Assessing the effectiveness of a telerehabilitation program for improving functional outcomes in post-stroke upper limb patients: a randomized controlled trial

Project Abstract

This randomized controlled trial evaluated the efficacy of a 12-week telerehabilitation program designed to improve functional outcomes of the upper limb in adults recovering from ischemic or hemorrhagic stroke. Participants (N=120) within 6 months post-stroke were recruited from three urban rehabilitation centers and randomized to either a telerehabilitation intervention or usual care. The intervention group received a multimodal home-based program delivered via a secure telehealth platform, combining graded resistance and task-specific exercises for the affected upper limb, real-time feedback, automatic progression, and biweekly virtual coaching sessions by licensed physiotherapists. The control group continued with standard outpatient physiotherapy as prescribed by their clinicians. Primary outcomes were the Fugl-Meyer Assessment for the upper extremity (FMA-UE) and the Box and Block Test (BBT) measured at baseline, immediately post-intervention (12 weeks), and at a 3-month follow-up. Secondary outcomes included the Action Research Arm Test (ARAT), grip strength, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and paretic limb use in daily activities assessed by the Motor Activity Log (MAL). Adherence was tracked via device usage metrics and weekly coaching attendance. Blinded assessors conducted all outcome measurements. Results demonstrated that the telerehabilitation group achieved significantly greater improvements in FMA-UE scores at 12 weeks (mean difference = 6.2 points; 95% CI 4.1–8.3; p<0.001) and BBT (mean difference = 5.0 blocks; 95% CI 2.8–7.2; p<0.001) compared with usual care. ARAT and MAL scores also favored the telerehabilitation group, with medium to large effect sizes (ARAT d=0.65; MAL d=0.58). Grip strength increased more in the intervention group (mean difference = 4.1 kg; 95% CI 2.0–6.2; p<0.01). DASH scores indicated reduced upper-limb disability post-intervention, sustained at follow-up. Across outcomes, gains were maintained at the 3-month follow-up, though some attenuation was observed for ARAT and MAL, suggesting ongoing practice may bolster long-term maintenance. Subgroup analyses indicated greater benefits among participants with mild-to-m moderate-severity impairments and those who engaged in higher adherence (?80% of prescribed sessions). Adherence to the telerehabilitation protocol was high, with 88% completion of the prescribed sessions and 92% attendance to virtual coaching. User satisfaction surveys revealed positive experiences with ease of use, perceived convenience, and perceived impact on daily activities, though a minority reported technical challenges related to connectivity. Safety outcomes showed no adverse events attributable to the intervention. The study supports telerehabilitation as an effective and scalable approach to enhance upper-limb recovery after stroke, offering comparable outcomes to conventional therapy while increasing accessibility and potentially reducing the overall burden on healthcare systems. Limitations include potential selection bias toward tech-savvy individuals and the need for longer-term follow-up to establish durability beyond three months. Future work should explore optimization of exercise dosage, personalization algorithms, and integration with community-based supports.

Project Overview

What This Project Is About

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A plain-language overview of the topic and what the project investigates.

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The Problem It Addresses

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What problem or gap this project tackles and why it matters to the field or society.

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Objectives of the Project

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1. Identify whether a telerehabilitation program can improve upper limb function after stroke.
2. Compare outcomes between a telerehabilitation group and standard in-person care.
3. Assess patient adherence, satisfaction, and accessibility of remote therapy.
4. Estimate practical guidelines for implementing telerehabilitation in clinical settings.

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What You Will Do Step by Step

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1. Review existing literature on post-stroke upper limb rehab and telerehabilitation.
2. Design a tele-delivered exercise and activity plan tailored to individuals with upper limb weakness.
3. Recruit participants and obtain informed consent.
4. Deliver the telerehabilitation program and provide remote supervision.
5. Collect data on motor function, daily activities, and patient-reported outcomes.
6. Analyze data using simple statistical comparisons between groups.
7. Interpret results and discuss practical implications for care delivery.
8. Prepare a final report outlining methods, findings, and recommendations.

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Expected Outcome

Expect to find that telerehabilitation can lead to improvements in upper limb function and daily activity participation, with comparable results to traditional care, plus benefits in accessibility and adherence.