Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA.
Shahid Sadoughi University of Medical Sciences, School of Medicine, Yazd, Iran.
PM R. 2023 Dec;15(12):1654-1672. doi: 10.1002/pmrj.12988. Epub 2023 Aug 16.
The purposes of this systematic review and meta-analysis were to (1) appraise the available evidence of telerehabilitation program effects on functional outcomes, adherence, and patient satisfaction compared to face-to-face programs after stroke; and (2) provide direction for future outcome measure selection and development for clinical research purposes. TYPE: Systematic review and meta analysis of randomized controlled trials.
MEDLINE, CINAHL, Embase, Scopus, Proquest Theses and Dissertations, Physiotherapy Evidence Database (PEDro), and Clinicaltrials.gov were searched for studies published in English from 1964 to the end of April 2022.
A total of 6450 studies were identified, 13 were included in the systematic review, and 10 with at least 3 reported similar outcomes were included the meta-analysis. Methodological quality of results was evaluated using the PEDro checklist.
Telerehabilitation demonstrated equivalency in outcomes across several domains and was favored compared to conventional face to face alone or when paired with semisupervised physical therapy on Wolf Motor Function performance score (mean difference [MD] 1.69 points, 95% confidence interval [CI] 0.21-3.17) and time score (MD 2.07 seconds, 95% CI -4.04 to -0.10, Q test = 30.27, p < .001, I = 93%), and Functional Mobility Assessment in the upper extremities (MD 3.32 points, 95% CI 0.90-5.74, Q test = 5.60, p = .23, I = 29% alone or when paired with semisupervised physical therapy). The Barthel Index participation measures of function demonstrated improvement (MD 4.18 points, 95% CI, 1.79-6.57, Q test = 3.56, p = .31, I = 16%). Over half of summarized study ratings were determined to be of good to excellent quality (PEDro score 6.6 ± 2.3 points). Adherence varied in available studies from 75%-100%. Satisfaction levels of telerehabilitation were highly variable.
Telerehabilitation can improve functional outcomes and promote therapy adherence after stroke. Therapy protocols and functional assessments need substantial refinement and standardization to improve interpretation and clinical outcomes.
本系统评价和荟萃分析的目的是：(1) 评估远程康复计划与面对面计划相比，在中风后对功能结果、依从性和患者满意度的影响的现有证据；(2) 为未来的临床研究目的提供选择和制定结果测量的方向。类型：随机对照试验的系统评价和荟萃分析。
从 1964 年到 2022 年 4 月底，检索了 MEDLINE、CINAHL、Embase、Scopus、Proquest 论文和论文集、物理治疗证据数据库（PEDro）和 Clinicaltrials.gov 上发表的英文研究。
共确定了 6450 项研究，其中 13 项被纳入系统评价，10 项至少有 3 项报告了相似结果的研究被纳入荟萃分析。使用 PEDro 清单评估结果的方法学质量。
远程康复在多个领域的结果上具有等效性，并且与传统的面对面治疗或与半监督物理治疗联合使用相比具有优势，在 Wolf 运动功能表现评分（平均差异 [MD] 1.69 分，95%置信区间 [CI] 0.21-3.17）和时间评分（MD 2.07 秒，95%CI-4.04 至-0.10，Q 检验=30.27，p<.001，I =93%）和上肢功能移动性评估（MD 3.32 分，95%CI 0.90-5.74，Q 检验=5.60，p=.23，I =29%，单独或与半监督物理治疗联合使用）。Barthel 指数参与功能测量显示出改善（MD 4.18 分，95%CI，1.79-6.57，Q 检验=3.56，p=.31，I =16%）。总结的研究评价中有一半以上被确定为质量良好到优秀（PEDro 评分 6.6±2.3 分）。在可用的研究中，依从性从 75%到 100%不等。远程康复的满意度差异很大。
远程康复可以改善中风后的功能结果并促进治疗依从性。需要对治疗方案和功能评估进行大量改进和标准化，以提高解释和临床结果的能力。
