Task-oriented telerehabilitation for upper limb functional recovery after stroke: a retrospective cohort study

In clinical practice, many patients cannot undergo inpatient rehabilitation in hospitals for extended periods due to personal financial constraints, as well as China's health insurance policy. They are often forced to terminate their rehabilitation training during the prime recovery phase. This makes tele-rehabilitation-based, home-based rehabilitation particularly important.

This retrospective cohort study aimed to compare the efficacy of tele-rehabilitation-based task-oriented training (TOT) versus face-to-face task-oriented training and conventional tele-neurofacilitation techniques.

Patients who met the criteria were assigned to either the telerehabilitation group, the FTF group, or the Tele-Control group while receiving standardized rehabilitation treatment and education. Moreover, the Tele-Rehab group underwent tele-rehabilitation-based task-oriented training, the FTF group underwent face-to-face task-oriented training, and the Tele-Control Group underwent tele-rehabilitation-based conventional neurofacilitation techniques. The main evaluation indices were the Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT). Secondary outcome indicators were Instrumental Activities of Daily Living (IADL). All patients underwent 3 weeks of treatment.

In total, 79 participants completed the trial: Tele-rehab group (n = 23), FTF group (n = 28), and Tele-Control group (n = 28). Improvements in FMA-UE, WMFT, ARAT, and IADL were found in all three groups (p<0.05). The mean change in FMA-UE was 9.4 in the Tele-rehab group, 6.4 in the FTF group, and 6.7 in the Tele-control group. The mean difference between the Tele-Rehab and FTF groups was 3.0, and the mean difference between the Tele-Rehab and Tele-Control groups was 2.7, with the upper limit of the 95% confidence interval not exceeding the margin of non-inferiority. Non-inferiority was demonstrated, as the 95% CI did not cross the margin in FMA-UE difference scores before and after the intervention in the Tele-rehab group compared with the FTF group (p > 0.05), nor in the FTF group compared with the Tele-Control group before and after the intervention (p > 0.05). The 95% CI for FMA-UE improvement between Tele-rehab TOT and face-to-face TOT was [-0.81, 7.39], not exceeding the non-inferiority margin of 12.4.

Task-oriented training and remote traditional neurofacilitation techniques for tele-rehabilitation of stroke patients can enhance upper limb motor function and improve quality of daily life with comparable efficacy to face-to-face task-oriented training. Therefore, telerehabilitation is a method that is not inferior to conventional rehabilitation and deserves to be used and promoted in homebound patients.