2015; 29: 623-635
- Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial.Clin Rehabil. 2016; 31: 207-216
- Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach.J Rehabil Med. 2009; 41: 1016-1020
- Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial.Arch Phys Med Rehabil. 2012; 93: 2177-2183
- A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial.Clin Rehabil. 2017; 31: 340-350
- Early supported discharge by caregiver-mediated exercises and e-health support after stroke: a proof-of-concept trial.Stroke. 2016; 47: 1885-1892
- Effectiveness of goal-setting telephone follow-up on health behaviors of patients with ischemic stroke: a randomized controlled trial.J Stroke Cerebrovasc Dis. 2016; 25: 2259-2270
- CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials.Ann Intern Med. 2010; 152: 726-732
- Cognitive impairment after stroke.Curr Opin Neurol. 2002; 15: 79-84
- Cognitive impairment after stroke.Curēus. 2015; 7: e335
- Effectiveness of technology-based distance physical rehabilitation interventions on physical activity and walking in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.Disabil Rehabil. 2016; 40: 373-387
- Effectiveness of technology-based distance interventions promoting physical activity: systematic review, meta-analysis and meta-regression.J Rehabil Med. 2017; 49: 97-105
- Effectiveness of physical activity promoting technology-based distance interventions compared to usual care. Systematic review, meta-analysis and meta-regression.Eur J Phys Rehabil Med. 2017; 53: 953-967
Article info
Publication history
Published online: December 07, 2018
Footnotes
Supported by the Social Insurance Institution of Finland (grant no. 31/26/2014).
Clinical Trial Registration No.: CRD42017065918.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
