Home-based telerehabilitation for stroke survivors: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Xiaoyan ¹ , WANG Pu ² , YAN Lijiao ^1,3,4 , WANG Yuanhong ⁵ , WANG Dou ¹ , QU Chang ¹ , CONG Xue ¹ ,  HAO Yufang ^1,3,4

1. School of Nursing, Beijing University of Chinese Medicine, Beijing, 102448, P.R.China;
2. Department of Rehabilitation Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, P.R.China;
3. Joanna Briggs Institute Center of Excellence, Beijing University of Chinese Medicine, Beijing, 102448, P.R.China;
4. Best Practice Spotlight Organization, Registered Nurses’Association of Ontario, BeiJing University of Chinese Medicine, Beijing, 102448, P.R.China;
5. Department of Rehabilitation Medicine, Longfu Hospital, Beijing, 102448, P.R.China;

Corresponding author：

HAO Yufang, Email: Haoyufang0903@sina.com

Keywords：

Home-based telerehabilitation; Stroke; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201904004

Video：

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Objectives To systematically review the efficacy of home-based telerehabilitation (HTR) for stroke survivors.Methods PubMed, EMbase, Web of Science, Joanna Briggs Institute Library, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on HTR for stroke survivors from inception to January 1^st, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 11 RCTs involving 793 patients were included. The results of meta-analysis showed that: after 1 to 2 years of treatment, BI scores (MD=20.22, 95%CI 17.10 to 23.35, P<0.000 01) in HTR group were higher than those in the traditional rehabilitation group. However, there were no statistical differences between two groups in ARAT scores (SMD=0.16, 95%CI −0.14 to 0.45, P=0.30) after 1 to 2 months of treatment, as well as MBI scores (SMD=0.98, 95%CI −0.33 to 2.29, P=0.14) and FMA scores (SMD=0.57, 95%CI −0.08 to 1.23, P=0.09) after 3 months of treatment, and CSI scores (MD=−1.48, 95%CI −3.90 to 0.94, P=0.23) and BBS scores (MD=1.33, 95%CI −1.15 to 3.81, P=0.29) after 6 months of treatment. The results of descriptive analysis indicated that there was no statistically significant difference in quality of life between the two groups at 6 months after intervention. However, the HTR group was superior to the traditional rehabilitation group after 2 years of treatment.Conclusions Current evidence shows that, compared with traditional rehabilitation, long-term intervention (1-2 years) with HTR can improve the ability to perform activities of daily living and quality of life of stroke survivors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

Citation： ZHANG Xiaoyan, WANG Pu, YAN Lijiao, WANG Yuanhong, WANG Dou, QU Chang, CONG Xue, HAO Yufang. Home-based telerehabilitation for stroke survivors: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1226-1232. doi: 10.7507/1672-2531.201904004 Copy

1.	Lackland DT, Roccella EJ, Deutsch AF, et al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke, 2014, 45(1): 315-353.
2.	《中国脑卒中防治报告 2018》编写组. 我国脑卒中防治仍面临巨大挑战—《中国脑卒中防治报告 2018》概要. 中国循环杂志, 2019, 34(2): 105-119.
3.	黄长琴, 钟艳. 脑卒中幸存者运动功能障碍康复治疗新进展. 检验医学与临床, 2017, 14(3): 449-451.
4.	王陇德, 王金环, 彭斌, 等. 《中国脑卒中防治报告 2016》概要. 中国脑血管病杂志, 2017, 14(4): 217-224.
5.	Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016, 47(6): e98-100.
6.	Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke, 2016, 11(4): 459-484.
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9.	Demiris G, Shigaki CL, Schopp LH. An evaluation framework for a rural home-based telerehabilitation network. J Med Syst, 2005, 29(6): 595-603.
10.	Nijenhuis SM, Prange-Lasonder GB, Stienen AH, et al. Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial. Clin Rehabil, 2017, 31(2): 207-216.
11.	Chen J, Jin W, Dong WS, et al. Effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia: a randomized controlled trial. Am J Phys Med Rehabil, 2017, 96(3): 152-160.
12.	高修明, 夏媛, 郭琳, 等. 基于视频互动的远程康复模式对脑卒中偏瘫幸存者疗效的研究. 中国继续医学教育, 2017, 9(22): 211-213.
13.	Chaiyawat P, Kulkantrakorn K. Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial. Clin Neurol Neurosurg, 2012, 114(7): 866-870.
14.	Blacquiere D, Linsay MP, Foley N. Canadian stroke best practice recommendations: telestroke best practice guidelines update 2017. Int J Stroke, 2017, 12(8): 886-895.
15.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
16.	Redzuan NS, Engkasan JP, Mazlan M, et al. Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial. Arch Phys Med Rehabil, 2012, 93(12): 2177-2183.
17.	王菲. 脑卒中患者远程视频家庭康复指导与常规家庭康复指导效果对比研究. 山西医药杂志, 2018, 47(13): 1553-1554.
18.	Adie K, Schofield C, Berrow M, et al. Does the use of Nintendo. Wii Sports Clin Rehabil, 2017, 31(2): 173-185.
19.	Huijgen BC, Vollenbroek-Hutten MM, Zampolini M, et al. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis. J Telemed Telecare, 2008, 14(5): 249-256.
20.	金燕, 陈静, 李煜珍, 等. 远程康复护理干预对急性脑卒中偏瘫幸存者日常生活能力及照顾者压力指数的影响. 护理研究, 2016, 30(2): 202-204.
21.	Han SY, Kim DI, Kim JH, et al. Effect of telerehabilitation using mobile phone on motor function recovery in chronic stroke patients. KJOT, 2012, 20(3): 67-79.
22.	Wolf SL, Sahu K, Bay RC, et al. The HAAPI (home arm assistance progression initiative) trial: a novel robotics delivery approach in stroke rehabilitation. Neurorehabil Neural Repair, 2015, 29(10): 958-968.
23.	金巍, 时芳芳, 董文帅, 等. 远程卒中医疗的研究进展和应用现状. 国际脑血管病杂志, 2015, 23(2): 111-115.
24.	佚名. 国家远程卒中中心在宣武医院揭牌. 中国医疗设备, 2014, 29(6): 180.
25.	Chen Y, Abel KT, Janecek JT, et al. Home-based technologies for stroke rehabilitation: A systematic review. Int J Med Inform, 2019, 123: 11-22.
26.	Josman N, Kizony R, Hof E, et al. Using the virtual action planning-supermarket for evaluating executive functions in people with stroke. J Stroke Cerebrovasc Dis, 2014, 23(5): 879-887.
27.	Piron L, Turolla A, Agostini M, et al. Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. J Rehabil Med, 2009, 41(12): 1016-1102.
28.	Cikajlo I, Rudolf M, Goljar N, et al. Telerehabilitation using virtual reality task can improve balance in patients with stroke. Disabil Rehabil, 2012, 34(1): 13-18.
29.	Sørensen T, Dyb K, Rygh E, et al. A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue. BMC Health Serv Res, 2014, 14(1): 643.
30.	Cherry CO, Chumbler NR, Richards K, et al. Expanding stroke telerehabilitation services to rural veterans: a qualitative study on patient experiences using the robotic stroke therapy delivery and monitoring system program. Disabil Rehabil Assist Technol, 2017, 12(1): 21-27.
31.	Saywell N, Taylor D. Focus group insights assist trial design for stroke telerehabilitation: a qualitative study. Physiother Theory Pract, 2015, 31(3): 160-165.

1. Lackland DT, Roccella EJ, Deutsch AF, et al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke, 2014, 45(1): 315-353.
2. 《中国脑卒中防治报告 2018》编写组. 我国脑卒中防治仍面临巨大挑战—《中国脑卒中防治报告 2018》概要. 中国循环杂志, 2019, 34(2): 105-119.
3. 黄长琴, 钟艳. 脑卒中幸存者运动功能障碍康复治疗新进展. 检验医学与临床, 2017, 14(3): 449-451.
4. 王陇德, 王金环, 彭斌, 等. 《中国脑卒中防治报告 2016》概要. 中国脑血管病杂志, 2017, 14(4): 217-224.
5. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016, 47(6): e98-100.
6. Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke, 2016, 11(4): 459-484.
7. 卫丹丹. 太原市脑卒中家庭照顾者健康状况及社区护理需要的研究. 太原: 山西医科大学, 2012.
8. 杨芷, 童晓飞. 颅脑损伤幸存者家庭远程康复护理的研究进展. 护理学杂志, 2018, 33(2): 102-105.
9. Demiris G, Shigaki CL, Schopp LH. An evaluation framework for a rural home-based telerehabilitation network. J Med Syst, 2005, 29(6): 595-603.
10. Nijenhuis SM, Prange-Lasonder GB, Stienen AH, et al. Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial. Clin Rehabil, 2017, 31(2): 207-216.
11. Chen J, Jin W, Dong WS, et al. Effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia: a randomized controlled trial. Am J Phys Med Rehabil, 2017, 96(3): 152-160.
12. 高修明, 夏媛, 郭琳, 等. 基于视频互动的远程康复模式对脑卒中偏瘫幸存者疗效的研究. 中国继续医学教育, 2017, 9(22): 211-213.
13. Chaiyawat P, Kulkantrakorn K. Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial. Clin Neurol Neurosurg, 2012, 114(7): 866-870.
14. Blacquiere D, Linsay MP, Foley N. Canadian stroke best practice recommendations: telestroke best practice guidelines update 2017. Int J Stroke, 2017, 12(8): 886-895.
15. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
16. Redzuan NS, Engkasan JP, Mazlan M, et al. Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial. Arch Phys Med Rehabil, 2012, 93(12): 2177-2183.
17. 王菲. 脑卒中患者远程视频家庭康复指导与常规家庭康复指导效果对比研究. 山西医药杂志, 2018, 47(13): 1553-1554.
18. Adie K, Schofield C, Berrow M, et al. Does the use of Nintendo. Wii Sports Clin Rehabil, 2017, 31(2): 173-185.
19. Huijgen BC, Vollenbroek-Hutten MM, Zampolini M, et al. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis. J Telemed Telecare, 2008, 14(5): 249-256.
20. 金燕, 陈静, 李煜珍, 等. 远程康复护理干预对急性脑卒中偏瘫幸存者日常生活能力及照顾者压力指数的影响. 护理研究, 2016, 30(2): 202-204.
21. Han SY, Kim DI, Kim JH, et al. Effect of telerehabilitation using mobile phone on motor function recovery in chronic stroke patients. KJOT, 2012, 20(3): 67-79.
22. Wolf SL, Sahu K, Bay RC, et al. The HAAPI (home arm assistance progression initiative) trial: a novel robotics delivery approach in stroke rehabilitation. Neurorehabil Neural Repair, 2015, 29(10): 958-968.
23. 金巍, 时芳芳, 董文帅, 等. 远程卒中医疗的研究进展和应用现状. 国际脑血管病杂志, 2015, 23(2): 111-115.
24. 佚名. 国家远程卒中中心在宣武医院揭牌. 中国医疗设备, 2014, 29(6): 180.
25. Chen Y, Abel KT, Janecek JT, et al. Home-based technologies for stroke rehabilitation: A systematic review. Int J Med Inform, 2019, 123: 11-22.
26. Josman N, Kizony R, Hof E, et al. Using the virtual action planning-supermarket for evaluating executive functions in people with stroke. J Stroke Cerebrovasc Dis, 2014, 23(5): 879-887.
27. Piron L, Turolla A, Agostini M, et al. Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. J Rehabil Med, 2009, 41(12): 1016-1102.
28. Cikajlo I, Rudolf M, Goljar N, et al. Telerehabilitation using virtual reality task can improve balance in patients with stroke. Disabil Rehabil, 2012, 34(1): 13-18.
29. Sørensen T, Dyb K, Rygh E, et al. A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue. BMC Health Serv Res, 2014, 14(1): 643.
30. Cherry CO, Chumbler NR, Richards K, et al. Expanding stroke telerehabilitation services to rural veterans: a qualitative study on patient experiences using the robotic stroke therapy delivery and monitoring system program. Disabil Rehabil Assist Technol, 2017, 12(1): 21-27.
31. Saywell N, Taylor D. Focus group insights assist trial design for stroke telerehabilitation: a qualitative study. Physiother Theory Pract, 2015, 31(3): 160-165.

Chinese Journal of Evidence-Based Medicine

Home-based telerehabilitation for stroke survivors: a systematic review

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