May 2020: This month, because of COVID19, I’ve reviewed a topic, rather than an article! In recent weeks, much of healthcare has moved online (and away from in-person,) so it complies to countries’ and regions’ physical distancing requirements. Acknowledging that at present most therapists have no choice in this matter, this month’s Journal Club asks: After stroke, when compared to in-person programs, is telerehabilitation (TR) feasible, effective and cost efficient?
To provide answers, I used the Google Scholar search engine, the search terms “stroke”. “telehealth” and “physical therapy”, and limited results to evidence published in the last two years. Here’s what I found:
- Laver et al (2020): In a Cochrane Review of RCTs only, all of which were specific to stroke, investigators found “short-term post-hospital discharge programmes have not been shown to reduce depressive symptoms, improve quality of life, or improve independence in activities of daily living, when compared to usual care. Studies comparing telerehabilitation and in-person therapy have also not found significantly different outcomes between groups, suggesting that telerehabilitation is not inferior.”
- Cramer et al (2019): In an RCT, investigators based in the US recruited 124 adult participants with a stroke-affected upper limb. Following 6 weeks of therapy, all participants experienced functional recovery irrespective of whether the program was TR or in-person. The authors concluded that TR could “substantially increase access to rehabilitation therapy on a large scale”.
- Galloway et al (2019): In Australian participants, these investigators found it was feasible to run a cardiorespiratory fitness program. Ninety-five percent of those recruited “enjoyed telehealth exercise sessions” and preferred 3 sessions per week, 20-30 mins long, in a program that lasted 6-12 weeks.
- Caughlin et al (2019): Canadian researchers found that although STR was more difficult than anticipated, its efficacy and cost efficiency matched in-person rehabilitation, as long as technology was user-friendly. Studies investigated interventions targeting memory, speech and physical training. The authors concluded: “telerehabilitation services work best to augment face-to-face rehabilitation or when no other options are available”.
Following this quick search, initial findings indicate that therapists can be reassured that when compared to in-person programs, TR is feasible, effective and cost efficient across a range of post-stroke consequences. As always, this is my humble opinion. Please check these articles and others for yourself. As always, I welcome your opinion.
Cramer et al (2019) Efficacy of home-based Telerehabilitation vs in-clinic therapy for adults after stroke: An RCT. JAMA Neurology, 76(9), 1079-1087
Galloway et al (2019) The feasibility of a telehealth exercise program aimed at increasing cardiorespiratory fitness for people after stroke. International Journal of Telerehabilitation, 11(2), 9-28