Knepley Kurt D, Mao Jennifer Z, Wieczorek Peter, Okoye Frederick O, Jain Abhi P, Harel Noam Y
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Telemed J E Health. 2021 Mar;27(3):239-246. doi: 10.1089/tmj.2020.0019. Epub 2020 Apr 23.
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.
在美国，中风是导致严重长期残疾的主要原因。康复的障碍包括成本、交通、缺乏训练有素的人员和设备。远程康复（TR）已成为一种有前景的方式，可降低成本、提高可及性并保持患者的独立性。TR使提供者能够远程提供治疗，有可能增加服务不足地区的可及性。
描述通过TR提供的中风康复治疗类型，并评估TR在提高满意度和改善中风后残留缺陷（如运动功能、言语和残疾）方面是否与传统的面对面门诊治疗同样有效。
在三个数据库中对“远程康复与中风”一词进行文献检索。对与TR干预相关结果的全文文章进行了综述。使用PEDro量表对文章的方法学质量进行评分。
纳入了34篇文章，共1025例患者。TR的类型包括言语治疗、虚拟现实（VR）、机器人辅助、基于社区的、目标设定和运动训练练习。经常测量的结果包括运动功能、言语、残疾和满意度。所有34项研究均报告TR治疗后较基线有改善。PEDro评分范围为2至8，平均为4.59±1.94（满分0 - 10分）。有对照干预、随机分配和盲法评估的研究PEDro评分显著更高。所有15项比较TR与传统治疗的研究均显示功能结局相当或更好。基于家庭的机器人治疗和VR比面对面治疗成本更低。患者对TR和面对面临床治疗的满意度相似。
在改善中风患者的功能结局方面，TR成本更低且与基于诊所的康复同样有效。TR产生相似的患者满意度。TR可与其他疗法（包括VR、言语和机器人辅助）联合使用，或用作直接面对面护理的辅助手段。
