Effectiveness of telerehabilitation on quality of life in stroke survivors: a systematic review and meta-analysis

Background: Recent advances in technology have made possible the delivery of health services to patients remotely, and telerehabilitation for stroke survivors has emerged as a promising intervention. This systematic review assessed the clinical effectiveness of telerehabilitation (TR) programmes on quality-of-life (QoL) of stroke survivor compared to standard care. Methods: MEDLINE, CINAHL, AMED, Web of Science, and Scopus databases were searched from inception to 10 June 2022. Studies were considered eligible for inclusion if they fulfilled the following criteria: assessed the efficacy of different telerehabilitation models in poststroke patients, employed randomised controlled trial, and non-randomised design, stroke survivor adults age >= 18 years, health-related quality of life outcome, and full text available. Data were extracted by two independent researchers. Risk of bias was assessed by the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed among trials presenting with similar clinical characteristics. Results: A total of 11 eligible studies that met the inclusion criteria were included in the review. These studies were conducted in Brazil (n = 1), Italy (n = 2), the Netherlands (n = 1), South Korea (n = 1), Taiwan (n = 1), United Kingdom (n = 1) and United States (n = 4) between 2004 and 2020. Except for blinding of participants to study group allocation, all the studies were (>50%) at low risk of bias to considering adequate sequence generation, allocation concealment, blinding of trial personnel or outcome assessors, evaluation of incomplete outcome data, and lack of selective reporting. The meta-analysis (n = 5) included 306 individuals with duration of follow-up ranged between 4 and 12 weeks. We found that there were no statistically significant difference (SMD = 0.089, confidence interval (CI) 95% = -0.184 to 0.362, p = 0.522) for Stroke Impact Scale between the interventions and the control. Conclusion: The review provides evidence for the effectiveness of TR interventions to improve the QoL of stroke survivors in a short term. Further research studies are required to examine the effectiveness of TR interventions for stroke survivors in a long-term follow-up.