Timing in smartphone-guided home stroke rehabilitation with functional electrical stimulation: feasibility of distributed supervision and retrospective comparison with a front-loaded model.

The groups were not randomized, so selection differences could explain the results. The front-loaded group was from Chicago and the distributed group from Santiago, with different healthcare systems, cultures, and recruitment timeframes, so supervision timing cannot be separated from country and context. The sample was small and the study was not powered to compare groups, so several null between-group results are inconclusive rather than evidence of no difference. The groups differed at baseline in age, chronicity, stroke type, and lesion side, which could affect lower limb strength and mobility outcomes. Adherence was tracked as session completion, duration, and perceived exertion, but not detailed within-session dose such as time on each component or actual stimulation time, so equal delivered dose cannot be confirmed. Therapist supervision was not blinded, and therapist style may have varied between sites. There was no long-term follow-up, so durability of gains is unknown.

This work was supported by a predoctoral pilot grant from the Midwest Roybal Center for Health Promotion and Translation and by departmental funds from the University of Illinois Chicago Department of Physical Therapy. The authors declared no conflicts of interest.

Do not conclude that distributed supervision is superior to front-loaded supervision. Both groups received the same home exercise and functional electrical stimulation program, and the comparison was retrospective, non-randomized, and confounded by different countries, time periods, and baseline characteristics, so the larger sit-to-stand and Timed Up and Go gains cannot be attributed to supervision timing alone.