Can Post Stroke Walking Improve With Telerehabilitation? A Systematic Review in Adults With Stroke

Objective(s): To analyze and synthesize primary studies investigating the effects of telerehabilitation on gait-specific outcomes in the treatment of adult stroke survivors.

Data Sources: PubMed, Embase and CINAHL databases were searched from January 2000 to February 2022 using combinations of several keywords such as: “telerehabilitation”, “stroke”, and “gait”. Results were limited to human clinical studies in adults with stroke published in the English language.

Study Selection: Studies were included if they administered telerehabilitation via a bidirectional form of videoconferencing with assessor presence on one interface and an assessment of walking function was administered in study participants, irrespective of stroke phase. Included articles aimed to study the feasibility and investigate the effectiveness of telerehabilitation protocols on improvement in overall walking function.

Data Extraction: Data extraction was performed from each full text by one author, and quality and bias were assessed using the Physiotherapy Evidence Database (PEDro).

Data Synthesis: A total of 302 nonduplicate articles were screened by one author, resulting in 30 articles for full-text review. Eight studies were included after full-text review, with a total sample size of 248 participants. Statistically significant improvements were seen in all outcome measures of walking function, which included walking, balance, and motor function tests, in seven out of eight total studies. Five studies included a control group out of which two observed greater statistically significant improvement in the telerehabilitation group compared to conventional in-person therapy. Differences in frequency, training duration, intervention, and absence of a conventional therapy control group were identified as causes of variation between studies.

Conclusions: These findings provide evidence supporting the use of telerehabilitation as an effective mode of therapy in providing a better continuum of care in stroke survivors and improving walking related outcomes, especially those pertaining to balance and endurance. Telerehabilitation was safe, feasible and showed good adherence which resulted in the observed improvement. Future research with a focus on real-time supervision is necessary to further improve understanding of cost-effectiveness and caregiver strain and to confirm long-term benefits.

Author(s) Disclosures: Authors declare no conflicts of interest.