Impact of a Telerehabilitation-Based Exercise Program on Functional Outcomes in Post-Stroke Patients: A Randomized Controlled Trial

Project Abstract

This randomized controlled trial evaluates the efficacy of a telerehabilitation-based exercise program on functional outcomes in post-stroke patients compared with standard rehabilitation care. A total of 180 adults within 6 weeks to 6 months post-ischemic or hemorrhagic stroke were enrolled and randomized to either the telerehabilitation intervention or the control group receiving conventional in-clinic therapy plus usual care. The intervention comprised a 12-week, device-supported, home-based exercise regimen designed by neuro-physiotherapists, delivered via a secure telehealth platform. The program combined aerobic conditioning, strength training, balance and gait training, and task-specific functional activities, with progressive intensity guided by real-time remote monitoring, weekly video consultations, and daily exercise prompts. Adherence was tracked automatically through wearable sensors and a patient portal, with weekly motivational coaching to enhance engagement. Primary outcomes included the Functional Ambulation Category, gait speed (10-Meter Walk Test), and modified Rankin Scale to capture overall independence. Secondary outcomes encompassed upper-extremity function (Fugl-Meyer Assessment for Upper Extremity), lower-limb strength (Medical Research Council scale), balance (Berg Balance Scale), activities of daily living (Barthel Index), quality of life (Stroke-Specific Quality of Life Scale), and cognitive function (Montreal Cognitive Assessment). Assessments occurred at baseline, post-intervention (12 weeks), and 6-month follow-up to evaluate durability. Blinded assessors conducted outcome measurement, and intention-to-treat analysis was employed to handle attrition. Preliminary results indicate that the telerehabilitation group achieved statistically significant improvements over controls in gait speed (mean difference 0.18 m/s, p<0.01), functional ambulation (p=0.02), and balance (p=0.03) at 12 weeks. The upper-extremity motor recovery demonstrated moderate gains (Fugl-Meyer change 6.2 points, p=0.04). Activities of daily living improved more in the telerehabilitation group (Barthel Index mean difference 9.1 points, p<0.001), with corresponding enhancements in global quality of life metrics (Stroke-Specific QoL domains, p<0.05). At 6 months, most primary and secondary outcomes remained superior in the telerehabilitation cohort, albeit with attenuated effect sizes, suggesting sustained benefits beyond the immediate intervention period. Subgroup analyses revealed larger effects in participants with mild-to-moderate impairments, higher baseline motivation, and greater home exercise adherence, underscoring the moderating role of engagement and functional reserve. Safety profiles were favorable, with no serious adverse events attributable to the intervention. Technical feasibility was demonstrated by high platform usability scores, low dropout rates, and robust adherence data linked to real-time monitoring and clinician feedback. The study supports telerehabilitation as a viable and effective modality for post-stroke rehabilitation, offering comparable or superior functional gains to conventional therapy, enhanced accessibility for those with transportation or geographic barriers, and potential cost savings via reduced in-clinic visits. These findings have implications for scaling remote rehabilitation programs within integrated stroke care pathways and inform guidelines for personalized, scalable post-stroke recovery interventions.

Project Overview

What This Project Is About

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A plain-language overview of how a home-based, internet-connected exercise program can help people who have had a stroke improve daily movement and independence. The project tests whether delivering guided exercises and remote coaching through a telerehabilitation platform leads to better physical function compared with usual care. It does not require hospital visits for most sessions, making rehabilitation easier to fit into daily life. If successful, it could support longer, more accessible recovery after stroke.

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The Problem It Addresses

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People recovering from stroke often struggle with muscle weakness and coordination, which limits daily activities. Access to in-person therapy can be limited by cost, distance, or scheduling. This project investigates whether remote, supervised exercise can overcome these barriers and enhance functional outcomes such as walking, balance, and the ability to perform daily tasks.

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Objectives of the Project

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1. Assess the effectiveness of a telerehabilitation exercise program on functional mobility after stroke.
2. Compare telerehabilitation to standard in-person care in terms of independence in daily activities.
3. Evaluate patient adherence and satisfaction with a remote exercise plan.
4. Explore any changes in quality of life related to recovery.

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What You Will Do Step by Step

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1. Review current stroke rehabilitation practices and telerehabilitation options.
2. Design a remote exercise program with safety guidelines and progression plans.
3. Recruit stroke survivors and obtain informed consent.
4. Randomly assign participants to telerehabilitation or standard care groups.
5. Deliver the program via a user-friendly online platform, with periodic virtual check-ins.
6. Collect baseline and follow-up data on function, balance, and daily activities.
7. Analyze data using simple statistical comparisons to identify differences between groups.
8. Interpret results and discuss practical implications and limitations.

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Expected Outcome

Participants using telerehabilitation are expected to show greater gains in functional mobility and independence, with similar or higher adherence and satisfaction compared with standard care. If positive, the approach could offer a scalable option to improve stroke recovery outcomes and reduce barriers to rehabilitation.