Tele-Rehab After Stroke Shows Promising Results

October 15, 2020

Stroke patients who engage in rehabilitation training at home through live video consultations may recover their motor skills better than those who attend rehabilitation sessions in person at an outpatient facility, results of a new study suggest.

The researchers say that the convenience of undergoing rehabilitation at home may have helped patients stick to their rehabilitation programs.

The Chinese study was published online in Neurology on September 30.

"During the pandemic, when travel and human contact might not be possible, it's important to find out if it's safe and effective for stroke patients to recover at home, using video consultations for their therapy," said study author Chuancheng Ren, PhD, of Fudan University, Shanghai, China.

The study involved 52 patients who had had a stroke an average of 14 days previously.

They were randomly assigned to either home-based motor training tele-rehabilitation or conventional rehabilitation at an outpatient facility. There were no significant differences with regard to the demographic and clinical characteristics between the two groups. Patients were classed as having stroke of mild to moderate severity (mean NIHSS, 5).

Both groups underwent the same intervention, comprising 10 sessions. Each session included occupational therapy, physical therapy, and electromyography-triggered neuromuscular stimulation.

There were two primary outcomes: an impairment-based measure, the Fugl-Meyer Assessment; and an activity-based measure, the modified Barthels Index. Assessments were made immediately post intervention and after 12 weeks of follow-up.

Results showed that both interventions produced a positive effect in both measures at both time points, fulfilling noninferiority criteria for the tele-rehabilitation group.

In fact, the tele-rehabilitation group showed a superior effect at the postintervention measure of the Fugl-Meyer, an improvement of 11.1 points vs 5.3 for the conventional group, a difference that reached significance (P = .01).

In addition, resting state functional MRI showed improved brain connectivity between the bilateral M1 areas in the remote training group compared to the conventional training group.

The researchers found that the number of treatment sessions and the total duration of therapy were higher in the remote training group, which completed an average of 109 hours of physical/occupational therapy compared to 97 hours in the conventional rehab group.

The total amount of electromyography-triggered neuromuscular stimulation was similarly increased in the remote group. However, the researchers say that this alone would not account for the better outcomes.

"The home-based motor training tele-rehabilitation approaches used in the current trial were designed to make the rehabilitation training accessible for stroke patients with movement disorders at home; they also lessen the travel burden," the authors note.

This strategy provided a convenient way for patients to conduct rehabilitation, which improved patient compliance, they state. Moreover, the tele-rehabilitation approach could offer more opportunities for patients to participate and learn from the realistic family and social environment.

"These unintended and individualized exercises, including daily routines and social participation activities, together with the rehabilitation prescription training, may jointly explain the positive role of the tele-rehabilitation approach in motor recovery."

In an accompanying editorial, Susan Hillier, PhD, and Brenton Hordacre, PhD, University of South Australia, note that an increase of at least 10 points in the Fugl-Meyer Assessment is needed to show meaningful improvement, so the functional improvement in the tele-health group is considered clinically relevant.

They describe the resting-state functional connectivity findings as "both reassuring and important," because they engender confidence in the reported behavioral improvements. The MRI findings also imply that resting-state measures have value in stroke recovery, underlining the need to develop further knowledge of this functional brain measure following stroke, they comment.

"We welcome these kinds of trials that help guide our decision-making for service provision and that consider brain level change as well as patient-level," the editorialists conclude.

This study was supported by Shanghai Strategic Emerging Industries Project Plan and the National Natural Science Foundation of China.

Neurol. Published online September 30, 2020. Abstract, Editorial

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