Telerehabilitation for stroke patients: an overview of reviews

摘要

The increasing number of survivors following stroke events are enlightening new needs to guarantee appropriate care and quality of life support at home. A potential application of telemedicine is to exploit home care and rehabilitation. Within the framework of an EU FP7 project called Integrated Home Care (IHC) we performed an overview of reviews on the telefacilites for the homecare in stroke patients, in order to plan a clinical trial. A broad literature research was conducted in PUBMED, Web of Science and The Cochrane Library databases. We included and graded all the reviews matching the following criteria: published in English in peer-reviewed journals, targeting stroke as adult patients (age>18yr.) and considering a homecare setting in the intervention. 6 full-text reviews were included: 1 systematic review with meta-analysis and 5 non-systematic reviews. Despite the absence of adverse effects, no conclusions can be stated on the effectiveness of telerehabilitation compared to other home treatment, due to the insufficient data available, nevertheless strong indications emerged for the inclusion of "all cause mortality" and "hospital admission" as primary outcomes. Besides "QoL", "cost", "adherence" and "patient acceptability" should be included as secondary outcomes, for a complete evaluation of the tele-intervention. This indications should be considered as relevant in planning a telerehabilitation trial, in order to observe the expected effectiveness from a multidimensional point of view in the clinical, financial and social perspectives.