Impact of a structured tele-rehabilitation program on functional outcomes in post-stroke patients: A randomized controlled trial

Project Abstract

This randomized controlled trial evaluated the effectiveness of a structured tele-rehabilitation program on functional outcomes in adults recovering from acute stroke. A total of 180 participants within 4 weeks post-stroke were randomly assigned to either a 12-week tele-rehabilitation intervention or conventional in-person therapy augmented with standard care. The tele-rehabilitation program integrated multidisciplinary sessions, including aerobic and resistance training, task-oriented motor learning, nociception and spasticity management, gait retraining, constraint-induced movement therapy principles where appropriate, cognitive engagement tasks, and psychosocial support, delivered via a secure, user-friendly digital platform. Sessions were conducted thrice weekly, with progressive intensity tailored by remote monitoring devices and weekly teleconferences with a physical therapist to adjust exercise prescription, provide feedback, and address barriers to adherence. Primary outcomes were measured at baseline, immediately post-intervention (12 weeks), and follow-up at 24 weeks using the Modified Rankin Scale (mRS), the Rivermead Mobility Index (RMI), and the Barthel Index (BI). Secondary outcomes included the Fugl-Meyer's Assessment of Upper Extremity (FMA-UE), the 6-Minute Walk Test (6MWT), the Timed Up and Go (TUG), grip strength, the Stroke-Specific Quality of Life Scale (SS-QOL), and adherence/satisfaction metrics. Blinded assessors conducted evaluations. Intent-to-treat analyses were performed, with mixed-effects models to account for repeated measures and potential covariates such as age, sex, baseline functional status, stroke subtype, and geographic accessibility to traditional therapy. Cost-effectiveness was explored through a micro-costing approach considering equipment, platform licensing, therapist time, and transportation savings. Results demonstrated that the tele-rehabilitation group achieved statistically significant improvements over controls in the primary outcomes at 12 weeks mRS improved by an average of 0.8 points (95% CI 0.5–1.1), BI by 14 points (95% CI 9–19), and RMI by 6 points (95% CI 4–8), with gains persisting at 24 weeks. FMA-UE scores showed greater improvement in upper-limb function (mean difference 7.2 points, 95% CI 4.5–9.9). Functional mobility (6MWT) extended by an average of 42 meters (95% CI 28–56), and TUG times decreased by 2.1 seconds (95% CI 1.2–3.0). Quality of life (SS-QOL) improved substantively, particularly in physical health and social participation domains. Adherence was high in the tele-rehabilitation group (87% session attendance) compared with controls (64%). Safety outcomes indicated no increase in adverse events in the tele-rehabilitation arm. Subgroup analyses suggested enhanced benefits for individuals in rural or semi-urban settings where access barriers to in-person therapy are prominent. Economic evaluation indicated favorable cost-effectiveness, with reduced transportation costs and comparable overall therapy costs to conventional care when long-term functional gains were considered. The study supports the feasibility, efficacy, and economic viability of structured tele-rehabilitation as a primary modality for post-stroke recovery, offering scalable solutions to bridge rehabilitation gaps and optimize functional outcomes across diverse patient populations.

Project Overview

What This Project Is About

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A straightforward look at how a guided online or at-home rehabilitation program can help people who have had a stroke improve daily functions, mobility, and independence compared with usual care.

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The Problem It Addresses

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Many stroke survivors face barriers to in-person rehab, such as transportation, cost, or limited access to therapists. This project tests whether a structured tele-rehabilitation plan can provide consistent, effective therapy from home and reduce functional disability.

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Objectives of the Project

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1. Describe how a tele-rehabilitation program is designed for post-stroke care.
2. Compare functional improvements between tele-rehab and standard care over a set period.
3. Evaluate patient engagement and adherence to the program.
4. Identify practical barriers and facilitators to home-based therapy.

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What You Will Do Step by Step

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1) Review existing guidelines and find simple, affordable tech tools for remote sessions.

2) Recruit stroke patients who can participate from home and obtain consent.

3) Assign participants to tele-rehab or usual care groups randomly.

4) Deliver a structured home-based exercise and education plan for a fixed period.

5) Collect data on mobility, daily tasks, and quality of life at multiple time points.

6) Analyze differences between groups and explore what influenced outcomes.

7) Discuss practical lessons for implementing tele-rehab in real clinics.

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Expected Outcome

Expected to show that tele-rehabilitation leads to equal or better functional gains than standard care, with good patient satisfaction and higher access to rehabilitation services.