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Effects of home-based telerehabilitation in patients with stroke: A randomized controlled trial
Jing Chen1, Dalong Sun1, Shufan Zhang1
1From the Departments of Neurology (J.C.) and Department of Gastroenterology and Hepatology (D.S.), Zhongshan Hospital, Fudan University, Shanghai; Department of Gastroenterology and Hepatology (D.S.), Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen; Departments of Neurology (J.C., S.Z., Y.S., C.R.), Rehabilitation (F.Q., Y.Z.), and Radiology (J.L.), Shanghai Fifth People's Hospital, Fudan University; and Department of Neurology (C.R.), Shanghai East Hospital, Tongji University, China.
Objective:
To determine the effects of a 12-week home-based motor training telerehabilitation program in patients with subcortical stroke by combining motor function assessments and multimodality MRI analysis methods.
Methods:
Fifty-two patients with stroke and hemiplegia were randomly assigned to either a home-based motor training telerehabilitation (TR) group or a conventional rehabilitation (CR) group for 12 weeks. The Fugl-Meyer assessment (FMA) for upper and lower extremities and the modified Barthel Index were used as primary outcomes. The secondary outcomes included resting-state functional connectivity (rsFC) between the bilateral M1 areas, gray matter volumes of the primary motor cortex (M1) areas, and white matter integrity of the corticospinal tract. Analysis of covariance was applied to examine the effects of the home-based motor training TR program on neural function recovery and brain plasticity.
Results:
Compared with the CR group, the TR group showed significant improvement in the FMA (p = 0.011) and significantly increased M1-M1 rsFC (p = 0.031) at the end of the rehabilitation. The M1-M1 rsFC change was significantly positively correlated with the FMA change in the TR group (p = 0.018).
Conclusion:
This study showed a beneficial effect of the home-based motor training telerehabilitation program on motor function in patients with stroke, which was accompanied by enhanced interhemispheric functional connectivity of the M1 areas. We inferred that it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home. The combined use of imaging biomarkers should be encouraged in motor training clinical studies in patients with stroke.
Classification Of Evidence:
This study provides Class II evidence that for patients with stroke with hemiplegia, home-based telerehabilitation compared to conventional rehabilitation significantly improves some motor function tests.
