Evaluating the Efficacy of Virtual Versus In-Person Neuromuscular Retraining in Treating Facial Palsy

Background: Virtual neuromuscular retraining (NMR) has grown rapidly since 2020, with limited evaluation compared with in-person therapy. Objective: To compare outcomes of patients with facial paralysis undergoing virtual and in-person NMR at a single institution, measured by Sunnybrook scores. Methods: Retrospective cohort study of medical records from a tertiary care center between 2018 and 2024. Data on demographics, Sunnybrook scores, therapy initiation, etiology, and visit metrics were collected for 161 patients. A doubly robust estimator evaluated relationships between visit modality, total visits, and therapy timing on Sunnybrook changes. Results: Patients with >50% or <50% virtual appointments showed no difference in age, etiology, or prior intervention. Males were more likely to receive in-person NMR (p = 0.003). Increasing virtual NMR visits by 20% and 40% did not alter Sunnybrook scores (p = 0.856; p = 0.996). Reducing the duration prior to treatment by 1, 5, or 12 months significantly improved Sunnybrook scores (p = 0.013; p = 0.006; p = 0.005). Fewer total visits correlated with significantly lower Sunnybrook scores, emphasizing frequent therapy (p < 0.0001). Conclusion: Virtual NMR generated comparable Sunnybrook scores with in-person therapy, and earlier treatment initiation and greater total visits were associated with improved outcomes independent of modality.