Posts Tagged telerehabilitation
BACKGROUND:One of the most interesting emerging medical devices is the medical avatar – a digital representation of the patient that can be used toward myriad ends, the full potential of which remains to be explored. Medical avatars have been instantiated as telemedical tools used to establish a representation of the patient in tele-space, upon which data about the patient’s health can be represented and goals and progress can be visually tracked. Manipulation of the medical avatar has also been explored as a means of increasing motivation and inducing neural plasticity.
OBJECTIVE:The article reviews the literature on body representation, simulation, and action-observation and explores how these components of neurorehabilitation are engaged by an avatar-based self-representation.
METHODS:Through a review of the literature on body representation, simulation, and action-observation and a review of how these components of neurorehabilitation can be engaged and manipulated with an avatar, the neuroplastic potential of the medical avatar is explored. Literature on the use of the medical avatar for neurorehabilitation is also reviewed.
RESULTS:This review demonstrates that the medical avatar has vast potentialities in neurorehabilitation and that further research on its use and effect is needed.
Telemedicine seemed like a new idea at the outset of the COVID-19 pandemic. However, it now appears to be part of the new norm and might be paving the way to the future.
In a recent review paper published in Telemedicine and e-Health, Brodie Sakakibara, along with the Centre for Chronic Disease Prevention and Management (CCDPM), suggest that virtual appointments, in the form of telerehabilitation, could also work for people recovering from a stroke.
After a stroke, a client is provided with a therapy program to help re-gain loss of skills or motion — this can range from speech and memory, strength, balance and endurance. While not initially introduced for disease outbreaks, Sakakibara, a UBCO assistant professor, suggests that research shows remote therapy can be effective during stroke recovery, a media release from University of British Columbia Okanagan campus notes.
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy. These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes.”
— Brodie Sakakibara
HOW EFFECTIVE IS IT?
To learn how effective telerehabilitation can be, six different clinical trials — examining stroke telerehabilitation programs — were launched across Canada as part of a Heart and Stroke Foundation initiative. People recovering from a stroke were provided with interventions ranging from lifestyle coaching to memory, speech skills and physical-exercise training.
Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context, Sakakibara shares in the release.
Going forward with telerehabilitation as a new reality, Sakakibara says the study authors determined there are important lessons learned from each of the six trials. Most notably, the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management.
He also notes patients mostly reported satisfaction with the telerehabilitation when therapists were trained appropriately, and when there was some social interaction. Overall, clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible.
And finally, since seniors are a key target group for stroke rehabilitation — as stroke is associated with aging — the technology needs to be easy to use and suit the needs of the end users, the release continues.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow. While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care.”
— Brodie Sakakibara
[Source(s): University of British Columbia Okanagan campus, Science Daily]
Telehealth may not have been at the top of mind before 2020, unless you live in a rural or hard-to-reach location, but these days, many people are facing the new reality of doctor appointments online or by phone. Telehealth isn’t reserved just for talking to your doctor or nurse practitioner about medical issues, though. It can also be part of a rehabilitation program following a serious illness, like a stroke.
In 2004 a group of Italian scientists conducted a study to see if a remote provider using “advanced communication technology” could help rehabilitate stroke patients at home. The study lasted only 4 weeks, but the researchers concluded that “telerehabilitation may represent a new home-based therapy to treated disabled people.”
Sixteen years later, a new study from the University of British Columbia in Canada confirms that telerehabilitation does work for patients recovering from a stroke.
Telerehabilitation Offers Alternatives
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy,” Brodie Sakakibara, PhD, the paper’s co-author, said in a press release. Dr. Sakakibara is with the Centre for Chronic Disease Prevention and Management (CCDPM).
The study’s data comes from 6 different clinical trials launched across Canada as part of the Heart and Stroke Foundation initiative. People recovering from a stroke were offered interventions from lifestyle coaching to memory, speech skills and physical exercise training. “Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of tele-rehab services withing a research context,” Dr. Sakakibara said.
Each trial provided important tele-rehab lessons, according to Dr. Sakakibara. Among the lessons was that cost and efficacy of tele-rehab is similar to traditional face-to-face programs. Also, patients were most satisfied with tele-rehab when the therapists were well trained and engaged in social interaction. Clinicians, however, preferred face-to-face rehab but used tele-rehab when necessary.
Since strokes are more often associated with older adults, a tele-rehab program’s technology must be easier to use.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow,” Dr. Sakakibara said. “While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult community of tomorrow likely is very comfortable using technology.”
Earlier Studies Had Similar Results
The Canadian study is the latest research validating the use of tele-rehabilitation for stroke patients. In a 2018, 6-week study conducted in 11 American cities with 124 stroke patients, researchers from the University of California at Irvine found that stroke patients using telerehabilitation did just as well as patients receiving face-to-face therapy.
“The current findings support the utility of a computer-based system in the home, used under the supervision of a licensed therapist, to provide clinically meaningful rehab therapy,” Steven C. Cramer, MD, whose research team is part of the National Institutes of Health StrokeNet consortium said in a press release.
Even before the research findings concluded that stroke telerehabilitation works, hospitals and medical systems incorporated it into stroke recovery programs. “Tele-rehabilitation is widely and successfully used to help people recover from stroke and other conditions,” Ana Mond Johnson, CEO of the American Telemedicine Association, wrote in an email to Medical Daily.
The ATA’s Telerehabilitation Special Interest Group includes a wide array of rehabilitation professionals including occupational and physical therapists, speech-language pathologists, rehabilitation physicians and nurses, neuropsychologists, as well as policy experts.
The Pandemic Changed Telehealth’s Profile
In the past 6 months, the COVID-19 pandemic has significantly raised telehealth’s profile. According to a CNBC report, analysts projected 36 million general medical care visits for 2020. Once the pandemic hit that number skyrocketed to 200 million by end of the year.
But telemedicine in all its forms was already carving out its niche in mainstream medicine. According to Medical Economics, at the beginning of 2020 patient adoption of telehealth was up 33% over the previous year. Funding for telehealth is expected to reach $185.6 billion by 2026.
Once these programs are implemented in practice, it will be part of the norm, even when the outbreak is over,” Dr. Sakakibara said. “It is important that we develop and study telerehabilitation programs to ensure the programs are effective and benefit the patients.”
Robert Calandra is an award-winning journalist and book author who has written extensively about health and medicine. His work has appeared in national and regional magazines and newspapers.
By Nilanjana Roy
A study shows the benefits of virtual stroke Of rehabilitation. In a recent review paper by Brodie Sakakibara with the center for chronic disease prevention and management has determined that virtual appointment in the form of telerehabilitation also works for people recovering from a stroke.
After a stroke a client provided with a therapy program to regain the loss of skills or motion this can range from speech and memory, strength, balance, and endurance. Sakakibara a UBCO assistant professor says research shows remote therapy can be effective during stroke recovery. Telerehabilitation has promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those who attend conventional therapy.
These services can be provided to remote locations through information and communication technology and can be accessed by the patients from their homes. To learn effective telerehabilitation six different clinical trials have been launched across Canada as a part of the heart and stroke foundation initiated. People who recovered from strokes were given intervention ranging from lifestyle vouching to. Memory speech skills and physical exercise training.
Research for every six trials came together to write a review paper to describe the experience of conducting a telerehabilitation study. And reports on the facilitators and barriers to implementing the telerehabilitation services.
Going with telerehabilitation As a new reality, the study determines there are important lessons to learn from. Each of the six trials. Most importantly the efficiency and cost of telerehabilitation are similar to the face to face management. Patients have mostly reported satisfaction from the telerehabilitation when therapists have trained appropriately and with some social interaction. Clinicians prefer face to face interaction but will use telerehabilitation when face to face is not feasible.
UBCO professor explores future of virtual stroke rehabilitation
Miriam Halpenny – Sep 5, 2020 Photo: Contributed
A new study from UBC Okanagan has revealed the benefits of virtual stroke rehabilitation programs as they may become part of the new normal amid the COVID-19 pandemic.
Virtual medical appointments were considered unconventional when the COVID-19 pandemic initially struck, but they may now be paving the way to the future.
Focused on stroke, a recent review paper by co-author Brodie Sakakibara with the Centre for Chronic Disease Prevention and Management has discovered that virtual appointments also known as telerehabilitation also work.
If someone has a stroke, the patient will be given a therapy program to aid them in regaining loss of motion or skills. This can include speech, memory, strength, balance and endurance.
While not typically used for disease outbreaks, Sakakibara, who is also a UBCO assistant professor, says remote therapy can work for stroke recovery.
“Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy,” says Sakakibara.
“These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes.”
Six clinical trials focused on stroke telerehabilitation were launched across Canada through a Heart and Stroke Foundation initiative to learn how effective the programs can be.
Through the trials, people who had suffered a stroke were given interventions ranging between lifestyle coaching, memory, speech skills and physical training.
“Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context,” says Sakakibara.
Going forward, important lessons were learned from each of the trials. Particularly, telerehabilitation’s efficacy and cost matches that of traditional in-person management. Sakakibara also says the majority of patients reported satisfaction with the programs when the therapists were trained accordingly and where there was some social interaction.
When it comes to clinicians, they mostly prefer face-to-face interactions but will settle for telerehabilitation when thats not feasible.
Another lesson learned was that because seniors are a main target group for stroke rehabilitation, the technology must be simple and easy to use.
“The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow,” says Sakakibara. “While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care.”
He also notes that the COVID-19 pandemic has amplified the need for telerehabilitation for lots of Canadians, especially ones in remote areas as well as the 70 per cent of stroke victims who can no longer drive.
“Prior to the outbreak, telehealth/rehabilitation was highly recommended in Canadian stroke professional guidelines, but was underused,” he says. “Now in response to COVID-19, the use of telerehabilitation has been accelerated to the forefront. Once these programs are implemented in practice, it’ll be part of the norm, even when the outbreak is over. It is important that we develop and study telerehabilitation programs to ensure the programs are effective and benefit the patients.”
[ARTICLE] Development of the Home based Virtual Rehabilitation System (HoVRS) to Remotely Deliver an Intense and Customized Upper Extremity Training – Full Text PDF
Background: After stroke, sustained hand rehabilitation training is required for continuous improvement
and maintenance of distal function.
Methods: In this paper, we present a system designed and implemented in our lab: the Home based
Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the
feasibility of the system as well as to rene the design and training protocol to prepare for a future
ecacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least
15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical
Results: All patients completed the study without any adverse events. Subjects on average spent 13.5
hours using the system. Clinical and kinematic data were collected pre and post study. The whole group
improved on the Fugl-Meyer (FM) assessment and on six kinematic measurements. In addition, a
combination of these kinematic measures was able to predict a substantial portion of subjects’ FM
Conclusion: The outcomes of this pilot study warrant further investigation of the system’s ability to
promote recovery of hand function in subacute and chronic stroke[…]
[Abstract] Feasibility of integrative games and novel therapeutic game controller for telerehabilitation of individuals chronic post-stroke living in the community
Intensive, adaptable and engaging telerehabilitation is needed to enhance recovery and maximize outcomes. Such services may be provided under early supported discharge, or later for chronic populations. A novel virtual reality game-based telerehabilitation system was designed for individuals post-stroke to enhance their bimanual upper extremity motor function, cognition, and wellbeing.
To evaluate the feasibility of novel therapeutic game controller and telerehabilitation system for home use.
Individuals chronic post-stroke and their caregivers were recruited (n = 8 + 8) for this feasibility study. One was a screen failure and seven completed 4 weeks (20 sessions) of home-based therapy with or without remote monitoring. Standardized clinical outcome measures were taken pre- and post-therapy. Game performance outcomes were sampled at every session, while participant and caregiver subjective evaluations were done weekly.
There was a 96% rate of compliance to protocol, resulting in an average of 13,000 total arm repetitions/week/participant. Group analysis showed significant (p <.05) improvements in grasp strength (effect size [ES] = 0.15), depression (Beck Depression Inventory II, ES = 0.75), and cognition (Neuropsychological Assessment Battery for Executive Function, ES = 0.46). Among the 49 outcome variables, 36 variables (73.5%) improved significantly (p = .001, binomial sign test). Technology acceptance was very good with system rating by participants at 3.7/5 and by caregivers at 3.5/5.
These findings indicate the feasibility and efficacy of the system in providing home-based telerehabilitation. The BrightBrainer system needs to be further evaluated in randomized control trials and with individuals early post-stroke.
This editorial introduces another of Journal of Physiotherapy‘s article collections.1,2 The studies in this article collection relate to telephysiotherapy. Telephysiotherapy can take many forms such as telemonitoring, telecoaching and telerehabilitation.
Telemonitoring is an automated process of data transmission about a patient’s physiological status (such as oxygen saturation and blood pressure) and clinical symptoms (such as dyspnoea and pain) from the home to the healthcare provider.3 In a Cochrane review, telemonitoring and structured telephone support have been shown to reduce the risk of all-cause mortality and heart failure-related hospitalisations, as well as improve health-related quality of life and self-care behaviours.3 The study by Rathleff et al4 progresses our understanding of monitoring exercise adherence in adolescents with patellofemoral pain. The innovative monitoring system they describe (consisting of an in-built sensor attached to an elastic resistance band and connected to a tablet) provided physiotherapists and patients with information on exercise dosage (such as time under tension and number of repetitions and sets) and pain intensity before and after each exercise during the unsupervised training. Interestingly, study participants only achieved 15% of the prescribed exercise dosage, confirming that self-reported diaries overestimated adherence.4 The authors suggested that this monitoring system could promote exercise adherence and assist physiotherapists to adjust the exercise dosage.4
Another study in this collection is on telecoaching, which can be used to provide in-home support or advice via motivational text messaging and phone coaching to help patients take greater responsibilities for the achievement and maintenance of treatment goals. Iles et al5 present a randomised controlled trial on the effects of phone coaching in patients with non-chronic, non-specific, low back pain. The coaching sessions encompassed identification of the patient’s readiness to change, motivational interviewing and goal setting. These authors reported that five coaching sessions added to usual physiotherapy improved both activity levels and recovery expectations at 12 weeks.5
Several studies in this article collection relate to telerehabilitation, which is the delivery of rehabilitation services at a distance via telecommunication technology such as phone, videoconferencing and the internet.6 In addition to telemonitoring, this approach enables clinical assessment and implementation of treatment. There has been a recent proliferation of literature investigating the effects of telerehabilitation in the management of health conditions such as stroke,6 musculoskeletal conditions7 and chronic diseases. Chien et al8 extended the evidence for phone-based telerehabilitation in patients with heart failure. In this study, participants in the intervention group were encouraged to undertake home-based strengthening exercises combined with walking for at least 30 minutes per session, three sessions per week, over 8 weeks. Participants received phone follow-up every 1 to 2 weeks to monitor progress, provide feedback and solve problems. These authors demonstrated improved quality of life and functional exercise capacity in the experimental group compared with a control group who maintained usual activities.8 Similarly, a 12-week exercise-based rehabilitation program delivered by videoconferencing has also been shown to be non-inferior to a traditional centre-based program in terms of functional exercise capacity but had higher attendance rates in patients with heart failure.9 These results indicate that videoconferencing has the benefit of providing direct supervision of a group-based exercise program and enabling real-time audiovisual feedback. Importantly, outcomes from both of these studies were achieved using readily available off-the-shelf equipment (such as telephone, laptop computer, videoconferencing software, automatic sphygmomanometer and pulse oximeter), which boosts their translation into the clinical settings.
Participation in a telerehabilitation program requires the patients to access and use technological devices such as smartphones, computers and tablets with a good internet connection. However, it is unclear if patients, especially those in cardiopulmonary rehabilitation programs, are technology engagers. Seidman et al10 presented an Australian survey that significantly advances understanding of the acceptability of telerehabilitation. Of 254 patients attending metropolitan pulmonary rehabilitation, 92% were classified as technology engagers (personal access to and use of at least one technological device in their home), and participants cited enhanced therapy and convenience as motivators to participate in telerehabilitation.10 The reported ability of pulmonary rehabilitation attendees to engage with technology was later confirmed in the study by Bonnevie et al.11 In this study of 105 adults with chronic respiratory disease who were referred to pulmonary rehabilitation, all could quickly learn to operate a Bluetooth pulse oximeter during home exercise.11 Almost all of the study participants also considered this monitoring equipment to be acceptable and the oximetry data were transmitted with a minimal artefact or invalid data.11 This is particularly welcome evidence, as the uptake of telerehabilitation requires patients to engage with the technology and associated monitoring equipment.
The remaining articles in this collection relate to general considerations for implementing telephysiotherapy. A key consideration for patients receiving telephysiotherapy is outcome assessment, including functional exercise capacity. Given the space constraints within the home environment, physiotherapists may be tempted to undertake a 6-minute walk test on a shorter track than the recommended guidelines. However, in a study by Beekman et al,12 shorter distances were achieved with a 10-metre track compared with the standard 30-metre track in patients with chronic obstructive pulmonary disease. These authors warned that the results obtained with a shorter track should be interpreted with caution, as studies on prognosis and normative values were generated through tests on longer tracks.12
The growing number of technologies also pose important considerations for physiotherapists. For instance, do mobile applications, virtual reality programs and wearable devices used in telephysiotherapy constitute medical devices and, if so, are they subject to regulatory approval? Physiotherapists have responsibilities in developing and recommending mobile applications or console games as a medium for therapy. To illustrate these responsibilities, Professor Trevor Russell and Anne Jones expertly discussed several scenarios in Tables 1 and 2 of their editorial.13
On a positive note, there are emergent opportunities to deliver physiotherapy services into the home via telehealth, in light of the technology advances and ubiquitous nature of the internet. Telephysiotherapy has the potential to overcome transport barriers reported in traditional centre-based rehabilitation programs. For instance, in an extensive literature review, Cox et al14 summarised a range of barriers to pulmonary rehabilitation, with the most frequently represented domain being ‘environment’ which included travel, transport and healthcare system resources. These findings reinforce the growing need for alternative models such as telephysiotherapy.
Furthermore, telephysiotherapy has the potential to distribute physiotherapists’ expertise to more patients across a wider geographical area. This provides an opportunity to augment existing services and expand services to meet the needs of new patients. This is vital for rural and remote regions that have difficulties in accessing traditional physiotherapy services but will also benefit metropolitan areas by alleviating transport barriers and fostering a more flexible delivery model. Telephysiotherapy also offers patients an opportunity to receive physiotherapy services in the comfort of their own homes, while supporting physiotherapists to monitor and progress the intervention. Fortunately for readers of Journal of Physiotherapy, Professor Anne Holland’s editorial provides some wise insights into telephysiotherapy.15
The extraordinary situation of the coronavirus disease 2019 (COVID-19) pandemic is leading to the rapid adoption of telephysiotherapy, as this delivery model may improve access and minimise cross-infection risk to patients. In addition to the papers in this article collection, some useful resources to guide telephysiotherapy have been compiled on the PEDro website.
This extraordinary situation is providing an unprecedented ‘natural experiment’ in our healthcare services by relaxing some system barriers. This provides an ideal opportunity to explore the feasibility and acceptability of integrating telephysiotherapy into routine service delivery. The experimental experience may inform future planning such as investment opportunities when resuming usual practices.
In summary, this article collection includes a range of important developments in telephysiotherapy. The studies in this article collection present evidence on telemonitoring, telecoaching, telerehabilitation and some general considerations for implementing telephysiotherapy. The limited research in long-term outcomes and cost-effectiveness warrants further research in the area. It may also be necessary to identify which subgroup of patients will most likely benefit from telephysiotherapy. Importantly, each clinical trial paper has clear implications for physiotherapists, which are highlighted in the paper’s ‘What this study adds’ summary box.
Provenance: Invited. Not peer reviewed.
Competing interests: Nil.
Source(s) of support: Nil.
Background: Stroke is the leading cause of serious long-term disability in the United States. Barriers to rehabilitation include cost, transportation, lack of trained personnel, and equipment. Telerehabilitation (TR) has emerged as a promising modality to reduce costs, improve accessibility, and retain patient independence. TR allows providers to remotely administer therapy, potentially increasing access to underserved regions.
Objectives: To describe types of stroke rehabilitation therapy delivered through TR and to evaluate whether TR is as effective as traditional in-person outpatient therapy in improving satisfaction and poststroke residual deficits such as motor function, speech, and disability.
Methods: A literature search of the term “telerehabilitation and stroke” was conducted across three databases. Full-text articles with results pertaining to TR interventions were reviewed. Articles were scored for methodological quality using the PEDro scale.
Results: Thirty-four articles with 1,025 patients were included. Types of TR included speech therapy, virtual reality (VR), robotic, community-based, goal setting, and motor training exercises. Frequently measured outcomes included motor function, speech, disability, and satisfaction. All 34 studies reported improvement from baseline after TR therapy. PEDro scores ranged from 2 to 8 with a mean of 4.59 ± 1.94 (on a scale of 0-10). Studies with control interventions, randomized allocation, and blinded assessment had significantly higher PEDro scores. All 15 studies that compared TR with traditional therapy showed equivalent or better functional outcomes. Home-based robotic therapy and VR were less costly than in-person therapy. Patient satisfaction with TR and in-person clinical therapy was similar.
Conclusions: TR is less costly and equally as effective as clinic-based rehabilitation at improving functional outcomes in stroke patients. TR produces similar patient satisfaction. TR can be combined with other therapies, including VR, speech, and robotic assistance, or used as an adjuvant to direct in-person care.
- Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial.Cramer SC, Dodakian L, Le V, See J, Augsburger R, McKenzie A, Zhou RJ, Chiu NL, Heckhausen J, Cassidy JM, Scacchi W, Smith MT, Barrett AM, Knutson J, Edwards D, Putrino D, Agrawal K, Ngo K, Roth EJ, Tirschwell DL, Woodbury ML, Zafonte R, Zhao W, Spilker J, Wolf SL, Broderick JP, Janis S; National Institutes of Health StrokeNet Telerehab Investigators.JAMA Neurol. 2019 Jun 24;76(9):1079-87. doi: 10.1001/jamaneurol.2019.1604. Online ahead of print.PMID: 31233135 Free PMC article.
- Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient’s home: study protocol of a randomized clinical trial.Kairy D, Veras M, Archambault P, Hernandez A, Higgins J, Levin MF, Poissant L, Raz A, Kaizer F.Contemp Clin Trials. 2016 Mar;47:49-53. doi: 10.1016/j.cct.2015.12.006. Epub 2015 Dec 4.PMID: 26655433 Clinical Trial.
- Telerehabilitation services for stroke.Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C.Cochrane Database Syst Rev. 2013 Dec 16;2013(12):CD010255. doi: 10.1002/14651858.CD010255.pub2.PMID: 24338496 Free PMC article. Updated. Review.
- Study protocol: home-based telehealth stroke care: a randomized trial for veterans.Chumbler NR, Rose DK, Griffiths P, Quigley P, McGee-Hernandez N, Carlson KA, Vandenberg P, Morey MC, Sanford J, Hoenig H.Trials. 2010 Jun 30;11:74. doi: 10.1186/1745-6215-11-74.PMID: 20591171 Free PMC article. Clinical Trial.
- Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation.Veras M, Kairy D, Rogante M, Giacomozzi C, Saraiva S.J Telemed Telecare. 2017 Jul;23(6):567-587. doi: 10.1177/1357633X16656235. Epub 2016 Jun 24.PMID: 27342850 Review.
[Abstract] Optimization of Upper Extremity Rehabilitation by Combining Telerehabilitation With an Exergame in People With Chronic Stroke: A Mixed-Method Study Protocol
Background: Exergames have the potential to provide an accessible, remote approach for post stroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed and lack of motivation to pursue exercise program, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant completion and adherence. Currently, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation.
Objective: 1) To determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life and motivation, in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program) 2) To examine the feasibility of using the technology with stroke participants at home 3) To identify the obstacles and facilitators for its use by stroke participants and therapists and understand the shared decision-making process.
Methods: A mixed-methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct video conferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 stroke participants, randomly assigned to a control group (n=26, 2 months on-paper home exercise program: the graded repetitive arm supplementary program with no supervision) and an experimental group (n=26, 2 months home program using the technology). A blinded trained evaluator will be responsible for the face to face administration of the outcome measures. The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE in 28 everyday tasks), Stroke Impact Scale-16 (impact on quality of life) and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process (recruitment and retention rates), resources (exercise adherence, time spent with therapist,), management (technical problems)and scientific (safety, simple size) outcomes. Qualitative data will be collected by interviews with both participants and therapists.
Results: We expect to: A) Collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke B) collect feasibility data with users at home (adherence, safety, technical difficulties, etc.) and C) identify the obstacles and facilitators for the technology use and understand the shared decision-making process.
Conclusions: This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation.
D Kairy et al. Contemp Clin Trials 47, 49-53. PMID 26655433. – Randomized Controlled TrialFindings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of car …
Mult Scler 22 (12), NP9-NP11. PMID 26041800.See Nilsagard et al.25Qualitative research approach. Interviewed (15-45 mins) within two weeks after the end of the intervention period. Interview covered refl …
Comparison of Kinect2Scratch Game-Based Training and Therapist-Based Training for the Improvement of Upper Extremity Functions of Patients With Chronic Stroke: A Randomized Controlled Single-Blinded TrialJW Hung et al. Eur J Phys Rehabil Med 55 (5), 542-550. PMID 30781936. – Randomized Controlled TrialKinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke.
KE Laver et al. Cochrane Database Syst Rev 1 (1), CD010255. PMID 32002991. – ReviewWhile there is now an increasing number of RCTs testing the efficacy of telerehabilitation, it is hard to draw conclusions about the effects as interventions and comparat …
KE Laver et al. Cochrane Database Syst Rev 2013 (12), CD010255. PMID 24338496. – ReviewWe found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials tha …