Effectiveness of telemedicine-based rehabilitation after stroke: a systematic review

Access to timely post-acute stroke rehabilitation remains inconsistent, contributing to persistent disability despite advances in acute stroke care. Telemedicine has been proposed as a strategy to improve continuity and access to rehabilitation services, but its effectiveness across functional domains remains incompletely defined.

To evaluate the effectiveness of telemedicine-delivered post-acute follow-up and rehabilitation on functional recovery and disability outcomes among adult stroke survivors.

A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched for studies published between January 2015 and December 2025. Eligible studies included adult stroke populations receiving telemedicine-based post-acute follow-up or rehabilitation and reporting functional, motor, balance, quality-of-life, or feasibility outcomes. Randomized controlled trials and observational studies were included. Risk of bias was assessed using validated tools, and findings were synthesized narratively without quantitative pooling due to heterogeneity.

Twenty-eight studies comprising approximately 1237 participants were included. Telerehabilitation was associated with improvements in activities of daily living, although between-group differences varied across studies. Activities of daily living improved post-discharge (Barthel Index + 23.3 vs + 9.3; p < 0.001), and Functional Independence Measure scores increased in tele-CIMT and wearable-assisted interventions. Upper limb performance improved (WMFT time - 2.28 s; Box and Block Test + 5.57 vs 1.0; Nine-Hole Peg Test - 71.6 s; Jebsen-Taylor - 26.6 s). Spasticity decreased (MAS) with wrist improvements maintained at 6 months. Mobility and balance also improved, with intervention groups walking farther (6MWT 141.6 ± 8.7 m vs 129.5 ± 7.1 m; p < 0.001) and showing comparable improvements in BBS outcomes across groups. Technology-assisted telerehabilitation programs were more frequently associated with statistically significant improvements; however, these findings were not consistently superior to standard rehabilitation across all studies. Most randomized trials had some concerns for bias, and half of non-randomized studies were rated as serious risk, limiting overall certainty.

Telemedicine-based post-acute stroke rehabilitation is feasible and associated with functional improvements comparable to in-person care. Reported adverse events were infrequent and generally minor, though safety outcomes were inconsistently measured across studies. High feasibility, adherence, and patient satisfaction support its role as a scalable component of post-stroke rehabilitation pathways.