Telerehabilitation Group Research Articles

Depression, anxiety and insomnia among isolated covid-19 patients: tele occupational therapy intervention vs. conventional one: a comparative study.

COVID-19 is known to cause psychological problems. Psychological rehabilitation can be performed to reduce anxiety, depression, and insomnia. Facing patients with infectious diseases can be difficult for medical staff. Therefore, this study compared the effects of psychiatric tele-rehabilitation (TR) and conventional psychiatric rehabilitation (CR) in isolated patients with COVID-19. This randomized controlled study, conducted at a single community-based hospital, included 40 patients (24 in the psychiatric tele-rehabilitation group [TRG] and 16 in the conventional psychiatric rehabilitation group [CRG]) with COVID-19 were recruited from November 18, 2021, to April 7, 2022. Psychiatric rehabilitation is an occupation-based intervention in which patients perform meaningful activities and tasks. Patients in the TRG selected activities, received counseling, and underwent monitoring over the phone, while those in the CRG participated in face-to-face sessions. The interventions were conducted for 50min each day during an isolation period of 7 days in both groups, and all participants received the interventions individually. The primary outcome was anxiety assessed using the Visual Analog Scale (VAS) and the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes include the Visual Analog Scale (VAS) and the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression, the Multidimensional State Boredom Scale-8 (MSBS-8) to assess boredom. The Korean version of the Insomnia Severity Index (ISI-K) was used to assess the quality of sleep, and the World Health Organization Quality of Life Assessment Instrument-BRIEF (WHOQOL-BREF) was used to evaluate quality of life. Questionnaires were administered at admission, discharge, and at the 6-month follow-up. In the time × group analysis, the SAS total score (p = .033) and the VAS score for depression (p = .012) in the CRG were significantly lower than those in the TRG at the time of discharge. The VAS score for anxiety (p = .007), total SAS score (p = .050), and VAS score for depression (p = .003) in the CRG were also significantly lower than those in the TRG at the 6-month follow-up. The PHQ-9, MSBS-8, ISI-K, and WHOQOL-BREF scores showed no significant interactions in the time × group analysis. TR was effective in reducing anxiety and improving quality of life during hospitalization, but had no remained effects after discharge. Otherwise, CR was more effective than TR for anxiety and depression during hospitalization and had remained effects at 6-month follow-up. However, considering the characteristics of infectious conditions that involve risk in contact, TR will still play an important role, and efforts will be needed to improve the effect that remained. The trial was registered with the Korea Clinical Trials Registry (KCT0006714, Date of registration 08/11/2021).

The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial.

Lung diseases have profound effects on the aging population. We aimed to hypothesize and investigate the effect of remote pulmonary telerehabilitation and motor imagery (MI) and action observation (AO) methods on the clinical status of elderly chronic obstructive pulmonary disease (COPD) patients. Twenty-six patients were randomly assigned to pulmonary telerehabilitation (PtR) or cognitive telerehabilitation (CtR) groups. The programs were carried out 3 days a week for 8 weeks. The 6-min walk test (6MWT), modified Medical Research Council dyspnea score, blood lactate level (BLL), measurement of peripheral muscle strength (PMS), and electromyography activation levels of accessory respiratory muscles were the main outcomes. There was a statistically significant improvement (p < 0.05) in both groups in the 6MWT distance and in secondary results, except for BLL. Generally, in the mean muscle activity obtained from the electromyography measurement after the program, there were statistically significant increases in the PtR group and decreases in the CtR group (p < 0.05). There was a statistically significant increase in PMS in both groups. An active muscle-strengthening program has the same benefits as applying the muscle-strengthening program to the patient as MI and AO. CtR can be a powerful alternative rehabilitation method in respiratory patients who cannot tolerate active exercise programs.

Spinal stabilization exercises for transversus abdominis and lumbar multifidus thickness via telerehabilitation and face-to-face approaches in patients with nonspecific chronic neck pain: a randomized controlled trial.

Strengthening the muscles of the lumbar region in individuals with neck pain may be protective against future back problems. In addition, telerehabilitation applications, which gained momentum in the literature and clinical practice during the COVID-19 pandemic, are among the applications preferred by patients thanks to their various advantages. This study aimed to compare the effects of telerehabilitation and spinal stabilization exercises applied with face-to-face approaches on the thickness of the transversus abdominis (M.TrA) and lumbar multifidus (M.LM) muscles in patients with nonspecific neck pain. The primary outcomes were the thickness of the M.TrA and M.LM. Neck pain intensity and neck disability were secondary outcomes. Muscle thickness was evaluated with an ultrasound device, neck pain intensity was assessed with a visual analog scale, and disability was assessed with the Neck Disability Index. Patients were randomly assigned to the telerehabilitation group (TRG) (n = 13) or the control group (CG) (n = 13). While the TRG did the exercises with live videos and video recordings, the CG did exercises face-to-face in the clinic. Both groups performed the same exercises for 45 minutes per session 3 days a week for 8 weeks. At the end of the treatment, the thicknesses of the M.TrA and M.LM were increased and neck pain intensity and neck disability were decreased in both groups (p < 0.05). The groups were similar in terms of these variables (p > 0.05). Telerehabilitation and face-to-face spinal stabilization exercises are both beneficial for spinal muscle architecture and clinical variables as a preventive measure against future lower back problems in individuals with neck pain.

The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial.

Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non-study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as "good" or "very good" across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747.

The Efficacy of the Cognitive Exercise Therapy Approach by Telerehabilitation in People Living with HIV: Preliminary Results.

The Cognitive Exercise Therapy Approach, referred to as BETY, is a biopsychosocial model that has demonstrated effectiveness in improving the quality of life among various patient populations with chronic diseases. This study aimed to determine the efficacy of BETY combined with telerehabilitation for people living with HIV (PLWH). Fifty PLWH who were virologically suppressed receiving follow-up and treatment at Şanlıurfa Training and Research Hospital were included in this study. Patients were divided into the telerehabilitation group (TG) and the control group (CG). In addition to routine treatments, the TG underwent group rehabilitation exercises via Zoom application for 60 minutes three times a week for 12 weeks (a total of 36 sessions) under the supervision of a physiotherapist, following the principles of BETY. The CG received no intervention and continued with routine medication treatments. Before and after the exercise therapy, the BETY Scale (BETY-BQ), Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Clinical Frailty Scale, and Frail Scale were administered to both the TG and the CG. The responses to the scales were compared between the two groups after the 12-week period. The preliminary results included data from 10 patients in the TG and 15 patients in the CG who completed the 12-week treatment. In the TG, significant differences were observed in the SF-36 pain subscale and the BETY total score, while in the CG, significant differences were found in the SF-36 emotional role functioning and vitality subscales (p<0.05). In the TG, negative values were observed in all BETY-BQ subscales, indicating improvement in all parameters. Additionally, the mean value of the SF-36 pain subscale increased from 79 before treatment to 91.5 after treatment. Our preliminary results indicate that the BETY method applied by telerehabilitation may be effective in reducing pain and improving biopsychosocial conditions in PLWH. Telerehabilitation with cognitive exercise therapy can provide an alternative treatment option by complementing routine therapies and offering the opportunity to participate anonymously in group therapies in PLWH.

App-based telerehabilitation program for older adults on waiting list for physiotherapy after hospital discharge: a feasibility pragmatic randomized trial

BackgroundInactivity while waiting for outpatient physiotherapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages. This study aimed to evaluate the feasibility of the study procedures of a telerehabilitation program for older adults waiting for outpatient physiotherapy after hospital discharge.MethodsThis pragmatic randomized controlled trial recruited older adults (≥ 60 years) with several clinical diagnoses on the waiting list for outpatient physiotherapy in the Brazilian public health system after hospital discharge. The telerehabilitation group (n = 17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n = 17) followed the usual waiting list. We assessed recruitment and dropout rates, safety, adherence, and satisfaction. The preliminary effects were verified on clinical outcomes.ResultsWe recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program. The weekly adherence was 2.85 (1.43) days, and in 63.3% of the weeks the participants were enrolled, they performed the exercise program at least twice a week. Participants rated the telerehabilitation program as 9.71 (0.21), and the safety of remote exercises without professional supervision as 8.6 (2.2) on a 0–10 scale.ConclusionsThe telerehabilitation program using a smartphone app was safe and presented high participants’ satisfaction and adequate adherence, recruitment, and dropout rates. Therefore, the definitive study can be conducted with few modifications.Trial registrationBrazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020. https://ensaiosclinicos.gov.br/rg/RBR-9243v7.

Multicomponent supervised tele-rehabilitation versus home-based self-rehabilitation management after anterior cruciate ligament reconstruction: a study protocol for a randomized controlled trial

IntroductionOur study aims to assess the effectiveness of multicomponent supervised tele-rehabilitation compared to home-based self-rehabilitation management in patients following anterior cruciate ligament reconstruction (ACLR).MethodsThe current study is designed as a single-center, single-blinded, randomized controlled, two-arm trial. Participants will be randomized and allocated at a 1:1 ratio into either a multicomponent supervised tele-rehabilitation group or a home-based self-rehabilitation group. All participants receive uniform preoperative education through the HJT software. Participants in the intervention group undergo multicomponent supervised tele-rehabilitation, while those in the control group follow a home-based self-rehabilitation program. All the participants were assessed and measured for the included outcomes at the outpatient clinic before the procedure, and in 2, 4, 8, 12, and 24 weeks after ACLR by two assessors. The primary outcome was the percentage of patients who achieve a satisfactory active ROM at the 12 weeks following the ACLR. The satisfactory active ROM was also collected at 2, 4, 8, and 24 weeks after ACLR. The secondary outcomes were active and passive range of motion (ROM), pain, muscle strength, and function results.Registration detailsEthical approval has been obtained from the West China Hospital Ethics Committee (approval number 2023−1929, December 2023). The trial has been registered on ClinicalTrials.gov (registration number NCT06232824, January 2024).

Telerehabilitation improves cardiorespiratory and muscular fitness and body composition in older people with post-COVID-19 syndrome.

The effects of post-coronavirus disease 2019 (COVID-19) syndrome on the cardiorespiratory and muscular fitness in older people are of utmost relevance. This study aimed to evaluate the effects of a 12-week telerehabilitation programme on cardiorespiratory and muscular fitness and body composition in older patients with post-COVID-19 syndrome. One hundred twenty older patients with post-COVID-19 syndrome were randomly assigned to one of two groups: patients who carried out the telerehabilitation programme (n=60; age: 65.0±5.2; female: 14.2%) and a control group (n=60; age: 64.3±5.0; female: 24.5%). An incremental cardiopulmonary exercise testing, isokinetic strength test, and bioelectrical impedance analysis were performed to compare cardiorespiratory and muscle strength responses and body composition between telerehabilitation and control groups. A significant increase in the cardiopulmonary exercise testing duration was found in the telerehabilitation group compared to the control group (mean difference=88.9s, P=0.001). Peak oxygen uptake increased in the telerehabilitation group (mean difference=3.0mL·kg-1·min-1, P<0.001) and control group (mean difference=1.9mL·kg-1·min-1, P<0.001). Power output in cycle ergometer (mean difference=25.9 watts, P<0.001), fat free mass (mean difference=2.1kg, P=0.004), soft lean mass (mean difference=2.1kg, P=0.003), and skeletal muscle mass (mean difference=1.4kg, P=0.003) only increased in the telerehabilitation group. A significant increase in the power output was observed in the telerehabilitation group compared with the control group in both lower limbs after isokinetic strength test of the leg extension at a speed of 60° (right: mean difference=18.7 watts, P=0.012; left: mean difference=15.3 watts, P=0.010). The peak torque of right leg extension increased only in the telerehabilitation group after isokinetic strength test at a speed of 60° (mean difference=13.1N·m, P<0.001). A significant increase in the power output was observed in the telerehabilitation group compared with the control group in the left leg extension after isokinetic strength test at a speed of 180° (mean difference=30.2 watts, P=0.003). The telerehabilitation programme improved cardiorespiratory and muscular fitness, and body composition in older patients with post-COVID-19 syndrome to a greater extent than a control group. The telerehabilitation programmes may be an alternative to improve the sequelae of post-COVID-19 syndrome in older patients.

The Impact Of Tele-Rehabilitation Nursing On The Daily Living Abilities Of Children With Cerebral Palsy

The objective of this study is to delve into the influence of tele-rehabilitation nursing on children diagnosed with cerebral palsy. To achieve this, we conducted a thorough search across multiple databases including the Cochrane Library, PubMed, ScienceDirect, CNKI, and WanFang Data, aiming to gather evidence on the efficacy of tele-rehabilitation for cerebral palsy. Subsequently, a comparative analysis was performed to assess the differences in physical structure, function, activities, and participation in daily living activities between children receiving tele-rehabilitation nursing and those undergoing home-based care. For the purpose of this investigation, a total of 30 subjects were divided into two groups: a control group that received tele-rehabilitation nursing, and an observation group that underwent traditional home-based rehabilitation. The findings of our data analysis revealed that tele-rehabilitation nursing significantly improved the daily living abilities of children with cerebral palsy, with statistical significance (P&lt;0.05). Notably, children in the tele-rehabilitation group exhibited a significantly higher level of participation in daily activities compared to the home-based rehabilitation group, while no significant differences were observed in terms of physical structure, function, and activity levels.

DTx-based cardio-oncology rehabilitation for lung cancer survivors: A randomized controlled trial.

12024 Background: Cardio-oncology rehabilitation holds significant importance for lung cancer survivors, particularly those diagnosed at an early stage requiring lobectomy, where the maximal oxygen uptake peak (VO2PEAK) stands out as a robust prognositic predictor. Home-based cardiac telerehabilitation serves as a substitute for traditional center-based rehabilitation, demonstrating higher participation and completion rates. Despite the potential benefits, wearable devices and mobile apps, which offer tailored video guides, real-time monitoring, individualized safety alerts, and exercise-specific feedback, have not gained widespread adoption in clinical practice. Here, we present findings on the efficacy, safety, and compliance of a 3-month cardio-oncology rehabilitation program based on digital therapeutics (DTx) for lung cancer survivors. Methods: Early-stage lung cancer survivors post-lobectomy, not requiring radiotherapy or chemotherapy, were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. For pts in the telerehabilitation group, exercise prescriptions with video guides and real-time HR monitoring were implemented using the R Plus Health APP, a software as medical device approved by CFDA for remote cardiac rehab. The AI-driven prescriptions were generated based on CPET, modified by physiologists, and dynamically optimized according to feedback. Pts in the usual care group received routine instructions. Outcome measurements included VO2PEAK (primary outcome), FEV1, DLCO, cardiac function, safety, compliance, and scales assessing symptoms (MDASI), psychology (HADS), sleep (PSQI), fatigue (MSFI-SF), and quality of life (QLQ-C30). Results: 40 of 47 (85%) pts completed the trial (22 in the telerehabilitation group and 18 in the usual care group). Pts in the telerehabilitation group engaged in exercise an average of 3.3 times per week. The average exercise duration was 151.4 min per week, with an average effective exercise duration (when the required heart rate was reached) of 92.3 min per week. The average prescription compliance rate (effective exercise duration/lower limit of prescription duration) was 101.2%. Cardiac telerehabilitation was associated with a higher average VO2PEAK improvement (3.660±3.232 vs 1.088±3.230 mL/Kg/min, p=0.023), better alleviation of affective interference (-0.883±1.500 vs 0.208±1.222, p=0.048), higher quality of life improvement (16.250±23.017 vs 1.042±13.903, p=0.027), fatigue (-0.889±15.960 vs 1.389±12.087, p=0.024), daytime dysfunction (-0.550±0.686 vs 0.000±0.516, p=0.015), and more anxiety relief (-0.314±0.444 vs -0.054±0.295, p=0.048) compared with usual care. Other efficacy outcomes did not show significant differences between the two groups. No exercise-related adverse events occurred during the intervention. Conclusions: DTx-based cardio-oncology rehabilitation demonstrated improvements in cardiorespiratory fitness and reductions in affective interference and anxiety among lung cancer survivors, indicating high compliance and safety. Clinical trial information: ChiCTR2200064000.

Telerehabilitation-based training to improve balance confidence, falls efficacy, functional independence in individuals with stroke: a randomized controlled trial

Background: The aim of the study was to investigate the effectiveness of telerehabilitation-based balance and coordination exercises on balance confidence, fall efficacy, and functional independence in stroke patients. Methods: A double-blind, randomized controlled trial was conducted on 30 stroke patients (15 in the telerehabilitation-based group and 15 in the paper-based control group). The telerehabilitation group received video-based exercise training, while the control group received paper-based exercise training. Fear of falling (FES-I), balance (ABC), self-management (SSEQ) and satisfaction with telemedicine (TSQ) were evaluated before and six weeks after treatment. Results: The results of the present study showed that both telerehabilitation-based video training and paper- based exercise prescription methods were effective in terms of balance confidence, fall efficiency and stroke-specific functional independence (p&lt;0.05). Besides, telerehabilitation-based video training was more effective in balance confidence (p=0.042) and functional independence (0.018). In addition, the satisfaction of individuals in the telerehabilitation group with the telerehabilitation application was above average (59.73±8.15). Conclusion: Telerehabilitation-based video exercises in stroke patients may provide additional advantages in terms of balance confidence and fall efficiency. In addition, individuals with stroke were satisfied with the remote rehabilitation application.

Effectiveness of telerehabilitation on pain and function in musculoskeletal disorders: A systematic review of randomized controlled trials

AbstractIntroductionMusculoskeletal disorders are common, causing high hospital and healthcare utilisation. Telerehabilitation (TR) is a new strategy to deliver treatment remotely to patients in their own homes, with lower costs and easier accessibility. This study investigated the effectiveness of TR on pain and function in musculoskeletal disorders.MethodsA literature search of randomised controlled trials (RCTs) in the Medline/PubMed, Cochrane Library, and PEDro databases was conducted by two reviewers on 10 Jan 2023. We included studies that investigated pain and function with TR compared with a control group in any musculoskeletal disorders. The data synthesis included the TR platforms and measured outcomes. Effectiveness was measured based on the pain and function results. The study methodological quality was assessed by the PEDro scale for RCTs.ResultsAfter removing duplicated and irrelevant studies, 200 were initially identified. This review includes seven RCTs of a total of 183 participants with musculoskeletal conditions such as low back pain, fibromyalgia, total knee arthroplasty, shoulder subacromial decompression, knee osteoarthritis, and rotator cuff syndrome. The TR platforms used were smartphone and web apps, video, phone calls, and teleconference sessions. The findings showed no significant differences between the TR and control groups in pain and function. TR showed better improvement with a significant short‐term difference in some variables, but this was not sustained in the long term.ConclusionTR was comparably effective to clinic‐based rehabilitation for treating musculoskeletal disorders. However, it was not superior to conventional rehabilitation. TR showed lower costs and a high level of adherence. We recommend implementing new TR tools to remotely treat patients.Systematic Review RegistrationPROSPERO Registration Number CRD42022375048.

Comparing the Efficacy of Manual Therapy and Exercise to Synchronized Telerehabilitation with Self-Manual Therapy and Exercise in Treating Subacromial Pain Syndrome: A Randomized Controlled Trial.

This study aimed to investigate the efficacy of manual therapy and exercise versus synchronized telerehabilitation with self-manual therapy and exercise in treating Subacromial Pain Syndrome (SAPS). Sixty individuals diagnosed with SPS, aged 18-50 years, were randomly assigned to home exercise (HE), manual therapy (MT), and telerehabilitation (TR) groups. Treatment protocols were administered over 8 weeks and included specific exercises and therapy interventions. Outcome measures included the Visual Pain Scale (VAS), shoulder range of motion (ROM) via goniometric measurements, Quick Disability Arm-Shoulder-Hand Problems Survey (Q-DASH), and patient satisfaction. Results revealed that both MT and TR groups exhibited reduced pain, increased ROM, lower Q-DASH scores, and higher patient satisfaction than the HE group. However, no significant differences were found between the MT and TR groups regarding pain levels, ROM, Q-DASH scores, or patient satisfaction. The study concludes that both telerehabilitation and manual therapy effectively alleviate pain and are well-received by patients with SPS. Additionally, manual therapy demonstrates superiority in enhancing functional levels compared to exercise-based interventions (Registration: NCT05200130).

The Effect of Telehealth-Based Rehabilitation on Patient Reported Outcomes and Objective Clinical Measurements in Patients With Degenerative Meniscal Tear

Aim: The study aimed to compare the effectiveness of telehealth-based home exercises and conventionally prescribed home exercises in patients with degenerative meniscal tears. Material and Method: A two-armed, randomized controlled study was conducted with 49 participants with degenerative meniscal disease. Patients were randomized into Telerehabilitation (TR=25) and Conventional Home Exercise Rehabilitation (CR=24) groups. The TR group provided video exercises and self-management education via an online platform. The same protocol was given to the CR group in the clinical setting. Pain with Visual Analog Scale, muscle strength with Hand-Held Dynamometer, proprioception with Baseline bubble inclinometer, functional status with Western Ontario and McMaster Universities Osteoarthritis Index, exercise adherence with Exercise Adherence Rating Scale, quality of life with Short Form-12 were evaluated at baseline and after eight weeks of intervention. In addition, satisfaction and usability were assessed with the Telemedicine Satisfaction and Usefulness Questionnaire at week 8. Results: The TR group improved activity pain, proprioception, some parameters of the muscle strength outcomes, and exercise adherence scores (p0.05). In addition, 52 percent of the TR group reported high levels of satisfaction and usability. Conclusion: Despite increased participation and satisfaction, the telerehabilitation group noticed improvements in clinician-based measures (proprioception, strength) but not in rest pain, function, and quality of life. As a result, telerehabilitation-based home exercises prescribed to these patient groups are more effective.

Online dance versus online therapeutic exercise on quality of life - a study protocol for a randomized controlled trial investigating social telerehabilitation efficacy in Parkinson disease

Background Social telerehabilitation delivers rehabilitation services over online video conferencing within a social context. The modality of multimodal therapeutic exercises is the most recommended rehabilitation for individuals with PD, although other modalities, such as dance, have shown potential benefits. The investigation of the feasibility and efficacy of these therapeutic strategies in a remote online format is unknown. Methods This is a prospectively registered two-arm randomised controlled trial investigating the efficacy of online dance compared to online multimodal therapeutic exercise by looking at the biopsychosocial PD aspects. Individuals diagnosed with idiopathic PD between 40 and 90 years old, at any stage of disease severity, and without cognitive impairment will be recruited from the community. Participants will be randomly allocated to one of the two social telerehabilitation groups: (1) dance and music or (2) multimodal therapeutic exercise and music. Interventions will occur twice a week for twelve weeks. Each session will last 60 min. Tele-assessments will be conducted pre-, post-, and one-month follow-up through a videoconference platform. Results For feasibility, primary outcomes will include adherence, attendance, adverse events, and participants’ perceptions of enjoyment and socialisation. For efficacy, primary outcomes will investigate well-being by positive affect (by the Positive Affect and Negative Affect Schedule) and persistent anxiety, episodic anxiety, and avoidance behaviour (by the Parkinson Anxiety Scale). Secondary outcomes will include motor severity (by the UPDRS III), functional lower extremity strength (by the Five Times Sit to Stand Test), memory and attention (by the Attention and Recognition Memory Test), and quality of life (by the Parkinson’s Disease Questionnaire 39). Conclusion We hypothesise that both interventions would effectively ameliorate motor symptoms. However, we expect dance to be more enjoyable and improve well-being by increasing positive affect and reducing anxiety signs.

An Opportunity for Management of Fatigue, Physical Condition, and Quality of Life Through Asynchronous Telerehabilitation in Patients After Acute Coronavirus Disease 2019: A Randomized Controlled Pilot Study

ObjectiveTo compare the preliminary efficacy of asynchronous telerehabilitation in patients after acute coronavirus disease 2019 (COVID-19) on fatigue, physical condition, quality of life, and feasibility of this pilot study with that of a booklet format. DesignRandomized pilot study with 2 intervention arms: asynchronous telerehabilitation group and booklet-based rehabilitation group, with 2 follow-ups at 3 and 6 months. SettingHospital. ParticipantsPatients discharged after COVID-19 were recruited and evaluated (N=35). InterventionsThe intervention consisted of a 12-week multimodal rehabilitation program via telerehabilitation or by a booklet. Main Outcome MeasuresFatigue as the main outcome and functional status, quality of life, and feasibility as secondary outcomes were evaluated. ResultsAfter the intervention, there was no significant difference between groups in fatigue, but there were significant differences in favor of the asynchronous telerehabilitation group for the 6-Minute Walk Test (p=.008), the 30-Second Sit-to-Stand Test (p=.019), and physical quality of life (p=.035). These improvements were maintained throughout the 6-month follow-up. Telerehabilitation was shown to be a viable option, without incidents and with a higher adhesion (p=.028) than the booklet format. ConclusionsA multimodal rehabilitation program by means of asynchronous telerehabilitation appears as a more effective option than traditional formats in improving post–acute COVID-19 sequelae.

Tele-rehabilitation program in patients with distal radius fracture: a controlled clinical trial

Distal radius fractures are very frequent fractures in the world, so it is necessary to establish new rehabilitation strategies. To determine the effectiveness of tele rehabilitation versus supervised treatment in the functional recovery of patients with distal radius fracture. A randomized clinical trial was conducted that included 91 patients with distal radius fractures grades AO23 A and AO23B, which were randomly assigned to a treatment group, the supervised rehabilitation group received for two weeks a program of 10 treatment sessions and the tele rehabilitation group received through the Moodle platform instructions to carry out the rehabilitation program. Outcome measures (functionality, active range of motion, hand grip strength, quality of life and pain) were measured at the time of admission to rehabilitation and at 1, 3 and 6 months. In both treatment groups at 6 months, statistically significant intragroup differences in functionality were demonstrated, with no intergroup differences. At 6 months, both rehabilitation programs increase functionality, range of motion, quality of life and decrease pain, without statistically significant differences intergroup.

The Effectiveness of Telerehabilitation for Functional Recovery After Orthopedic Surgery: A Systematic Review and Meta-Analysis.

The aim of this systematic review is to evaluate the effectiveness of physiotherapy treatment provided remotely via the Internet in the postoperative treatment of orthopedic patients and compare it with standard physiotherapy (face-to-face treatment or home-based treatment) in terms of motor performance, pain symptoms, and functional recovery. A systematic search of MEDLINE, Physiotherapy Evidence Database; EMBASE, SCOPUS, and CINHAL was conducted. Two independent reviewers performed study selection, data extraction, risk of bias (ROB) assessment using Cochrane ROB 2 tools, and summarize the results by Grading of Recommendations Assessment, Development, and Evaluation. Eleven randomized controlled trial were selected. Pooled results showed improvement in motor performance in favor of the telerehabilitation group at 4-6 weeks (standardized mean difference -0.24, 95% confidence interval -0.45, -0.02, p = 0.03), and these differences were close to the minimum clinically important difference for Time Up and Go test. For pain and functional recovery, the results showed differences not statistically important. The certainty of evidence ranged from moderate to very low. For joint replacement patients, treatment conducted via telerehabilitation appears able to provide levels of motor performance better to that achieved through home-based treatment. In contrast, conclusive evidence that telerehabilitation is comparable to standard face-to-face treatment are not available.

Effectiveness of telerehabilitation-based structured exercise program in individuals with unilateral transtibial amputation: a randomized controlled study

Purpose The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. Materials and methods The telerehabilitation group (n = 24) received telerehabilitation combined with home exercise, while the control group (n = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA. Results The group-by-time interactions were significant for TUG (p = 0.002, F[1;41] = 10.74) and 30CST (p = 0.001, F[1;41] = 11.48). The mean difference (6th week-baseline) was −0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and −0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC (p = 0.0004, F[1;41] = 14.47), the TAPES-activity restriction (p = 0.0001, F[1;41] = 28.96), TAPES-prosthesis satisfaction (p = 0.004, F[1;41] = 9.19), and the NHP (p = 0.0002, F[1;41] = 16.07) favoring the telerehabilitation group. Conclusions Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation. Implications for rehabilitation Exercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively. Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy. Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization. In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life.

Investigation of the barriers to and functional outcomes of telerehabilitation in patients with hand injury

BackgroundTelerehabilitation is an approach that is growing in importance and rapidly becoming more prevalent. However, the potential barriers to this approach and its effectiveness relative to face-to-face treatment still need to be determined. PurposeThe aim of this study was to investigate the technology and access barriers, implementation and organizational challenges, and communication barriers faced by patients undergoing postoperative telerehabilitation after hand tendon repair surgery. It also aimed to investigate the effect of telerehabilitation on pain, kinesiophobia, and functional outcomes. Study designProspective, open-label, nonrandomized comparative clinical study. MethodsThe study was conducted with 44 patients who underwent tendon repair surgery due to tendon injuries of the extrinsic muscles of the hand. Participants were divided into two groups (face-to-face group and telerehabilitation group). All participants received three physiotherapy sessions per week for 8 weeks from their surgery (via video conference using mobile phones to the telerehabilitation group). An early passive motion protocol was applied for flexor tendon and zone 5-7 extensor tendon repairs. Mallet finger rehabilitation was performed for zone 2 extensor tendon repairs, while an early active short arc approach was used for zone 3-4 repairs. The telerehabilitation and face-to-face groups received the same treatment protocols three times a week. In the eighth week of treatment (in the 24th session), the Turkish version of the Arm, Shoulder, and Hand Injury Questionnaire (DASH-T) and Tampa Scale for Kinesiophobia were administered to all patients. The telerehabilitation group also underwent a barrier questionnaire. A pretreatment assessment could not be conducted. The independent-sample t-test was used for DASH-T data, and the Mann-Whitney U-test was used for Tampa Scale for Kinesiophobia to compare groups. ResultsIn the study, there were 24 participants (age: 31.58 ± 12.02 years) in the face-to-face group and 20 participants (age: 39.25 ± 12.72 years) in the telerehabilitation group. The two groups were similar in terms of DASH-T and pain (p = 0.103, effect size = 0.647, and p = 0.086, effect size = 0.652, respectively) in the 8 weeks. However, the telerehabilitation group had a higher fear of movement (p = 0.017, effect size = 3.265). The most common barriers to telerehabilitation practices were the fear of damaging the tendon repair and the need for help during the treatment. ConclusionsWe determined that face-to-face treatment in acute physiotherapy for patients who have undergone tendon repair may be more effective compared to telerehabilitation, as it appears to be less likely to induce kinesiophobia. However, in situations where face-to-face treatment is not possible (such as lockdown), telerehabilitation can also be preferred after at least one in-person session to teach and perform exercises.