Effectiveness of a tele-rehabilitation program combining real-time gait analysis and home-based exercises for post-stroke mobility improvement: a randomized controlled trial

Project Abstract

This randomized controlled trial evaluated the effectiveness of a tele-rehabilitation program that integrates real-time gait analysis with structured home-based exercises to improve mobility in post-stroke individuals. A total of 120 adult participants (mean age 62.8 ± 9.4 years; 52% male) within 3–12 months post-stroke were recruited from five rehabilitation centers and randomly assigned to the intervention (n=60) or control (n=60) group. The intervention combined (1) a wearable sensor-based gait analysis system providing real-time feedback on spatiotemporal parameters and symmetry, (2) personalized, progressive home exercise plans targeting paretic limb strengthening, balance, and functional gait tasks, delivered through a secure tele-rehabilitation platform with weekly remote supervision and monthly in-person assessments for three months, and (3) motivational strategies including goal setting, automated reminders, and progress dashboards. The control group received standard in-clinic physiotherapy based on usual care protocols matched for contact time. Primary outcomes were 6-minute walk test (6MWT) distance and Timed Up and Go (TUG) performance measured at baseline, immediately post-intervention (12 weeks), and 6-month follow-up. Secondary outcomes included gait velocity, step length symmetry, measured via instrumented gait analysis, Functional Ambulation Category, Activities of Daily Living (ADL) scales, Berg Balance Scale, and patient-reported outcomes such as the Stroke Impact Scale and Likert-based satisfaction with therapy. Adherence was tracked via platform usage metrics and home exercise completion rates. Safety outcomes included adverse events related to movement disorders or equipment. Results demonstrated that the tele-rehabilitation group achieved a statistically significant greater improvement in 6MWT distance at 12 weeks (mean difference 48.6 meters; 95% CI 34.2–63.0; p<0.001) and improved TUG times (mean difference -2.9 seconds; 95% CI -4.2 to -1.6; p<0.001) compared with controls. Gait velocity increased by 0.15 m/s (95% CI 0.09–0.21; p<0.001), and step length symmetry improved (symmetry index reduction of 0.07; 95% CI 0.04–0.10; p<0.001). Secondary outcomes showed enhanced ADLs (Barthel Index increase of 9.2 points; 95% CI 5.8–12.6; p<0.001) and higher balance scores (Berg Balance Scale improvement 5.4 points; 95% CI 3.1–7.7; p<0.001). Patient-reported outcomes indicated greater perceived mobility and participation, with higher satisfaction scores (mean 4.6/5 vs 3.9/5; p=0.002). Effects were maintained at 6-month follow-up, though attenuated for some metrics, suggesting durable benefits of the tele-rehabilitation program. Adherence was significantly higher in the intervention group (average completion rate 86% vs 62%; p<0.001), and there were no significant differences in adverse events between groups, indicating a favorable safety profile. Subgroup analyses suggested greater gains in individuals with moderate stroke severity and those commencing therapy within the earlier post-stroke window. The study supports the feasibility, effectiveness, and sustainability of a tele-rehabilitation approach that leverages real-time gait analytics to optimize home-based exercise regimens for post-stroke mobility, offering a scalable alternative to traditional in-person rehabilitation with potential to reduce disability and enhance quality of life.

Project Overview

What This Project Is About

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A straightforward exploration of whether a tele-rehabilitation program that uses real-time gait feedback and simple home exercises can help people recover walking after a stroke. The project compares remote-guided rehab to usual care to see if mobility improves.

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The Problem It Addresses

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Many stroke survivors struggle with walking and must travel frequently for therapy. Access limits, distance, or cost can hinder recovery. This project looks at a scalable solution that guides patients remotely while providing feedback on how they walk.

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Objectives of the Project

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1. Describe how a tele-rehab program is set up and what it includes.
2. Measure changes in walking ability before and after the program.
3. Compare remote rehab with standard in-person care to see which is more effective.
4. Identify any barriers or facilitators to using tele-rehab at home.

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What You Will Do Step by Step

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1. Review existing research on tele-rehabilitation and gait training.
2. Develop a simple protocol combining real-time gait feedback and home exercises.
3. Recruit stroke survivors and assign them to remote or standard care groups.
4. Collect data on walking speed, balance, and daily activity at baseline and after 8–12 weeks.
5. Analyze changes within and between groups using basic statistics.
6. Identify practical challenges and user experiences with the tele-rehab tool.

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Expected Outcome

Anticipate that the tele-rehab group will show greater or comparable improvements in walking ability, with positive feedback on accessibility and ease of use, supporting scalable remote therapy options.