Can post stroke walking improve via telerehabilitation? A systematic review in adults with stroke.

Only 8 studies were included, with small individual sample sizes (10 to 61 participants per study). Half of the included studies were rated only fair quality on the PEDro scale, mainly because neither the therapist nor the participant could be blinded. Three of the eight studies had no control group, so no between-group comparison was possible. The interventions varied widely: virtual reality, neuromuscular stimulation, ankle movement training, conventional exercises, and neurodevelopmental approaches. It is not possible to tell which type of intervention, if any, drove the results. Balance was included as a proxy for walking ability, but the authors note that balance improvement does not predict better walking speed or endurance. Only one study measured walking speed, and it found no improvement. The absence of walking speed as an outcome in the other studies is a major gap. No study reported long-term follow-up, so it is unknown whether any improvements were sustained after treatment ended. Participants spanned acute, subacute, and chronic stroke phases, and the authors note that results from the acute phase may not generalise to chronic stroke. No study reported objective safety measures, and the authors could not make recommendations on safety strategies for remote walking training. It was not reported in the included studies whether the interventions were delivered by a trained physical therapist.

The authors state they did not receive funding for the work and have no conflicts to report.

Do not read the balance improvements as evidence that telerehabilitation improves walking. The authors state that balance gains do not predict better walking speed or endurance, and the one study that actually measured walking speed found no improvement. The two studies showing telerehabilitation superior to control had weak comparison groups: one used telephone guidance only as the control, and the other used a different intervention content, so the advantage may reflect the control being weaker rather than telerehabilitation being better.