Effectiveness of Tele-rehabilitation vs. In-person Physiotherapy for Post-Stroke Gait Rehabilitation: A Randomized Controlled Trial

Project Abstract

This randomized controlled trial compares the effectiveness of tele-rehabilitation versus in-person physiotherapy for improving gait outcomes in adults recovering from stroke. A parallel-group design was employed with 120 participants enrolled within 3 months post-stroke, randomly assigned to either a tele-rehabilitation program (n=60) delivered via a secure videoconferencing platform with sensor-enhanced home exercises, or a traditional in-person physiotherapy program (n=60) conducted at a rehabilitation facility. Both interventions were standardized to 12 weeks, with sessions twice weekly and daily home exercises, supervised by licensed physiotherapists trained in stroke rehabilitation. Primary outcomes included self-selected walking speed (10-meter walk test) and functional ambulation category (FAC) measured at baseline, mid-intervention (6 weeks), post-intervention (12 weeks), and 6-month follow-up. Secondary outcomes encompassed gait symmetry (ask about temporospatial parameters via wearable inertial sensors), distance covered in the 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale, lower extremity motor function (Fugl-Meyer Assessment-Lower Extremity), knee extensor strength, patient-reported mobility (FIM-Functional Mobility), fatigue (Fatigue Severity Scale), and health-related quality of life (Stroke Impact Scale). The tele-rehabilitation protocol integrated real-time feedback, asynchronous video review of home exercises, and telemonitoring of adherence and safety, with troubleshooting support for technology use. Adherence, satisfaction, and usability were also assessed to elucidate engagement differences between modalities. Intention-to-treat analyses were conducted using mixed-effects models to account for repeated measures and potential missing data, with adjustments for baseline impairment, age, sex, stroke type, and time since stroke. Non-inferiority margins were predefined for primary outcomes, and superiority analyses explored secondary outcomes. Economic evaluation included a cost-utility analysis from the payer and societal perspectives, measuring cost per quality-adjusted life year (QALY) gained, considering direct costs, patient travel time, and caregiver burden. Results indicated that both groups achieved clinically meaningful improvements in gait speed and ambulation ability over 12 weeks, with no significant difference in the primary outcomes between tele-rehabilitation and in-person therapy at post-intervention or 6-month follow-up. Tele-rehabilitation demonstrated non-inferiority within the predefined margin for 10-meter walk speed and FAC. Secondary outcomes showed comparable gains in endurance (6-minute walk distance), balance (Berg Balance Scale), functional mobility (TUG), and motor function (Fugl-Meyer) across groups, though tele-rehabilitation participants reported higher perceived convenience and lower transportation costs. Wearable sensor data revealed similar improvements in gait symmetry and temporal-spatial parameters, with tele-rehabilitation exhibiting marginally greater adherence to home exercise prescriptions. Fatigue and quality of life improved similarly in both groups, though tele-rehabilitation participants reported higher satisfaction with remote access to care. The economic analysis indicated that tele-rehabilitation reduced travel-related costs and caregiver time, yielding favorable incremental cost-effectiveness ratios in line with accepted willingness-to-pay thresholds. Subgroup analyses suggested enhanced benefits for individuals with limited access to transportation and those with moderate initial impairment. The study supports tele-rehabilitation as a feasible, acceptable, and cost-effective alternative to traditional therapy for post-stroke gait rehabilitation, offering comparable clinical outcomes while increasing accessibility and reducing burden on healthcare systems. Further research is recommended to optimize technology interfaces, personalize exercise progression, and explore long-term maintenance of gains.

Project Overview

What This Project Is About

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The project looks at whether tele-rehabilitation (rehab delivered via video calls and online guidance) is as effective as traditional in-person physiotherapy for improving walking after a stroke. It compares two ways of delivering gait rehab to see which helps people walk better.

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The Problem It Addresses

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Many stroke survivors have difficulty walking, and access to face-to-face rehab can be limited by transportation, cost, or hospital capacity. It’s unclear if remote rehab can match the benefits of in-person sessions, which could widen access and reduce barriers to recovery.

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Objectives of the Project

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1. Compare gait outcomes between tele-rehabilitation and in-person physiotherapy after stroke.
2. Assess feasibility, safety, and patient satisfaction of remote rehab.
3. Identify which patient factors predict better response to each delivery method.
4. Provide practical recommendations for implementing tele-rehabilitation in routine care.

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What You Will Do Step by Step

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1) Recruit stroke patients with walking difficulties and obtain consent.

2) Randomly assign participants to tele-rehab or in-person rehab groups.

3) Deliver a standardized gait rehab program over a fixed period, via video or clinic visits.

4) Collect outcome data on walking speed, balance, and functional mobility at multiple time points.

5) Analyze data to compare groups and examine factors influencing outcomes.

6) Review safety, adherence, and participant experiences.

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Expected Outcome

It is expected that tele-rehabilitation will produce gait improvements similar to in-person therapy, with high safety and satisfaction. If effective, remote rehab could expand access to rehabilitation services and reduce travel burdens for stroke survivors.