Effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning in stroke: a systematic review and meta-analysis of randomized controlled trials

Publication date: Available online 6 December 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Aki Rintala, Ville Päivärinne, Sanna Hakala, Jaana Paltamaa, Ari Heinonen, Juha Karvanen, Tuulikki Sjögren

ABSTRACT

Objective

To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke.

Data sources

A systematic literature search was conducted in six databases from January 2000 to May 2018.

Study selection

Inclusion criteria applied PICOS (Patient, Intervention, Comparison, Outcome, Study design) framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies.

Data extraction

The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable.

Data synthesis

Thirteen studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified – activities of daily living (ADL), upper and lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of six RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference (SMD) 0.06; 95%CI: -0.22 to 0.35, p = .67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low.

Conclusions

The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke.

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