Telerehabilitation for motor function: a systematic review A Turolla 1 , L Piron 1 , T Gasparetto 2 , M Agostini 1 , HR Jorgensen 3 , P Tonin 1 , T Larsen 4 1. Laboratory of Kinematics and Robotics, I.R.C.C.S. Fondazione Ospedale San Camillo, Venice, Italy 2. Social and Health Programs, Regione Veneto, Venice, Italy 3. Sygheus Vendsyssel Brønderslev Neurorehabiliteringscenter. Brønderslev, Denmark 4. Southern Denmark University, Centre for Applied Health Services Research and Technology Assessment (CAST). Odense, Denmark
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Telerehabilitation for motor function: a systematic review A Turolla 1, L Piron 1, T Gasparetto 2, M Agostini 1, HR Jorgensen 3, P Tonin 1, T Larsen 4.
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Telerehabilitation for motor function:a systematic review
A Turolla1, L Piron1, T Gasparetto2, M Agostini1, HR Jorgensen3, P Tonin1, T Larsen4
1. Laboratory of Kinematics and Robotics, I.R.C.C.S. Fondazione Ospedale San Camillo, Venice, Italy2. Social and Health Programs, Regione Veneto, Venice, Italy3. Sygheus Vendsyssel Brønderslev Neurorehabiliteringscenter. Brønderslev, Denmark4. Southern Denmark University, Centre for Applied Health Services Research and Technology Assessment
“…care given using telecommunications technologies, in which at least two communication media are used interactively (e.g. video consultation between hospital consultant and general practitioner).”
Implications for research in 2000
• Re-consider the focus and scope of telemedicine
• RCTs of telemedicine applications are feasible and should be carried out.
• Taking account of changes in distribution and use of telematics in society generally, not just in the health care context.
• Consider changing patterns of health care needs with emphasis on care for:– people with chronic conditions– the elderly– disease prevention– health promotion
•TFU patients show clinically-equivalent results compared to control groups, due to the low methodological quality of the studies
ConclusionsIn stroke patients, should be preferred an on-line interactive device (allowing
also videoconference) than a store and forward device to provide telerehabilitation.
Hard primary outcomes like:• overall mortality• hospital admissionshould also be included to prove efficacy.
Secondary outcomes like:• QoL,• costs,• adherence to treatment• patient acceptabilityshould be taken into consideration to perform a complete analysis of
telerehabilitation.
How much broad or narrow should be a
systematic review on telerehabilitation?
Research methods
• PubMed = 964 records
• EMBASE = 328 records
• The Cochrane Library – CENTRAL=113 records
Inclusion criteria
InterventionTele-based therapy programs defined as:1. provided by means of any kind of technological
device which should allow a healthcare professionals/patient on-line interaction;
2. provided by healthcare professionals or individuals under the supervision of healthcare professionals;
3. including at least one or more than one specific intervention targeted to motor function.
Inclusion criteria
Type of studies• RCTs• qRCTs• CCT• First phase of cross over trial
Inclusion criteria
Comparison
• Tele-based therapy programs vs. placebo or no intervention
• Tele-based therapy prograse vs usual care
• Tele-based therapy programs vs in-presence care
Outcome
• Motor function
Quality assessment
Items:1. generation of randomization sequence;2. allocation concealment;3. baseline comparison between groups;4. blinding of outcome assessors;5. intention-to-treat analysis;6. type of study.
Flowchart of the publications’ selection process
Potentially relevant studies identified and screened for retrieval (n=1405)