Effectiveness of telerehabilitation in patients with post-COVID-19: a systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To assess the effects of telerehabilitation on clinical symptoms, physical function, psychological function and quality of life (QoL) in patients with post-COVID-19. DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: PubMed, Web of Science, Embase and Cochrane Library were searched for publications from 1 January 2020 to 17 April 2024. ELIGIBILITY CRITERIA: RCTs investigating the effects of telerehabilitation in patients with post-COVID-19 were included. The outcomes of interest encompassed clinical symptoms, physical function, psychological function and QoL. Only studies reported in English were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and evaluated the risk of bias. Statistical analysis was conducted using Review Manager V.5.3, employing mean difference (MD) with a 95% CI, and the corresponding P value was used to ascertain the treatment effect between groups. Heterogeneity was quantified using the I2 statistic. The quality of evidence was assessed by GRADE. RESULTS: 16 RCTs (n=1129) were included in this systematic review, 15 of which (n=1095, 16 comparisons) were included in the meta-analysis. The primary pooled analysis demonstrated that, compared with no rehabilitation or usual care, telerehabilitation can improve physical function (measured by 30 s sit-to-stand test [6 RCTs, n=310, MD=1.58 stands, 95% CI 0.50 to 2.66; p=0.004]; 6 min walking distance [6 RCTs, n=324, MD=76.90 m, 95% CI 49.47 to 104.33; p<0.00001]; and physical function from the 36-item short-form health survey [5 RCTs, n=380, MD=6.12 units, 95% CI 2.85 to 9.38; p=0.0002]). However, the pooled results did not indicate significant improvements in clinical symptoms, pulmonary function, psychological function or QoL. The quality of the evidence was graded as low for physical function and Hospital Anxiety and Depression Scale-anxiety and very low for other assessed outcomes. The overall treatment completion rate was 78.26%, with no reports of severe adverse events in any included trials. CONCLUSIONS: Despite the lack of significant improvements in certain variables, telerehabilitation could be an effective and safe option for enhancing physical function in patients with post-COVID-19. It is advisable to conduct further well-designed trials to continue in-depth exploration of this topic. STUDY REGISTRATION: PROSPERO, CRD42023404647.

The future of telerehabilitation: embracing virtual reality and augmented reality innovations.

The integration of virtual reality (VR) and augmented reality (AR) into the telerehabilitation initiates a major change in the healthcare practice particularly in neurological and also orthopedic rehabilitation. This essay reflects the potential of the VR and AR in their capacity to create immersive, interactive environments that facilitate the recovery. The recent developments have illustrated the ability to enhance the patient engagement and outcomes, especially in tackling the complex motor and cognitive rehabilitation needs. The combination of artificial intelligence (AI) with VR and AR will bring the rehabilitation to the next level by enabling adaptive and responsive treatment programs provided through real-time feedback and predictive analytics. Nevertheless, the issues such as availability, cost, and digital gap among many others present huge obstacles to the mass adoption. This essay provides a very thorough review of the existing level of virtual reality and augmented reality in rehabilitation and examines the many potential gains, drawbacks, and future directions from a different perspective.

The effects of telerehabilitation on physiological function and disease symptom for patients with chronic respiratory disease: a systematic review and meta-analysis.

OBJECTIVE: To compare the impact of telerehabilitation versus conventional rehabilitation on the recovery outcomes of patients with chronic respiratory disease (CRD). METHODS: The Cochrane Library, MEDLINE, Web of Science and Embase were searched to collect randomized controlled trials (RCTs) on telerehabilitation for the rehabilitation of patients with chronic respiratory system diseases since the establishment of the database to November 14, 2023. Two researchers independently screened the literature and extracted valid data according to the inclusion criteria. The quality assessment of included studies was conducted individually by using the RoB 2(Risk of Bias 2) tool, followed by meta-analysis using RevMan5.3 software. RESULTS: Based on inclusion and exclusion criteria, 21 RCTs were included, comprising 3030 participants, with 1509 in the telerehabilitation group and 1521 in the conventional rehabilitation group. Meta-analysis results indicated that compared to conventional rehabilitation, video conference-based telerehabilitation demonstrated significant improvements in short-term (≤ 6 months) outcomes, including 6-min walk distance (6MWD) (MD = 7.52, 95% CI: 2.09, 12.94), modified Medical Research Council Dyspnea Scale (mMRC) (MD = -0.29, 95% CI: -0.41, -0.18), COPD assessment test (CAT) (MD = -1.77, 95% CI: -3.52, -0.02), HADS (MD = -0.44, 95% CI: -0.86, -0.03), and St. George's Respiratory Questionnaire (SGRQ's) activity, impact, and symptom scores. In the long term (> 6 months), although improvements persisted in 6WMD [MD = 12.89, 95% CI (-0.37, 26.14)], mMRC [MD = -0.38, 95% CI (-0.56, -0.21)], CAT [MD = -1.39, 95% CI (-3.83, 1.05)], Hospital anxiety and depression scale (HADS) [MD = -0.34, 95% CI (-0.66, -0.03)], and SGRQ's Activity, Impact, and Symptom scores between intervention and control groups, statistically significant differences were observed only for mMRC and HADS. Without considering time factors, the intervention group exhibited some improvement in FEV1% predicted and the forced expiratory volume in the first one second (FEV1)/ forced vital capacity (FVC) (%) without statistical significance compared to the control group. CONCLUSION: Telerehabilitation therapy demonstrates short-term benefits in enhancing patients' daily activity capacity, improving respiratory function, and enhancing mental health status, thereby improving patients' quality of life. However, further high-quality, large-sample RCTs are required to ascertain its long-term effectiveness conclusively. TRIAL REGISTRATION: This study protocol was approved and registered in PROSPERO: CRD 42024509154.

Multicomponent supervised tele-rehabilitation versus home-based self-rehabilitation management after anterior cruciate ligament reconstruction: a study protocol for a randomized controlled trial.

INTRODUCTION: Our study aims to assess the effectiveness of multicomponent supervised tele-rehabilitation compared to home-based self-rehabilitation management in patients following anterior cruciate ligament reconstruction (ACLR). METHODS: The current study is designed as a single-center, single-blinded, randomized controlled, two-arm trial. Participants will be randomized and allocated at a 1:1 ratio into either a multicomponent supervised tele-rehabilitation group or a home-based self-rehabilitation group. All participants receive uniform preoperative education through the HJT software. Participants in the intervention group undergo multicomponent supervised tele-rehabilitation, while those in the control group follow a home-based self-rehabilitation program. All the participants were assessed and measured for the included outcomes at the outpatient clinic before the procedure, and in 2, 4, 8, 12, and 24 weeks after ACLR by two assessors. The primary outcome was the percentage of patients who achieve a satisfactory active ROM at the 12 weeks following the ACLR. The satisfactory active ROM was also collected at 2, 4, 8, and 24 weeks after ACLR. The secondary outcomes were active and passive range of motion (ROM), pain, muscle strength, and function results. REGISTRATION DETAILS: Ethical approval has been obtained from the West China Hospital Ethics Committee (approval number 2023-1929, December 2023). The trial has been registered on ClinicalTrials.gov (registration number NCT06232824, January 2024).

Real-time video telerehabilitation shows comparable satisfaction and similar or better attendance and adherence compared with in-person physiotherapy: a systematic review.

QUESTION: How does physiotherapy delivered by real-time, video-based telerehabilitation compare with in-person delivery for the outcomes of attendance, adherence and satisfaction? DESIGN: Systematic review of randomised control trials indexed in PubMed, CINAHL, Embase, Cochrane and PEDro on 12 March 2024. PARTICIPANTS: Adults aged > 18 years. INTERVENTION: Physiotherapy delivered via real-time video telerehabilitation. OUTCOME MEASURES: Attendance, adherence and satisfaction. RESULTS: Eight studies were included for attendance (n = 1,110), nine studies for adherence (n = 1,190) and 12 studies for satisfaction (n = 1,247). Telerehabilitation resulted in attendance at treatment sessions that was 8% higher (95% CI -1 to 18) and adherence to exercise programs that was 9% higher (95% CI 2 to 16) when compared with in-person physiotherapy. Satisfaction was similar with both modes of delivery (SMD 0.03 in favour of telerehabilitation, 95% CI -0.23 to 0.28). The level of certainty assessed by GRADE ranged from very low to low, primarily due to inconsistency and high risk of bias. DISCUSSION: Attendance at appointments among participants assigned to telerehabilitation was somewhere between similar to and considerably higher than among control participants. Adherence to self-management with telerehabilitation was better than with in-person delivery, although with some uncertainty about the magnitude of the effect. Reported satisfaction levels were similar between the two modes of treatment delivery. Given the significance of attendance, adherence and satisfaction for successful outcomes, telerehabilitation offers a valuable alternative mode for physiotherapy delivery. CONCLUSION: Real-time telerehabilitation has potentially favourable effects on attendance at treatment appointments and adherence to exercise programs, with similar satisfaction when compared with traditional in-person physiotherapy. REGISTRATION: PROSPERO CRD42022329906.

Automated, IMU-based spine angle estimation and IMU location identification for telerehabilitation.

BACKGROUND: Telerehabilitation is a promising avenue for improving patient outcomes and expanding accessibility. However, there is currently no spine-related assessment for telerehabilitation that covers multiple exercises. METHODS: We propose a wearable system with two inertial measurement units (IMUs) to identify IMU locations and estimate spine angles for ten commonly prescribed spinal degeneration rehabilitation exercises (supine chin tuck head lift rotation, dead bug unilateral isometric hold, pilates saw, catcow full spine, wall angel, quadruped neck flexion/extension, adductor open book, side plank hip dip, bird dog hip spinal flexion, and windmill single leg). Twelve healthy subjects performed these spine-related exercises, and wearable IMU data were collected for spine angle estimation and IMU location identification. RESULTS: Results demonstrated average mean absolute spinal angle estimation errors of 2.59 ∘ and average classification accuracy of 92.97%. The proposed system effectively identified IMU locations and assessed spine-related rehabilitation exercises while demonstrating robustness to individual differences and exercise variations. CONCLUSION: This inexpensive, convenient, and user-friendly approach to spine degeneration rehabilitation could potentially be implemented at home or provide remote assessment, offering a promising avenue to enhance patient outcomes and improve accessibility for spine-related rehabilitation. TRIAL REGISTRATION:  No. E2021013P in Shanghai Jiao Tong University.

Heart failure patients' experiences of telerehabilitation.

In the UK, almost 1 million people are living with heart failure, with heart and circulatory diseases accounting for 27% of all deaths, according to the British Heart Foundation. Current heart failure guidelines support cardiac rehabilitation as an intervention to reduce cardiovascular events, increase exercise tolerance and enhance patients' quality of life. Research indicates that telerehabilitation is an effective component of heart failure management, which helps overcome perceived barriers to cardiac rehabilitation including travel to appointments, long waiting times and accessibility. Understanding patient experiences and increasing telerehabilitation among heart failure patients is pertinent to implementing person-centred care, reducing risk and optimising quality of life.

Effectiveness of a 12-week telerehabilitation training in people with long COVID: A randomized controlled trial.

BACKGROUND: Telerehabilitation has been developed and applied for years for cardiac and pulmonary diseases with good clinical outcomes. However, its application to participants with long COVID remains limited. OBJECTIVES: To investigate the effectiveness of a 12-week telerehabilitation training program in participants with long COVID. The primary outcome was cardiorespiratory fitness (CRF), and secondary outcomes were physical activity (PA) amounts, exercise self-efficacy, sleep quality, and health-related quality of life (HRQOL). METHODS: A parallel-group, randomized controlled trial was conducted. Eligible participants with long COVID (n = 182) were randomly assigned in a 1:1 ratio to either the experimental group (EG) or the control group (CG). The EG received 12 weeks of telerehabilitation training with weekly remote monitoring for exercise maintenance and support. The CG received PA counseling only. CRF, PA amounts, exercise self-efficacy, sleep quality, and HRQOL were assessed at baseline and 12 weeks. Generalized estimating equations were used to analyze the intervention effects by examining the interaction between time and group. RESULTS: One hundred twenty-two participants (67 %) completed the study, and 182 were included in the intention-to-treat analysis. The EG had greater walking behavior (ß = -763.3, p < 0.001), total amount of PA (ß= -711, p = 0.003), exercise self-efficacy (ß = -1.19, p < 0.001), and better sleep quality (ß = 1.69, p = 0.012) after the 12-weeks of telerehabilitation training than the CG. However, there were no significant differences in any CRF parameters or HRQOL at 12 weeks between the EG and CG. CONCLUSION: Telerehabilitation training offers a personalized and convenient approach that can increase exercise willingness and PA amounts and improve sleep quality. These findings underscore the potential benefits of telerehabilitation training for promoting healthier lifestyles and improving overall health outcomes. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT05205460) on January 25, 2022.

Remote Delivery of Vestibular Rehabilitation for Vestibular Dysfunction: A Systematic Review.

BACKGROUND: People with vestibular dysfunction encounter many obstacles when seeking vestibular rehabilitation treatment. Remote delivery of vestibular rehabilitation may offer a promising avenue for overcoming these barriers, ensuring uninterrupted and cost-effective care. OBJECTIVE: To evaluate clinical trials studying telerehabilitation and virtual reality devices as therapeutic interventions for individuals with vestibular dysfunction. METHODS: A PRISMA systematic review of PubMed, EMBASE, Cochrane, Web of Science, and SCOPUS was conducted for randomized controlled trials describing the use of remote care delivery for vestibular rehabilitation. Bias of studies was assessed with the revised Cochrane risk-of-bias tool (RoB2). RESULTS: The search identified 1,358 unique articles and 14 articles matched the search criteria. Study samples size ranged from 20 to 337, with mean ages ranging from 29.3 to 77.7 years. Interventions included telephone and online communication, exergaming devices, web-based applications, and head-mounted devices to deliver vestibular rehabilitation. Outcomes included validated questionnaires, objective clinical tests, and physical examinations. CONCLUSIONS: The studies reviewed in this article reported greater or equivalent outcomes when incorporating remote care options as supplements or alternatives to standard care for patients with vestibular dysfunction. Further research is required to address limitations in these studies such as heterogeneity of control groups and cost-effectiveness of these interventions.

Feasibility and acceptability of a telerehabilitation intervention on patients undergoing total knee arthroplasty in Iran: randomised controlled trial protocol.

INTRODUCTION: Telerehabilitation is a promising avenue to enhance post-total knee arthroplasty (TKA) rehabilitation by improving accessibility, convenience and cost-effectiveness. Despite its potential benefits, its application in the context of TKA in Iran is in its early stages, lacking comprehensive studies on feasibility, acceptance and programme adherence. This article outlines a protocol for an open-label, parallel-group, randomised controlled trial investigating the impact of a 4 week telerehabilitation programme alongside usual care. METHODS: Thirty patients (aged 50-90) undergoing TKA for severe Knee Osteoarthritis at Atiyeh Hospital in Tehran, Iran, will be recruited using block randomisation. Participants will be assigned to either the intervention group, receiving telerehabilitation or the control group without telerehabilitation. The intervention will include virtual physiotherapy sessions thrice weekly, lasting 30-45 min each, over 4 weeks. The primary objective is to assess the feasibility and acceptability of telerehabilitation, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction using appropriate questionnaire and adherence to the intervention. Secondary outcomes encompass four Knee Injury and Osteoarthritis Outcome Score questionnaire subscales (function in Activities of Daily Living, Pain, Symptoms, Quality of Life). Patient global assessment will use a standardised question. An online survey will evaluate walking assistant device usage, exercise adherence and adverse events. The number of individuals receiving in-person rehabilitation will be documented after the first postoperative surgeon visit. Assessments occur at baseline and 4 weeks postsurgery. ANALYSIS: Statistical analysis, including independent samples t-test, paired samples t-test, χ2 test, Fisher's exact test, analysis of covariance and multiple linear regression, will use SPSS software version 16, with significance set at p<0.05. ETHICS AND DISSEMINATION: Approved by AJA University of Medical Sciences Ethics Committee (IR.AJAUMS.REC.1402.126), trial results will be presented to relevant groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: TCTR20231020004.

Effects of modified-constraint induced movement therapy based telerehabilitation on upper extremity motor functions in stroke patients.

INTRODUCTION: The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions in stroke patients. METHODS: Eighteen stroke patients were included and randomly allocated into two groups. The Tele-CIMT (modified-constraint induced movement therapy-based telerehabilitation) (n = 10) group received m-CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3 weeks at home. Additionally, both the Tele-CIMT group and the control group (CG) (n = 8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3 weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FM-UE), Wolf Motor Function Test (WMFT), 9-Hole Peg Test (9-HPT), grip strengths, pinch strengths, Motor Activity Log-28 (MAL-28), and Functional Independence Measure (FIM). RESULTS: Significant group-by-time interactions on STREAM, FM-UE, WMFT, grip strength, pinch strengths, MAL-28, and FIM were found to be in favor of the Tele-CIMT group. Additionally, post hoc analyses revealed that the Tele-CIMT group significantly improved in terms of these parameters (p > .05). CONCLUSION: This is the first randomized controlled trial showing that Tele-CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele-CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics.

[Comprehensive approach to rehabilitation of patients with COVID-19. (A literature review)]. / Kompleksnyi podkhod v reabilitatsii patsientov s COVID-19. (Obzor literatury).

The COVID-19 epidemic has made significant changes in the organization of treatment process both at the inpatient and outpatient stages. OBJECTIVE: To analyze the work results of the rehabilitation units dealing with patients who have suffered from COVID-19, in order to summarize the used approaches to medical rehabilitation and improve the effectiveness of care delivery in the recovery phase. RESULTS AND CONCLUSION: Currently, the rehabilitation system has been effectively rebuilt to meet new challenges of the COVID-19 pandemic. Recovery of patients with pronounced neurotic disorders has become a showing good results direction in rehabilitation. It is necessary to implement a tight integration of physical exercises and telerehabilitation facilities in order to effectively settle the main issues directly related to the treatment and recovery of patients with COVID-19 and other pathologies. The control, prevention, treatment and rehabilitation of other infectious diseases will have great prospects regarding the possibility of remote follow-up of patients and correction of their functional state of the body in the nearest future.

Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study.

BACKGROUND: Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a "stepper" for 6 minutes. OBJECTIVE: This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings. METHODS: Three centers (Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec in Québec, Groupement des Hôpitaux de l'Institut Catholique de Lille in France, and FormAction Santé in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Québec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Québec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants' perspectives. RESULTS: Ethical approval was received for this project (October 12, 2023, in Québec and September 25, 2023, in France) and the first participant was recruited in February 2024. CONCLUSIONS: This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11). TRIAL REGISTRATION: ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57404.

Advanced Home-Based Shoulder Rehabilitation: A Systematic Review of Remote Monitoring Devices and Their Therapeutic Efficacy.

Shoulder pain represents the most frequently reported musculoskeletal disorder, often leading to significant functional impairment and pain, impacting quality of life. Home-based rehabilitation programs offer a more accessible and convenient solution for an effective shoulder disorder treatment, addressing logistical and financial constraints associated with traditional physiotherapy. The aim of this systematic review is to report the monitoring devices currently proposed and tested for shoulder rehabilitation in home settings. The research question was formulated using the PICO approach, and the PRISMA guidelines were applied to ensure a transparent methodology for the systematic review process. A comprehensive search of PubMed and Scopus was conducted, and the results were included from 2014 up to 2023. Three different tools (i.e., the Rob 2 version of the Cochrane risk-of-bias tool, the Joanna Briggs Institute (JBI) Critical Appraisal tool, and the ROBINS-I tool) were used to assess the risk of bias. Fifteen studies were included as they fulfilled the inclusion criteria. The results showed that wearable systems represent a promising solution as remote monitoring technologies, offering quantitative and clinically meaningful insights into the progress of individuals within a rehabilitation pathway. Recent trends indicate a growing use of low-cost, non-intrusive visual tracking devices, such as camera-based monitoring systems, within the domain of tele-rehabilitation. The integration of home-based monitoring devices alongside traditional rehabilitation methods is acquiring significant attention, offering broader access to high-quality care, and potentially reducing healthcare costs associated with in-person therapy.

The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders - a systematic review.

Introduction: The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research. Method: This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally. Results: A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting. Discussion: This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions. Systematic review registration: PROSPERO (CRD42020210663).

Enhancing stroke care in Ghana: A systematic review of stroke rehabilitation services.

OBJECTIVE: In Ghana, the shifting demographics of stroke incidence towards young adults have prompted the expansion of stroke care and rehabilitation efforts. Nevertheless, the precise impact of stroke rehabilitation remains unclear. We conducted a systematic review to explore the landscape and effects of stroke rehabilitation in Ghana. METHOD: We identified articles on stroke rehabilitation services in Ghana through searches of PubMed, Scopus, Embase, and Web of Science from inception until February 2024. The Critical Appraisal Skills Programme (CASP) Qualitative Checklist was employed to assess the risk of bias in the included studies, supplemented by qualitative synthesis. RESULTS: Among the 213 articles screened, 8 were deemed suitable for review. These studies primarily focused on two groups: stroke survivors (n = 335) and healthcare professionals (HCPs) (n = 257). Many stroke survivors reported significant benefits from telerehabilitation, with increased participation in rehabilitation activities correlating with improved physical and cognitive outcomes. The findings also underscored a lack of knowledge about stroke rehabilitation among HCPs, alongside variations in the availability of protocols and guidelines for stroke management across different hospital levels. CONCLUSIONS: The review reveals several challenges in stroke rehabilitation in Ghana, including disparities in HCPs' perceptions and utilization of rehabilitation services. The findings emphasize the need for comprehensive, patient-centered approaches, standardized training for HCPs, improved resource allocation, and the integration of telehealth to overcome barriers and enhance stroke rehabilitation in Ghana. These insights hold significance not only for Ghana but also for guiding strategies in similar contexts worldwide, aiming to improve stroke rehabilitation outcomes.

EvolvRehab-MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study.

INTRODUCTION: Stroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb function, people who have had a stroke often employ abnormal 'compensatory' movements. In the short term, these compensatory movements allow the individual to complete tasks, though long-term movement in this manner can lead to limitations. Telerehabilitation offers the provision of rehabilitation services to patients at a remote location using information and communication technologies. 'EvolvRehab' is one such telerehabilitation system, which uses activities to assess and correct compensatory upper body movements, although the feasibility of its use is yet to be determined in National Health Service services. Using EvolvRehab, we aim to assess the feasibility of 6 weeks telerehabilitation in people after a stroke. METHODS AND ANALYSIS: A multisite feasibility study with embedded design phase. Normally distributed data will be analysed using paired samples t-tests; non-normally distributed data will be analysed using related samples Wilcoxon signed rank tests. Thematic content analysis of interview transcripts will be used to investigate the usability and perceived usefulness of the EvolvRehab kit. ETHICS AND DISSEMINATION: This study has received ethical approval from Solihull Research Ethics Committee (REC reference: 23/WM/0054). Dissemination will be carried out according to the dissemination plan co-written with stroke survivors, including academic publications and presentations; written reports; articles in publications of stakeholder organisations; presentations to and publications for potential customers. TRIAL REGISTRATION NUMBER: NCT05875792.

Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis.

PURPOSE: Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS: PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS: A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION: This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.

Educational telerehabilitation program for women with pelvic floor dysfunctions after gynecological pelvic cancer treatment: protocol study for a randomized and controlled clinical trial.

BACKGROUND: Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical-emotional factors of participants post-treatment for gynecological pelvic cancer. METHODS: Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results. DISCUSSION: Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women's quality of life.