The effectiveness of telerehabilitation on independence, balance, disability and function in stroke patients: A meta-analysis of randomized controlled trials

Abstract

Objective: To determine whether the use of telerehabilitation leads to improved independence, balance, and quality of life, reduces disability, and enhances the function to perform activities of daily living among stroke survivors compared with usual care. Methods: This is a meta-analysis of randomized controlled trials that have been conducted. Relevant published studies from inception to November 2022 were retrieved from Embase (Ovid), the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, CINAHL, CBM, VIP, CNKI and Wanfang. The literature search and data extraction processes were conducted by two independent authors. The methodological quality of the included studies was assessed by the Cochrane Risk-of-Bias Assessment Tool, version 2. The data analysis was performed using Review Manager (Version 5.4). Results: Ten randomized controlled trials published between 2009 and 2022 were included in this meta-analysis. Most of the studies were assessed as having some concerns. The certainty of the evidence in this review varied across outcomes, ranging from low to high. The meta-analysis showed statistically significant effects of tele-rehabilitation on function (standardized mean difference (SMD)=1.05, 95% confidence interval (CI): 0.42 to 1.67, P = 0.44), balance((SMD)= 0.88, 95% CI: 0.25 to 1.51, P = 0.20). However, no statistically significant effect on disability, independence and quality of life were found in our review. Conclusions: Telerehabilitation may be effective for improving functional outcomes and balance among adult stroke patients, but the effect on disability, independence and quality of life is nonsignificant. More randomized controlled trials with larger sample sizes, more follow-up times, and rigorous study designs should be further conducted to identify the effect of Telerehabilitation on stroke patients.