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Home-Based Telerehabilitation for Stroke Patients Is as Effective as the Clinic


​BY ED SUSMAN

HONOLULU–Telerehabilitation for stroke patients appears to work as well as going to a clinic for treatment, researchers suggested here at the 2019 International Stroke Conference, sponsored by the American Stroke Association.

"In our presentation we showed that telerehabilitation is non-inferior to in-clinic rehabilitation and improves arm motor status," said Steven C. Cramer, MD, FAAN, professor of neurology, anatomy and neurobiology, and professor of physical medicine and rehabilitation at the University of California, Irvine.

"We had a very motivated study population," Dr. Cramer said in his oral late-breaker report, attested by the fact that 98.3 percent (58 of 62 patients) of the home telerehabilitation population completed the 36-session trial as did 93.4 percent (57 of the 62) in-clinic participants.

The researchers sought to show that treating patients with telerehabilitation would have results that were within 30 percent of the improvements seen in rehabilitation clinics, and the results fell well within that margin, Dr. Cramer reported.

For the primary endpoint, improvement in the arm motor Fugl-Meyer score from baseline to 30 days from the start of rehabilitation, the in-clinic baseline score was 42.7 and that improved by an average of 8.36 points, while the telerehabilitation patients started with baseline Fugl-Meyer scores of 42.8 and improved by an average of 7.86 points. The adjusted difference between the groups was 0.6 points, while the 30 percent non-inferiority margin was 2.47 points. The researchers adjusted the scores based on age, baseline Fugl-Meyer score, time post-stroke, enrollment site, and stroke subtype.

The rehabilitation methods included various arm strengthening activities often included in video-type games similar to "Whack-a-mole" games; grasp and hold maneuvers, driving video games, and educational games to enhance the patients' knowledge of their disease. The number of telerehabilitation arm movement repetitions averaged 1,031 per day.

Dr. Cramer said that in the future he can envision telerehabilitation being paired with a drug and the treatment could be extended to beyond the arm to rehabilitate other deficits such as language or leg movements. He also said telerehabilitation could be used to enable a "stroke-smart home."

Commenting on the study, Daniel T. Lackland, DrPH, professor of public health and epidemiology at the Medical College of South Carolina in Charleston, told Neurology Today At the Meetings that telerehabilitation could be generally available.

"This is a method of improving compliance with rehabilitation regimens and can also reduce costs, which is a key component of this process after a stroke," Dr. Lackland said. "Almost every academic medical center now has a telemedicine or telehealth unit, and they are often the newest and most up-to-date parts of the hospital, so there is a good possibility this could be available in most areas. Everyone wants to promote this."

"The hospitals recognize that this is a tremendous cost saving," Dr. Lackland continued. "It improves adherence to the therapy; it is reimbursable, and the hospital gets to retain the patient. You don't ship the patient off to another facility."

Dr. Cramer serves as a consultant on the advisory boards of MicroTransponder, Dart Neuroscience, Neurolutions, Regenera, Abbvie, SanBio, and TRCare.

LINK UP FOR RELATED INFORMATION:

ISC Abstract LB23: Cramer SC, Dodakian L, Le V, et al, for the NIH StrokeNet Telerehab Investigators. Telerehabilitation in the home versus therapy in-clinic for patients with stroke.