Telerehab may have a greater effect on stroke patients than those who attend sessions in person, a new study has suggested.
Research has found that stroke patients who engage in rehabilitation via video at home may recover their motor skills better than those who have to attend outpatient facilities.
The Chinese study, published in Neurology, also finds that the convenience of telerehab being done at home could be a significant factor in helping patients stick to their programmes through a greater ability to increase patient participation and compliance, alongside increased opportunities for patients to benefit from completing their rehab in a family and social environment.
“The home-based motor training telerehabilitation approaches used in the current trial were designed to make the rehabilitation training accessible for stroke patients with movement disorders at home; they also lessen the travel burden,” say the study authors.
“These unintended and individualised exercises, including daily routines and social participation activities, together with the rehabilitation prescription training, may jointly explain the positive role of the telerehabilitation approach in motor recovery.”
The use of telerehab has seen a surge in use during the pandemic, with therapists often using technology for the first time in supporting their clients when in-person therapy was not possible. Many have spoken of their intention to continue to use telerehab, to some extent, post-pandemic, though others remain more sceptical.
The study involved 52 patients who had had a stroke an average of 14 days previously, who were randomly assigned to either home-based telerehab or traditional in-person rehab.
Both underwent the same ten sessions, which included occupational therapy, physical therapy and electromyography-triggered neuromuscular stimulation.
The remote group delivered strong outcomes, with an improvement of 11.1 points in the Fugl-Meyer Assessment measure, compared to 5.3 for the outpatient group.
Furthermore, researchers found that the number of sessions and the total duration of participation were higher in the telerehab group, which completed an average of 109 hours of physical/occupational therapy, compared to 97 hours for in-person therapy patients.
The total amount of electromyography-triggered neuromuscular stimulation was similarly increased in the remote group, the study found.
Additionally, resting state functional MRI showed improved brain connectivity between the bilateral M1 areas in the remote group, compared to the in-person group.
“During the pandemic, when travel and human contact might not be possible, it’s important to find out if it’s safe and effective for stroke patients to recover at home, using video consultations for their therapy,” says study author Chuancheng Ren, PhD, of Fudan University, Shanghai, China.
Susan Hillier, PhD, and Brenton Hordacre, PhD, University of South Australia, write in a piece which accompanies the study, that an increase of at least 10 points in the Fugl-Meyer Assessment is needed to show meaningful improvement, so the functional improvement in the tele-health group is considered clinically relevant.
They conclude that the resting-state functional connectivity findings are “both reassuring and important,” because they engender confidence in the reported behavioural improvements. MRI findings also imply that resting-state measures have value in stroke recovery, underlining the need to develop further knowledge of this functional brain measure following stroke, they comment.
“We welcome these kinds of trials that help guide our decision-making for service provision and that consider brain level change as well as patient-level,” say Hillier and Hordacre.
