A Home-Based Telerehabilitation Program for Patients With Stroke.
Lucy Dodakian, Alison L McKenzie, Vu Le and 9 others
PMID 29072556WHAT IT FOUND
Patients completed nearly all assigned home telerehabilitation days, and arm Fugl-Meyer scores increased, but this was a small uncontrolled pilot that also included daily L-Dopa or placebo.
Key findings
01The 12 patients completed at least 30 of the required 60 minutes on 329 of 336 assigned days (97.9%).
02Arm Fugl-Meyer score increased from baseline to one month post-therapy by 4.8±3.8 points (p=0.0015), and six of 12 subjects exceeded the minimal clinically important difference of 4.25 points, while patients also took daily L-Dopa or placebo and built on standard of care physical or occupational therapy.
03Neither computer literacy score was significantly related to amount of system usage, arm motor gains, or stroke education gains.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study enrolled only 12 patients and had no control group, so observed changes cannot be separated from time, standard physical or occupational therapy, daily L-Dopa or placebo, or the telerehabilitation components. Assessors were unblinded. Patients needed substantial support, at least during the initial days at home. The sample had high motivation for rehabilitation, very good social support, and overall high optimism, so compliance may not generalize. The therapy was mostly tabletop activities, with some three-dimensional components. The drug results were not analyzed here, and the paper says the drug had no significant effect.
The easy way to misread this
Do not read the arm Fugl-Meyer score increase as proof that telerehabilitation alone improves arm function. This was a 12-patient pilot with no control group and unblinded assessors. Patients also received daily L-Dopa or placebo and standard physical or occupational therapy, and the telerehabilitation package included therapist-selected activities, patient-selected games, education, blood pressure recording, and videoconferences, so the contribution of any single component cannot be separated.