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Telerehabilitation for motor function: a systematic review

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 Laboratory of Kinematics and Robotics, I.R.C.C.S. Fondazione Ospedale San Camillo, Venice, Italy

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Telerehabilitation for motor function: a systematic review

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  1. Telerehabilitation for motor function:a systematic review A Turolla1, L Piron1, T Gasparetto2, M Agostini1, HR Jorgensen3, P Tonin1, T Larsen4 Laboratory of Kinematics and Robotics, I.R.C.C.S. Fondazione Ospedale San Camillo, Venice, Italy Social and Health Programs, Regione Veneto, Venice, Italy Sygheus Vendsyssel Brønderslev Neurorehabiliteringscenter. Brønderslev, Denmark Southern Denmark University, Centre for Applied Health Services Research and Technology Assessment (CAST). Odense, Denmark

  2. Background definition TELEMEDICINE / TELECARE / TELEREHABILITATION “…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).”

  3. 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 • Patient-centred approaches. • Studies of: • Effectiveness • Efficiency • Appropriateness • Formal economic appraisal

  4. Framework • FP7 - EU HEALTH: INTEGRATED HOME CARE(grant n. 222954) • Research for better ways to ensure continuity in clinical care for patients with chronic conditions: • Stroke • Heart failure • COPD • WP 5 - Telerehabilitation www.integratedhomecare.eu

  5. Broad reviews’ search strategies

  6. Flow chart of the selected reviews

  7. Intervention Telemonitoring (HF, COPD) • Telephone follow-up (TFU) • Interactive Health Communication Applications (IHCA) • Automated telemonitoring of vital signs and symptoms • Automated physiologic monitoring • Automated computer-based telephone messaging • Monitoring of patients carrying implanted electrical devices Telerehabilitation (STROKE) • Telephone follow-up (TFU) • Remote control and interaction with devices based on position/sensing technologies • Remote control and interaction with virtual reality based devices

  8. Evidences(4 metanalysis)

  9. Conclusions In 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 admission should also be included to prove efficacy. Secondary outcomes like: • QoL, • costs, • adherence to treatment • patient acceptability should be taken into consideration to perform a complete analysis of telerehabilitation.

  10. How much broad or narrow should be a systematic review on telerehabilitation?

  11. Research methods • PubMed = 964 records • EMBASE = 328 records • The Cochrane Library – CENTRAL=113 records

  12. Inclusion criteria Intervention Tele-based therapy programs defined as: • provided by means of any kind of technological device which should allow a healthcare professionals/patient on-line interaction; • provided by healthcare professionals or individuals under the supervision of healthcare professionals; • including at least one or more than one specific intervention targeted to motor function.

  13. Inclusion criteria Type of studies • RCTs • qRCTs • CCT • First phase of cross over trial

  14. 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

  15. Quality assessment Items: • generation of randomization sequence; • allocation concealment; • baseline comparison between groups; • blinding of outcome assessors; • intention-to-treat analysis; • type of study.

  16. Potentially relevant studies identified and screened for retrieval (n=1405) Duplicates (n=199) Studies retrieved (n=1207) Not meeting inclusion criteria (n=1197) Studies included in the metanalysis (n=9) Flowchart of the publications’ selection process

  17. Quality assessment

  18. Treated populations

  19. Treated patients

  20. Telerehabilitation vs usual careOutcome: Motor function

  21. Telerehabilitation vs usual careOutcome: Motor function

  22. Conclusions • Little but no significant benefit of telerehabilitation compared to usual care (0.1 SD) • If measured, others advantages could sustain the use of telerehabilitation: • Costs • Accessibility • Acceptability • A low number of authors have published in the field  No random distribution of bias in different studies • Trial sequence analysis  STOP randomization?

  23. “You can discover more about a person in a hour of play, than in a life of conversation” Plato

  24. Thanks for your attention! andrea.turolla@ospedalesancamillo.net San Marco square looking southeast (1735-40)Gian Antonio Canal called “Canaletto”

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