Effectiveness of Telerehabilitation Versus Conventional Rehabilitation on Motor Function and Activities of Daily Living After Stroke: A Systematic Review of Randomized Controlled Trials.

Abstract

BackgroundAlthough telerehabilitation is an increasingly popular method for delivering physiotherapy remotely, its efficacy compared with traditional in person therapy for stroke patients remains uncertain.ObjectiveThis systematic review evaluates the effectiveness of telerehabilitation compared with conventional physiotherapy on motor function (Fugl-Meyer Assessment, FMA) and activities of daily living (Barthel Index) in stroke patients.ResultsFour trials involving 226 randomized participants were included. Cramer et al. showed noninferiority of dose-matched home telerehabilitation for Fugl-Meyer change (adjusted difference 0.06 points, 95% CI -2.14 to 2.26; p = .96). Shamweel and Gupta found no post-treatment FMA-UE difference (p = .337). Saygili et al. reported significant group-by-time interactions for FM-UE (p = .001) and FIM (p = .006), but Tele-CIMT was added to a home-exercise program and was not dose matched. Chen et al. found no differential Modified Barthel Index trajectory (group-by-time p = .897). Two trials were judged low risk of bias and two had some concerns. Certainty was very low for motor and ADL outcomes because of inconsistency, indirectness, and imprecision, with additional risk-of-bias concerns.ConclusionsTelerehabilitation can produce clinically relevant gains, and one adequately powered dose-matched trial supports noninferiority for arm motor recovery. The evidence does not establish general superiority over equivalent in-person rehabilitation. Larger trials should match content and dose, prespecify comparative estimands, and report standardized outcomes.