Evidence reviews for the clinical and cost-effectiveness of telerehabilitation for adults after a stroke

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Evidence reviews for the clinical and cost-effectiveness of telerehabilitation for adults after a stroke

Stroke rehabilitation in adults (update)

Evidence review G

NICE Guideline, No. 236

London: National Institute for Health and Care Excellence (NICE); 2023 Oct.

ISBN-13: 978-1-4731-5456-8

1. Telerehabilitation

1.1. Review question

In people after stroke, what is the clinical and cost effectiveness of telerehabilitation compared with standard rehabilitation and as an adjunct to standard rehabilitation?

1.1.1. Introduction

Telerehabilitation is the delivery of rehabilitation at a distance using electronic communication rather than ‘in person’. Often helpful in more rural areas its use has increased by necessity during the covid pandemic and has enabled people to continue to receive rehabilitation. Telerehabilitation is delivered with an individual or a group and the types of technology used are varied.

1.1.2. Summary of the protocol

For full details see the review protocol in Appendix A.

Table 1

PICO characteristics of review question.

1.1.3. Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in Appendix A and the methods document.

Declarations of interest were recorded according to NICE’s conflicts of interest policy.

1.1.4. Effectiveness evidence

1.1.4.1. Included studies

One Cochrane review²⁰ and thirty-two randomised control trial studies were included in the review^{1–13, 15, 16, 18, 19, 21–25, 28, 30–36, 38, 39}, these are summarised in section 1.1.5. Evidence from these studies is summarised in the clinical evidence summary in section 1.1.6. This incorporated the results from one Cochrane review²⁰. There were differences in the protocol which meant that some studies included in the Cochrane review were not included in this review. These are highlighted in the excluded studies table in Appendix J.

Telerehabilitation is an alternate way of delivering rehabilitation services. It incorporates a range of different techniques involving information and communication technologies that can facilitate communication between the healthcare professional and the patient in a remote location.

A recent Cochrane review by Laver 2020²⁰ provided the basis for the above definition. The committee acknowledged when designing the protocol that this definition could include various interventions delivered by different members of the multidisciplinary team. Due to the lack of evidence available, the committee decided that these interventions should be combined together in the meta-analyses. However, they reflected on the effectiveness of individual interventions where possible when considering the evidence and making recommendations.

The following interventions were compared:

Telerehabilitation compared to:
- In-person rehabilitation: 10 studies^{1, 7, 8, 10, 22, 24, 25, 30, 31, 36}
- Usual care: 9 studies^{4, 5, 9, 11, 28, 32, 33, 35, 38}
Combined telerehabilitation compared to:
- In-person rehabilitation: 5 studies^{12, 19, 21, 23, 39}
- Usual care: 8 studies^{2, 3, 6, 13, 15, 16, 18, 34}

Comparator interventions differed between the studies. However, in person rehabilitation generally involved face to face therapy that was time matched to the telerehabilitation therapy. Usual care interventions varied and could involve minimal contact with health care professionals (for example: the patient booking their own GP appointments as needed or information and advice only). Alternatively, usual care could involve face to face therapy that was not time matched to the intervention group. Combined telerehabilitation involved telerehabilitation delivered alongside any form of in person therapy.

Evidence was available for all outcomes apart from carer generic health-related quality of life and swallow function and ability.

Intervention factors

Interventions were included if they involved the delivery of post stroke rehabilitation services via information and communication technologies and enabled a two-way communication channel between the therapist and the patient.

These services could involve intervention, supervision, education, consultation, and counselling. Interventions that provided assessment only or consultation services were excluded as these did not provide a rehabilitation intervention and fell outside of the scope of the review question. This was a difference to the Laver 2020 Cochrane review.

Interactive and communication technologies included the telephone, video conferencing, the internet and online apps or messaging services, virtual reality, and monitoring via sensors or wearable devices. There were a mixture of information and communication technologies used however, the majority were delivered via teleconferencing with real time communication. Interventions were provided by one or more health disciplines, including physiotherapists, occupational therapists, speech and language therapists, cognitive therapists, psychologists, nurses and the multidisciplinary team.

The majority of studies included physiotherapy or occupational therapy interventions and were focused on rehabilitation for the upper limb (9 studies)^{1, 4, 10, 13, 16, 30, 31, 34, 36}, balance (4 studies)^{6, 21, 22 4911, 23}, core stability (2 studies)^{32, 33} and functional independence or mobility (4 studies)^{2, 9, 11, 15}. There were two studies which involved physiotherapy plus electromyography triggered neuromuscular stimulation, with the aim of improving limb function, mobility, and balance^{7, 8}. Four studies focused on speech and language therapy interventions^{12, 24 4931, 25, 28} and one study reported a speech and language therapy intervention combined with cognitive therapy³⁹. Two studies focused on well-being and mood^{19, 35} and three studies reported a mixed focus intervention involving a multi-disciplinary team^{3,Wu 2020 #4938,Jonsdottir, 2021 #4875}.

Population factors

The majority of participants in the included studies were living in the community and were mixed between subacute and chronic populations. One study²¹ included an inpatient population but the intervention was set up to mimic telerehabilitation, with the telerehabilitation delivered in a separate room and no contact with the therapist. The severity of stroke reported on the NIHSS was not reported in the majority of studies (four studies reported a moderate severity population and one a mild population).

Inconsistency

The majority of outcomes included only one study. In the limited cases where meta analysis was possible, a significant number of analyses indicated statistical heterogeneity. This could not be resolved by subgroup or sensitivity analysis, with most outcomes containing an insufficient number of studies to allow valid conclusions on the analyses to be drawn. Therefore, these outcomes were downgraded for inconsistency.

See also the study selection flow chart in Appendix C, study evidence tables in Appendix D, forest plots in Appendix E and GRADE tables in Appendix F.

1.1.4.2. Excluded studies

See the excluded studies list in Appendix J.

1.1.5. Summary of studies included in the effectiveness evidence

Table 2

Summary of studies included in the evidence review that report telerehabilitation alone used as the intervention.

Table 3

Summary of studies included in the evidence review that report a combination of telerehabilitation and in person rehabilitation used as the intervention.

See Appendix D for full evidence tables.

1.1.6. Summary of the effectiveness evidence

1.1.6.1. Telerehabilitation compared to in person rehabilitation and usual care

Table 4

Clinical evidence summary: telerehabilitation compared to in person rehabilitation only.

Table 5

Clinical evidence summary: telerehabilitation compared to usual care.

1.1.6.2. Combination of telerehabilitation and in person rehabilitation compared to in person rehabilitation and usual care

Table 6

Clinical evidence summary: combination of telerehabilitation and in person rehabilitation compared to in person rehabilitation.

Table 7

Clinical evidence summary: combination of telerehabilitation and in person rehabilitation compared to usual care.

See Appendix F for full GRADE tables

1.1.7. Economic evidence

1.1.7.1. Included studies

Two health economic studies with relevant comparisons were included in this review.^{23, 37} The first study²³ compared a virtual reality (VR)-based balance recovery telerehabilitation programme at-home versus in-clinic, with both groups receiving standard rehabilitation. The second study³⁷ compared a home-based written exercise programme plus a VR-based home exercise programme to the written exercise programme alone. These are summarised in the health economic evidence profile below (Table 8) and the health economic evidence tables in Appendix H.

1.1.7.2. Excluded studies

No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.

See also the health economic study selection flow chart in Appendix C.

1.1.8. Summary of included economic evidence

Table 8

Health economic evidence profile: Telerehabilitation versus usual care.

1.1.9. Economic model

This area was not prioritised for new cost-effectiveness analysis.

1.1.10. Unit costs

Studies included in the clinical review reported varied resource use (see Table 2 and Table 3 for details) due to the following factors listed below:

Equipment required: several studies used videoconferencing via platforms such as Zoom to allow therapists to supervise therapy, which may be cost saving as staff time could be used more efficiently between appointments and would not require the use of a therapy room. One study (Grau-Pellicer 2020¹⁵) also assessed a free application (mHealthapp) that stores and records patient performance for staff to monitor progress off-line, which could further improve staff time efficiency.
More costly interventions were also reported, including VR programs (Allegue 2022¹), in-home messaging devices (Chumbler 2012⁹) or interactive games that required touch screens or tablets (Maresca 2019²⁴). A significant resource impact would be incurred for the NHS in cases where patients do not currently possess the necessary technology to facilitate telerehabilitation (for example computer equipment or internet access). One of the economic analyses included in the review³⁷ accounted for this and estimated that providing computer and internet access increased the cost of a 4-week VR balance program (Jintronix) by approximately £237 (£400 versus £163 per participant).
Additional resource use required also depended on the use of staff training, educational or instructional videos, telephone calls and text messages between staff and patients and monthly program subscription fees.
The frequency and duration of therapy delivered also varied, as sessions ranged from 20–60 minutes, occurring 2–5 days per week, with interventions lasting between 3 weeks to 3 months. Staff time also varied depending on whether patients required hardware assistance from a technician.
Additional resource use would be incurred from studies reporting an initial therapy appointment aimed at designing the telerehabilitation program according to patient need. Home visits to patients also incurs additional resource use from travel time and therapy set-up for rehabilitation staff.

Relevant unit costs are provided below to aid consideration of cost effectiveness.

Table 9

Unit costs of healthcare professionals who may be involved in delivering Telerehabilitation.

1.1.11. Evidence statements

1.1.11.1.: Effectiveness/Qualitative

1.1.11.2. Economic

One cost-effectiveness analysis found that a VR-based balance recovery telerehabilitation programme incurred lower costs (£457 less per participant) compared to the same program conducted in a clinical setting for adults who had experienced a stroke more than six months prior. No significant differences were found between the groups in any balance scale or in the feedback questionnaires. This study was assessed as partially applicable with potentially seriously limitations.
One comparative cost analysis found that for post-stroke adults with an upper limb impairment, home-based telerehabilitation platform (Jintronix system) using VR plus the written exercise programme in incurred higher costs (£400 per participant) compared to a control group receiving the written exercise programme alone. The additional cost was reduced (£163 more per participant) for a scenario that assumed participants were in current possession of the necessary computer equipment and internet access. This study was assessed as partially applicable with potentially seriously limitations.

1.1.12. The committee’s discussion and interpretation of the evidence

1.1.12.1. The outcomes that matter most

The committee included the following outcomes: person/participant generic health-related quality of life, carer generic health-related quality of life, activities of daily living, mobility, balance, psychological distress - depression, physical function - upper limb, stroke specific measures of cognition, swallow function and ability, functional communication, stroke-specific Patient-Reported Outcome Measures and withdrawal due to adverse events. All outcomes were considered equally important for decision making and therefore have all been rated as critical.

This review updated a published Cochrane review by Laver 2020. Therefore, the outcomes used in this review are the same as those reported in the Cochrane review with the inclusion of 4 additional outcomes measures which were agreed by the guideline committee: carer generic health-related quality of life, swallow function and ability, stroke-specific Patient-Reported Outcome Measures and withdrawal due to adverse events.

Person/participant health-related quality of life was considered particularly important as a holistic measure of the impact on the person’s quality of living. Withdrawal due to adverse events was important to understand if any negative consequences can be attributed to the intervention and lack of physical supervision (for example: falls) and the committee acknowledged that these may differ depending on the type of intervention and the focus of care. Mortality was not considered as it was deemed unlikely to be a direct result of the treatment and would be included in withdrawal due to adverse events. If mortality was reported as an adverse event, then this was highlighted to the committee during their deliberation.

The committee chose to investigate these outcomes at less than 6 months and greater than and equal to 6 months, as they considered that there could be a difference in the short term and long-term effects of the interventions.

The evidence for this question was limited, and in many cases only comprised of one study per outcome. Some outcomes were not reported in every comparison. No study investigated the effects of telerehabilitation on carer generic health-related quality of life or swallow function and ability. The majority of outcomes were reported at less than 6 months and the most widely reported outcomes were activities of daily living, mobility, balance and physical function – upper limb.

1.1.12.2. The quality of the evidence

Thirty-one randomised control trial studies were included in the review. Outcomes ranged from high to very low quality, with the majority being of low and very low quality. This was mainly due to risk of bias and imprecision.

Risk of bias was mainly due to bias arising from the randomisation process, bias due to deviations from the intended intervention and bias due to missing outcome data. However, all reasons for downgrading outcomes for risk of bias were present at least once during the analysis.

A large number of outcomes were downgraded due to imprecision and uncertainty around the effect estimate. This was likely due to the included studies comprising of small populations (study sample sizes ranged from 9 to 536 participants), and that there were limited studies to meta-analyse to improve the precision in the outcome.

Where meta-analysis was conducted, three outcomes were downgraded for inconsistency due to heterogeneity. Sensitivity and subgroup analyses generally did not resolve the heterogeneity due to there being an insufficient number of studies included in the results to allow for valid subgroups to be formed.

The committee noted that studies took place in a wide range of countries worldwide and no studies were based in the UK, which may limit applicability to the NHS. These factors introduced additional uncertainty in the results. The committee took all of these factors into account when interpreting the evidence.

1.1.12.3. Benefits and harms

Telerehabilitation compared to in person rehabilitation and usual care

Telerehabilitation was compared to in person rehabilitation and usual care. The results showed that, when compared to in person rehabilitation, there were clinically important benefits of telerehabilitation for person/participant health-related quality of life at greater than and equal to 6 months and activities of daily living at less than 6 months. Clinically important harms were identified in psychological distress - depression, stroke specific measures of cognition, 2 stroke-specific Patient-Reported Outcome Measures and withdrawal due to adverse events. There were no clinically important differences seen for activities of daily living at greater than and equal to 6 months, along with balance and physical function – upper limb at both follow up time points. One stroke-specific Patient-Reported Outcome Measure also reported no difference at less than 6 months.

When telerehabilitation was compared to usual care, there were clinically important benefits of telerehabilitation for activities of daily living, physical function – upper limb and stroke specific patient reported outcomes at less than 6 months. A clinically important harm was reported for withdrawal due to adverse events at less than 6 months and no clinically important differences were seen for activities of daily living at greater than and equal to 6 months, mobility, balance, psychological distress – depression, and physical function – upper limb at greater than and equal to 6 months.

The committee discussed the benefit reported for person/participant generic health-related quality of life at greater than and equal to 6 months as this was highlighted as an important outcome. They noted that this benefit came from one small study looking at an app-based speech and language therapy intervention for aphasia. While this was a clinically important benefit for person/participant generic health-related quality of life they also acknowledged that the same study reported a harm for physiological distress - depression at greater than and equal to 6 months. This led them to conclude that, while telerehabilitation interventions may improve some aspects of quality of life, they could also have a negative impact on others and further research may be required to investigate this. The committee suggested that mood should be monitored closely when delivering interventions remotely. Due to the study population, they noted that this may be particularly important for people with speech and language difficulties, who may be impacted by the lack of face-to-face interaction or support.

The committee considered the clinically important harm for withdrawal due to adverse events that was present in both comparisons. This outcome was reported by 1 study when compared to in-person rehabilitation and 2 studies when compared to usual care. Both outcomes were rated very low quality and had small sample sizes. The committee acknowledged the reasons for withdrawal, which were either due to unrelated medical complications or mortality. 3 people died in the telerehabilitation group compared to 1 in the usual care group. Ultimately the committee, agreed that there was insufficient evidence to draw any conclusions from these results and these events were unlikely to be attributable to the intervention. Therefore, they did not give this significant weight in their decision making.

The committee discussed the clinically important harms present for stroke specific measures of cognition. These were reported in one small study examining a combined speech and language therapy and cognitive rehabilitation intervention. However, the committee were wary of drawing any conclusions from these findings due to the small sample size of only 11 participants and outcomes of very low quality. There was a similar consensus for the harm reported in the stroke-specific Patient-Reported Outcome Measures, measured on the stroke impact scale. The committed noted this data came from 1 study of 9 participants, that took place during the COVID-19 pandemic and involved several protocol breaches which likely influenced the results. The committee took this into account when considering these findings.

The committee considered the large number of outcomes that reported no clinically important differences across both comparisons. In the context of this review, they agreed that these outcomes should be considered as positive results. They noted this was particularly evident when compared to in person rehabilitation (which was time matched to the telerehabilitation group) as they indicate no difference between telerehabilitation and in-person rehabilitation. This conclusion was echoed by several lay members, who had received telerehabilitation since the COVID-19 pandemic and reported that the interventions worked equally effectively. However, they highlighted that they needed greater self-motivation to stay engaged with the therapy and they missed the in person interaction. They noted that the outcomes where harms were noted came from small studies where there was very low quality evidence and so, when balanced against the evidence of equivalent or clinically important benefits in outcomes, telerehabilitation appeared to be a clinically effective method for supporting people after stroke.

Combined telerehabilitation compared to in person rehabilitation and usual care

Combination telerehabilitation was compared to in-person rehabilitation and usual care. The results showed that, when compared to in-person rehabilitation, there was a clinically important benefit of combined telerehabilitation for person/participant health-related quality of life at less than 6 months. No clinically important difference was reported in activities of daily living, balance, psychological distress - depression, 2 stroke specific measures of cognition, and functional communication at less than 6 months. A clinically important harm was reported for mobility at less than 6 months.

When combination telerehabilitation was compared to usual care there were benefits reported for 2 of the person/participant generic health-related quality of life outcomes at less than 6 months and physical function – upper limb at more than and equal to 6 months. No clinically important differences were reported for activities of daily living, mobility, balance, physical function - upper limb, stroke specific measures of cognition, functional communication, stroke specific patient-reported reported outcomes and withdrawal due to adverse events at less than and more than and equal to 6 months. A clinically important harm was reported for person/participant generic health-related quality of life at more than and equal to 6 months and psychological distress – depression at less than and more than and equal to 6 months.

The committee considered the evidence across both comparisons and noted the improvements in person/participant generic health-related quality of life at less than 6 months in both, which were based on 3 physiotherapy/occupational therapy-based interventions. The committee considered this to be a positive finding in favour of telerehabilitation, but they recognised the small sizes and potential bias due to selective reporting (one study was unclear in their reporting of EQ-5D) when making their decisions. The committee judged these benefits against the borderline harm for person/participant health-related quality of life reported by one study at 12 months. They noted that this was a long follow up time point for a 6 month intervention and agreed that any changes to person/participant generic health-related quality of life at that time may not be attributable to the intervention (particularly as same outcome at the 6 month follow up time point reported the opposite effect). One lay member suggested that a big benefit of telerehabilitation is not having to leave the home for therapy sessions, particularly in the sub-acute post stroke period. Getting to appointments, particularly when relying on public transport, can be unsettling and stressful during this time and could explain the benefit in person/participant health-related quality of life with telerehabilitation at the less than 6 months follow up. Additionally, rehabilitation delivered in the home environment can be tailored to personal goals or functional tasks and allows family members or careers to join in which may improve overall quality of life.

The committee once again highlighted the clinically important harm present for psychological distress depression, reported by one study at both follow up time points. They considered that this study was a family-based telephone intervention focused on psychoeducation, family functioning and functional independence and compared to standard medical follow up. The committee were therefore surprised by the negative finding but noted that baseline values for depression were very low and fell within the non-depressed range, which may explain the lack of efficacy for this outcome. However, the committee still agreed that psychological distress and the wellbeing of the stroke survivor should be closely monitored throughout the delivery of telerehabilitation interventions. This was reiterated by one committee member who highlighted that increases in stress and depression were notable during the COVID-19 pandemic when a number of services switched from face to face to fully remote delivery.

The committee concluded that overall, the results were positive and appeared to display a benefit or equal effect of telerehabilitation and combined telerehabilitation when compared to in person rehabilitation or usual care. While several harms were present the committee agreed that generally these were based on small studies with high risk of bias and therefore their applicability was limited.

Several committee members agreed that these findings are generally in line with what they see in current practice. They suggest that a number of services are already being delivered via the telephone or teleconferencing since the COVID-19 pandemic and are having comparable effects to usual care.

The committee agreed that there did not appear to be any additional benefit of combination telerehabilitation over telerehabilitation delivered alone, although direct comparison of the 2 types of telerehabilitation was beyond the scope of this review. The committee therefore decided to make one recommendation for both types of telerehabilitation and agreed that it could be delivered independently or in conjunction with face to face rehabilitation depending on clinical justification.

1.1.12.4. Cost effectiveness and resource use

Two economic evaluations with relevant comparisons were included in this review, both of which assessed virtual reality (VR) programs. The first study was a cost-effectiveness analysis that compared a VR-based balance recovery telerehabilitation program at-home versus in-clinic, with both groups receiving standard rehabilitation. The results found that the clinic-based virtual reality program incurred higher costs (£457 more per patient) compared to home-based virtual reality telerehabilitation, with no significant differences were found between the groups in any balance scale or in the feedback questionnaires. The study was assessed as partially applicable as QALYs (and cost per QALY gained) were not presented, as well as the analysis having the perspective of the 2014 Spanish healthcare system, which may not reflect the current UK NHS context. Potentially serious limitations were identified, as the study was a within-trial analysis based on a single RCT and so only reflects this study and not the wider evidence base identified in the clinical review. The 12-week time horizon may also not sufficiently assess the full costs and benefits, and references for unit costs (including cost year) were not reported which limits interpretation of results for UK context. Finally, no sensitivity analyses were performed on parameters of uncertainty.

The second study was a comparative cost analysis based on a single-blind pilot RCT, that compared a control group who received a written exercise program to home-based telerehabilitation platform (Jintronix system) using VR plus the written exercise program. The results found that the total costs were higher for the home-based telerehabilitation VR program (£400 more per patient) compared to the control group. This incremental cost fell (£163 more per patient) when a scenario was applied that assumed participants already were in possession of the necessary computer equipment and internet access at home, but not the Kinetic camera to record their exercise program.

An additional hypothetical scenario was considered, where the total costs from the pilot 4-week program were extrapolated to one year in order to estimate the cost of a fully operational permanent program. Considering there were 4 complete sets of equipment available, and that each set of equipment could be used by 10 patients per year, allowing one week for the equipment to be switched between patients, it was assumed that the fully operational programme would be used by 40 patients per year. The results for this scenario estimated the incremental cost of a permanent 1-month program used to be £264 per person (or £135 if participants do not require computer equipment and internet access). This study was considered to be partially applicable as no health outcomes were reported (including no QALYs or cost per QALY gained) and the 2015 Canadian societal perspective may not reflect a UK NHS context. Potentially serious limitations included how this was a within-trial analysis based on a single-blind RCT not included in the clinical review and so the results only reflected this study. The 4-week follow-up may not sufficiently assess the full costs and references for unit costs were not reported which limits interpretation of results for UK context. No probabilistic sensitivity analyses were performed either.

In addition to published economic studies, relevant unit costs were presented to the committee to aid consideration of cost effectiveness of telerehabilitation. In the clinical review, combination telerehabilitation interventions required additional resource use compared to usual care alone, related to staff time and equipment, while interventions consisting of telerehabilitation alone could potentially incur less resource use if compared to usual care provided in both inpatient and outpatient rehabilitation settings.

Studies included in the clinical review reported varied resource use, which was largely attributable to equipment requirements, as several studies used videoconferencing via platforms such as Zoom to allow therapists to supervise therapy, which may be cost saving as staff time could be used more efficiently between appointments and would not require the use of a therapy room. One study also assessed a free application that stores and records patient performance for staff to monitor progress off-line, which could further improve staff time efficiency. More costly interventions were also reported, including VR programs, in-home messaging devices or interactive games that required touch screens or tablets. The frequency and duration of therapy delivered also varied, with sessions ranging from 20–60 minutes, occurring 2–5 days per week for between 3 weeks and 3 months. Staff time requirements were also dependent on whether an initial therapy appointment was needed to design the program according to patient need or if patients required hardware assistance from a technician. Studies also mentioned resource use such as staff training, educational or instructional videos, telephone calls and text messages between staff and patients and monthly program subscription fees as part of the intervention, with interventions including home visits to patients incurring additional costs from travel time and therapy set-up for rehabilitation staff.

Committee members’ personal experience was that the use of telerehabilitation services varies across current practice and in some rural areas telerehabilitation is the main option for people to access rehabilitation and that platforms such as Zoom are frequently used for check-ups. Following the results of the clinical review, the committee acknowledged that the evidence was limited and that none of the studies were based in the UK, however clinically important benefits were seen for telerehabilitation both when compared to usual care and when combined with usual care and compared to in-person rehabilitation and usual care for activities of daily living, physical function – upper limb.

The committee felt that the economic evidence was limited as it focused on VR programs when videoconferencing interventions are more commonly used in current practice and are also considered to incur cost-savings from increasing staff-time efficiency and reducing the demand for therapy rooms. In addition, a significant resource impact would be incurred for the NHS in cases where patients do not currently possess the necessary technology to facilitate telerehabilitation.

Concerns were raised towards what proportion of the population would be eligible for telerehabilitation as some people may lack confidence in engaging with technology while those with more severe cases of stroke may have difficulty in concentrating over a screen for extended periods of time. One benefit of telerehabilitation noted however was that it can serve individuals who have logistical difficulties with attending in-person rehabilitation (for example they live in a rural area or require carer assistance) or find it daunting to use public transportation. Providing telerehabilitation could therefore result in better quality of life for those who have no alternative access to rehabilitation services. This also has the potential to lower resource use in instances where the NHS is funding transportation to access rehabilitation.

Considering the limited economic and clinical evidence, the committee made a ‘consider’ recommendation for telerehabilitation services as an alternative or adjunct to face-to-face therapy if this aligns with patient goals and in agreement between the patient and therapist/clinician.

1.1.12.5. Other factors the committee took into account

The committee were unable to make recommendations for individual therapy types as the results were pooled together in the analyses. They noted that physiotherapy interventions and occupational therapy interventions in particular appeared to be effective, but less evidence was available for the other therapy types. The committee therefore considered all forms of therapy could be considered for telerehabilitation as long as individual needs, preferences, and impairments are taken into account.

The committee highlighted a number of barriers to telerehabilitation that should be considered during the assessment of suitability for these programmes. One issue was surrounding ‘digital poverty’ whereby, people are unable to engage in online rehabilitation either due to lack of knowledge, availability of the technology or location (living in remote locations where signal is an issue). The committee also highlighted that specific populations may face increased challenges in using information technologies, for example, people with cognitive, visual or other impairments.

The committee discussed issues surrounding implementation of telerehabilitation and specifically queried if formal training would be required for all clinicians. Several committee members suggested that telerehabilitation is already current practice for a number of services and formal training was not required. However, others suggested that some form of competency based training should be carried out. In the absence of any evidence on this point, and uncertainty about the availability of recognised training, the committee were unable to come to an agreement on whether specialist training for telerehabilitation interventions would be needed. This may depend on the therapy or type of intervention delivered, along with the information technology being used.

The impact of telerehabilitation on carers was not captured in the clinical evidence. Although, several studies examined stroke survivor and carer dyads, these studies did not report any carer generic health-related quality of life measures - which was the only carer specific outcome measure included in the protocol. The committee agreed that it was important to highlight the impact that these interventions could have on carers. For example, telerehabilitation could lead to increased carer burden due to them needing to physically assist with the rehabilitation or be responsible for the setting up of any equipment. However, on the contrary, one lay member noted that it may ease the pressure on carers if they do not need to travel to face to face appointments. Therefore, carers needs and preferences should also be taken into account when prescribing telerehabilitation interventions.

Several lay members highlighted the importance of having an open communication channel between the therapist and stroke survivor during telerehabilitation to limit social isolation and to maintain motivation and engagement with therapy. They specified that telerehabilitation interventions must involve a two-way communication channel whereby the stroke survivor can feedback to the clinician (as specified in the inclusion criteria for clinical evidence). This could be through the use of video conferencing, the telephone or other form of information technology device depending on the needs and preferences of the person.

1.1.13. Recommendations supported by this evidence review

This evidence review supports recommendations 1.3.1 to 1.3.3 and the recommendation for research on the impact of telerehabilitation on cognition and mood in Appendix K.

1.1.14. References

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Appendices

Appendix A. Review protocols

A.1. Review protocol for the clinical and cost effectiveness of telerehabilitation

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A.2. Health economic review protocol

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Appendix B. Literature search strategies

B.1. Clinical search literature search strategy

Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies as these concepts may not be indexed or described in the title or abstract and are therefore difficult to retrieve. Search filters were applied to the search where appropriate.

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B.2. Health Economics literature search strategy

Health economic evidence was identified by conducting searches using terms for a broad Stroke Rehabilitation population. The following databases were searched: NHS Economic Evaluation Database (NHS EED - this ceased to be updated after 31^st March 2015), Health

Technology Assessment database (HTA - this ceased to be updated from 31^st March 2018) and The International Network of Agencies for Health Technology Assessment (INAHTA). Searches for recent evidence were run on Medline and Embase from 2014 onwards for health economics, and all years for quality-of-life studies. Additional searches were run in CINAHL and PsycInfo looking for health economic evidence.

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Appendix I. Health economic model

This area was not prioritised for new cost-effectiveness analysis.

Appendix J. Excluded studies

J.1. Clinical studies

Table 16Studies excluded from the clinical review

Study	Code [Reason]
(2010) Remote supervision of stroke therapy is safe and effective at smaller hospitals. AHRQ Research Activities: 10–11	- Conference abstract
(2012) Effectiveness of video-based therapy for stroke patients. Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation): 50–50	- Conference abstract
ACTRN12616001056482 (2016) Efficacy of computer versus group memory training for memory rehabilitation post-stroke. http://www.anzctr.org.au/ACTRN12616001056482.aspx	- Full text paper not available
Adie Katja and James Martin A (2010) Does telephone follow-up improve blood pressure after minor stroke or TIA?. Age and ageing 39(5): 598–603 [PubMed: 20667838]	- Population not relevant to this review protocol >20% had a transient ischaemic attack
Agostini M., Garzon M., Benavides-Varela S. et al (2014) Telerehabilitation in poststroke anomia. BioMed Research International 2014: 706909 [PMC free article: PMC4009336] [PubMed: 24829914]	- Data not reported in an extractable format or a format that can be analysed No useable results as data presented as percentages
Aguirre Luis G, Urrunaga-Pastor Diego, Lazo-Porras Maria et al (2018) Post-stroke rehabilitation devices offered via the Internet: Based on randomized controlled evidence?. Annals of physical and rehabilitation medicine 61(1): 54–55 [PubMed: 29051116]	- Study design not relevant to this review protocol
AHC, MEDIA (2021) Employing Technology and Exergames to Improve Balance Post-Stroke. Integrative Medicine Alert 24(4): 1–3	- Study design not relevant to this review protocol Grey literature
Aimola Lina, Lane Alison R, Smith Daniel T et al (2014) Efficacy and feasibility of home-based training for individuals with homonymous visual field defects. Neurorehabilitation and neural repair 28(3): 207–18 [PubMed: 24048623]	- Comparator in study does not match that specified in this review protocol Comparison between reading therapy and usual care rather than telerehabilitation and usual care
Alhatou A. and Alhatou M. (2017) Onsite consultation by neurologist vs. tele-neurology, referring physician satisfaction. Neurology 88(16supplement1)	- Conference abstract
Amerschalk Bart M.; Vargas Jason E.; Channer Dwight D. (2011) Reaching out: smartphone teleradiology application can be incorporated into a telestroke environment. RT Image 24(5): 24–22	- Full text paper not available
Appleby Emma, Gill Sophie Taylor, Hayes Lucinda Kate et al (2019) Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review. PloS one 14(11): e0225150 [PMC free article: PMC6850545] [PubMed: 31714924]	- Systematic review used as source of primary studies
Aprile I., Gallotti M., Schirru M. et al (2022) Robotic telerehabilitation: a feasibility study in patients with stroke. Gait & Posture 97: npag–npag	- Conference abstract
Arri Eunate Arana, Ortiz-Fernández Leire, Orcajo Janire et al (2020) PP316 Efficacy And Usability Of eHealth Technologies In Stroke Survivors For Improvement Of Self-Management: Clinical Trial. International Journal of Technology Assessment in Health Care 36(s1): 28–28	- Conference abstract
Asano M, Tai BC, Chen C et al (2018) Home-based tele-rehabilitation presents comparable and positive impact on self-reported functional outcomes as center-based rehabilitation: singapore tele-technology aided rehabilitation in stroke (STARS) trial. Annals of physical and rehabilitation medicine [PubMed: 31462136]	- Conference abstract
Bagot KL, Cadilhac DA, Hand PJ et al (2016) Telemedicine expedites access to optimal acute stroke care. Lancet 388(10046): 757–8 [PubMed: 27560271]	- Conference abstract
Ballantyne Rachael and Rea Paul M (2019) A Game Changer: 'The Use of Digital Technologies in the Management of Upper Limb Rehabilitation'. Advances in experimental medicine and biology 1205: 117–147 [PubMed: 31894574]	- Not a peer-reviewed publication
BARRETT David (2015) Systematic review summary - Telerehabilitation Services for Stroke. Singapore Nursing Journal 42(2): 31–32	- Study design not relevant to this review protocol Summary report of a Cochrane review that is now out of date
Baykal D. and Tulek Z. (2022) The effect of discharge training on quality of life, self-efficacy and reintegration to normal living in stroke patients and their informal caregivers: A randomized controlled trial. Neurology Asia 27(1): 73–82	- Study does not contain an intervention relevant to this review protocol Education provided before discharge from hospital by a webpage or in a booklet form - one direction provision of information and therefore is unlikely to be telerehabilitation
Bellomo R.G., Paolucci T., Saggino A. et al (2020) The WeReha Project for an Innovative Home-Based Exercise Training in Chronic Stroke Patients: A Clinical Study. Journal of Central Nervous System Disease 12 [PMC free article: PMC7739083] [PubMed: 33402861]	- Study design not relevant to this review protocol
Bhatnagar K.; Bever C.T.; Conroy S. (2018) Correlating home-based upper extremity activity monitoring with clinical evaluations for chronic moderate to severe hemiparesis post-stroke. Annals of Neurology 84(supplement22): 55	- Conference abstract
Birns J.; Roots A.; Bhalla A. (2013) Role of telemedicine in the management of acute ischemic stroke. Clinical Practice 10(2): 189–200	- Systematic review used as source of primary studies
Bizzi E (2002) Telerehabilitation for motor retraining in stroke. CRISP (computer retrieval of information on scientific projects) database. http://crisp.cit.nih.gov/	- Full text paper not available
Bowman Thomas, Gervasoni Elisa, Arienti Chiara et al (2021) Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases. Sensors (Basel, Switzerland) 21(10) [PMC free article: PMC8156914] [PubMed: 34063355]	- Systematic review used as source of primary studies
Braley M., De Oliveira E., Munsell M. et al (2020) A Phase II Randomized, Virtual, Clinical Trial of Speech Therapy App for Speech, Language, and Cognitive Intervention in Stroke. Archives of Physical Medicine and Rehabilitation 101(11): e62	- Conference abstract
Braley Michelle, Pierce Jordyn Sims, Saxena Sadhvi et al (2021) A Virtual, Randomized, Control Trial of a Digital Therapeutic for Speech, Language, and Cognitive Intervention in Post-stroke Persons With Aphasia. Frontiers in neurology 12: 626780 [PMC free article: PMC7907641] [PubMed: 33643204]	- Comparator in study does not match that specified in this review protocol Both groups complete videoconferencing follow up with a therapist (while each group receive different forms of delivery of the intervention)
Bramanti Alessia; Manuli Alfredo; Salvatore Calabrò Rocco (2018) STROKE TELEREHABILITATION IN SICILY: A COST-EFFECTIVE APPROACH TO REDUCE DISABILITY?. Innovations in Clinical Neuroscience 15(12): 11–12 [PMC free article: PMC5819715] [PubMed: 29497574]	- Study design not relevant to this review protocol Letter only
Broderick M, Almedom L, Burdet E et al (2021) Self-directed exergaming for stroke upper limb impairment increases exercise dose compared to standard care. Neurorehabilitation and Neural Repair 35(11): 974–85 [PMC free article: PMC8593287] [PubMed: 34449290]	- Study design not relevant to this review protocol
Broeren Jurgen, Claesson Lisbeth, Goude Daniel et al (2008) Virtual rehabilitation in an activity centre for community-dwelling persons with stroke. The possibilities of 3-dimensional computer games. Cerebrovascular diseases (Basel, Switzerland) 26(3): 289–96 [PubMed: 18667809]	- Study design not relevant to this review protocol Pseudo-randomised study (initial 6 people were not randomised, which makes it appear that the study as a whole is not sufficiently randomised)
Buick Alison R, Kowalczewski Jan, Carson Richard G et al (2016) Tele-Supervised FES-Assisted Exercise for Hemiplegic Upper Limb. IEEE transactions on neural systems and rehabilitation engineering: a publication of the IEEE Engineering in Medicine and Biology Society 24(1): 79–87 [PubMed: 25775494]	- Study design not relevant to this review protocol Single arm trial
Burdea Grigore C, Grampurohit Namrata, Kim Nam et al (2020) Feasibility of integrative games and novel therapeutic game controller for telerehabilitation of individuals chronic post-stroke living in the community. Topics in stroke rehabilitation 27(5): 321–336 [PMC free article: PMC8130884] [PubMed: 31875775]	- Study design not relevant to this review protocol
Byl Nancy N, Abrams Gary M, Pitsch Erica et al (2013) Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist. Journal of hand therapy: official journal of the American Society of Hand Therapists 26(4): 343–352 [PubMed: 23911077]	- Study does not contain an intervention relevant to this review protocol Intervention took place in a rehabilitation centre under supervision
Cacciante Luisa, Kiper Pawel, Garzon Martina et al (2021) Telerehabilitation for people with aphasia: A systematic review and meta-analysis. Journal of communication disorders 92: 106111 [PubMed: 34052617]	- Systematic review used as source of primary studies
Cadilhac D., Andrew N., Busingye D. et al (2018) Pilot randomised controlled trial of an e-health discharge support intervention for stroke. International Journal of Stroke 13(2supplement1): 49–50	- Conference abstract
Cadilhac Dominique A, Andrew Nadine E, Busingye Doreen et al (2020) Pilot randomised clinical trial of an eHealth, self-management support intervention (iVERVE) for stroke: feasibility assessment in survivors 12–24 months post-event. Pilot and feasibility studies 6(1): 172 [PMC free article: PMC7648386] [PubMed: 33292693]	- Study does not contain an intervention relevant to this review protocol Not delivering rehabilitation therefore likely not relevant
Cai Huihui, Lin Tao, Chen Lina et al (2021) Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial. Trials 22(1): 91 [PMC free article: PMC7836462] [PubMed: 33494805]	- Study design not relevant to this review protocol
Capampangan Dan J, Wellik Kay E, Bobrow Bentley J et al (2009) Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic. The neurologist 15(3): 163–6 [PubMed: 19430275]	- Study does not contain an intervention relevant to this review protocol Discusses telemedicine rather than telerehabilitation (discusses stroke care before hospital admission rather than rehabilitation care)
Carbajal Galarza M., Abanto Perez S., Chinchihualpa Paredes N. et al (2021) Effectiveness of technological interventions to improve upper limb motor function in people with stroke in low-and middleincome countries: A systematic review and meta-analysis. International Journal of Stroke 16(2suppl): 49	- Conference abstract
Carey James R, Durfee William K, Bhatt Ela et al (2007) Comparison of finger tracking versus simple movement training via telerehabilitation to alter hand function and cortical reorganization after stroke. Neurorehabilitation and neural repair 21(3): 216–32 [PubMed: 17351083]	- Comparator in study does not match that specified in this review protocol Compares two different types of telerehabilitation, which was not a valid comparison listed in the protocol for this review (this study was included in the Cochrane review)
Cassarly Christy, Doyle Anna, Ly Trinh et al (2021) Speech Entrainment for Aphasia Recovery (SpARc) phase II trial design. Contemporary clinical trials communications 24: 100876 [PMC free article: PMC8606333] [PubMed: 34841125]	- Study design not relevant to this review protocol
Cassel S. (2016) A comparison of traditional face-to-face and tele-dysphagia instructional methods in geriatric TBI and CVA populations. Archives of Physical Medicine and Rehabilitation 97(10): e16–e17	- Conference abstract
Cha Yu-Jin and Kim Hee (2013) Effect of computer-based cognitive rehabilitation (CBCR) for people with stroke: a systematic review and meta-analysis. NeuroRehabilitation 32(2): 359–68 [PubMed: 23535800]	- Full text paper not available
Chen Jing, Jin Wei, Zhang Xiao-Xiao et al (2015) Telerehabilitation Approaches for Stroke Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 24(12): 2660–8 [PubMed: 26483155]	- Systematic review used as source of primary studies
Chen T.Y., Cheng Y.C., Huang S.J. et al (2017) Does task-oriented virtual reality training on chronic stroke patients decrease the resources utilization of physical therapy in Taiwan?. International Journal of Stroke 12(3supplement1): 50–51	- Conference abstract
Chen Xinming, Liu Fang, Lin Shaohong et al (2022) Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Archives of physical medicine and rehabilitation 103(7): 1422–1435 [PubMed: 35417757]	- Study does not contain an intervention relevant to this review protocol Virtual reality but not specific to telerehabilitation
Chen Yu, Abel Kingsley Travis, John T Janecek et al (2019) Home-based technologies for stroke rehabilitation: A systematic review. International journal of medical informatics 123: 11–22 [PMC free article: PMC6814146] [PubMed: 30654899]	- Systematic review used as source of primary studies
Cherney Leora R, Lee Jaime B, Kim Kwang-Youn A et al (2021) Web-based Oral Reading for Language in Aphasia (Web ORLA R): A pilot randomized control trial. Clinical rehabilitation 35(7): 976–987 [PubMed: 33472420]	- No relevant outcomes reported
Chinthammit Winyu, Merritt Troy, Pedersen Scott et al (2014) Ghostman: augmented reality application for telerehabilitation and remote instruction of a novel motor skill. BioMed research international 2014: 646347 [PMC free article: PMC4009317] [PubMed: 24829910]	- No relevant outcomes reported
Cho H.-Y., Song E., Moon J.-H. et al (2021) Effects of virtual reality based therapeutic exercise on the upper extremity function and activities of daily living in patients with acute stroke: A pilot randomized controlled trial. Medico-Legal Update 21(2): 676–682	- Study does not contain an intervention relevant to this review protocol Virtual reality intervention performed in hospital with a therapist present for the intervention (therefore not telerehabilitation)
Cho Ki Hun, Kim Min Kyu, Lee Hwang-Jae et al (2015) Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients. The Tohoku journal of experimental medicine 236(4): 273–80 [PubMed: 26228205]	- Population not relevant to this review protocol
Cho Ki Hun; Lee Kyoung Jin; Song Chang Ho (2012) Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. The Tohoku journal of experimental medicine 228(1): 69–74 [PubMed: 22976384]	- Study does not contain an intervention relevant to this review protocol Virtual reality therapy delivered in hospital by a therapist who was present for the whole intervention (therefore, not telerehabilitation)
Cho Ki Hun and Lee Wan Hee (2014) Effect of treadmill training based real-world video recording on balance and gait in chronic stroke patients: a randomized controlled trial. Gait & posture 39(1): 523–8 [PubMed: 24091250]	- Study does not contain an intervention relevant to this review protocol Virtual reality treadmill training completed in hospital (therefore not telerehabilitation)
Cho Ki Hun and Lee Wan Hee (2013) Virtual walking training program using a real-world video recording for patients with chronic stroke: a pilot study. American journal of physical medicine & rehabilitation 92(5): 371–458 [PubMed: 23598900]	- Study does not contain an intervention relevant to this review protocol Technology approach completed in hospital rather than over distance therefore not being a form of telerehabilitation
Choi Yoon-Hee, Ku Jeonghun, Lim Hyunmi et al (2016) Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke. Restorative neurology and neuroscience 34(3): 455–63 [PubMed: 27163250]	- Data not reported in an extractable format or a format that can be analysed Outcomes reported in graphs as means without standard deviations or methods of calculating standard deviations or equivalents for summary statistics
Choi Yoon-Hee and Paik Nam-Jong (2018) Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation. Journal of visualized experiments: JoVE [PMC free article: PMC5931529] [PubMed: 29578520]	- Study design not relevant to this review protocol Quasi randomised and sufficient randomised controlled trials included.
Choudhury S, Singh R, Shobhana A et al (2020) A novel wearable device for motor recovery of hand function in chronic stroke survivors. Neurorehabilitation and Neural Repair 34(7): 600–8 [PMC free article: PMC8207486] [PubMed: 32452275]	- Data not reported in an extractable format or a format that can be analysed Reports data as medians and interquartile range only
Chumbler N.R., Roudebush R.L., Morey M.C. et al (2011) The effects of a stroke telerehabilitation in-home intervention on function and disability: Preliminary results of a randomized clinical trial. Stroke 42(3): e76–e77	- Study design not relevant to this review protocol
Chumbler Neale R, Li Xinli, Quigley Patricia et al (2015) A randomized controlled trial on Stroke telerehabilitation: The effects on falls self-efficacy and satisfaction with care. Journal of telemedicine and telecare 21(3): 139–43 [PMC free article: PMC4548802] [PubMed: 25680390]	- Secondary publication of an included study that does not provide any additional relevant information
Chumbler Neale R, Quigley Patricia, Sanford Jon et al (2010) Implementing telerehabilitation research for stroke rehabilitation with community dwelling veterans: lessons learned. International journal of telerehabilitation 2(1): 15–22 [PMC free article: PMC4296788] [PubMed: 25945169]	- Study design not relevant to this review protocol
Chun H.Y. Y., Carson A., Tsanas T. et al (2019) Treating anxiety after stroke (TASK): Proof-of-concept of telemedicine cognitive behavioural therapy (TASKCBT) in a streamlined randomised controlled trial. European Stroke Journal 4(supplement1): 59	- Conference abstract
Chun H.Y. Y., Carson A.J., Dennis M.S. et al (2018) TASK (Treating Anxiety after StroKe)-development of a telemedicine intervention using a systematic, logical and evidence-based methodology. International Journal of Stroke 13(3supplement1): 64	- Conference abstract
Chun Ho-Yan Yvonne, Carson, Martin S Dennis et al (2018) Treating anxiety after stroke (TASK): the feasibility phase of a novel web-enabled randomised controlled trial. Pilot and feasibility studies 4: 139 [PMC free article: PMC6092858] [PubMed: 30128164]	- Study design not relevant to this review protocol Protocol only
Chun Ho-Yan Yvonne, Carson Alan J, Tsanas Athanasios et al (2020) Telemedicine Cognitive Behavioral Therapy for Anxiety After Stroke: Proof-of-Concept Randomized Controlled Trial. Stroke 51(8): 2297–2306 [PMC free article: PMC7382539] [PubMed: 32576090]	- No relevant outcomes reported
Chung B.P. H., Chiang W.K. H., Lau H. et al (2020) Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial. Hong Kong Physiotherapy Journal 40(1): 63–73 [PMC free article: PMC7136530] [PubMed: 32489241]	- Study does not contain an intervention relevant to this review protocol Computer-assisted technology but not telerehabilitation as no use of technology to feed back information to the rehabilitation professional
Cikajlo I, Rudolf M, Goljar N et al (2012) Telerehabilitation using virtual reality task can improve balance in patients with stroke. Disability and rehabilitation 34(1): 13–18 [PubMed: 21864205]	- Study design not relevant to this review protocol Single armed trial
Cikajlo Imre, Rudolf Marko, Mainetti Renato et al (2020) Multi-Exergames to Set Targets and Supplement the Intensified Conventional Balance Training in Patients With Stroke: A Randomized Pilot Trial. Frontiers in psychology 11: 572 [PMC free article: PMC7142230] [PubMed: 32300321]	- Study does not contain an intervention relevant to this review protocol Intervention took place with therapist present
Clark PG, Dawson SJ, Scheideman-Miller C et al (2002) TeleRehab: stroke teletherapy and management using two-way interactive video. Neurology Report 26(2): 87–93	- Study design not relevant to this review protocol Case report
Coias A.R.; Lee M.H.; Bernardino A. (2022) A low-cost virtual coach for 2D video-based compensation assessment of upper extremity rehabilitation exercises. Journal of NeuroEngineering and Rehabilitation 19(1): 83 [PMC free article: PMC9336113] [PubMed: 35902897]	- Study design not relevant to this review protocol Single arm study
Connor D.O., Stockley R., Moss S. et al (2016) Using virtual reality for upper limb recovery post stroke: A pilot study. Cerebrovascular Diseases 41(suppl1): 49	- Conference abstract
Conroy SS (2016) Translating Intensive Arm Rehabilitation in Stroke to a Telerehabilitation Format (TeleBATRAC).	- Full text paper not available
Cramer S., Lucy D., Le V. et al (2018) Telerehabilitation in the home versus therapy in-clinic for patients with stroke. European Stroke Journal 3(1supplement1): 590–591	- Conference abstract
Cramer Steven C, Dodakian Lucy, Le Vu et al (2020) A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Frontiers in neurology 11: 611453 [PMC free article: PMC7888185] [PubMed: 33613417]	- Study design not relevant to this review protocol
Crotty M, Killington M, van den Berg M et al (2014) Telerehabilitation for older people using off-the-shelf applications: Acceptability and feasibility. Journal of Telemedicine and Telecare 20(7): 370–6 [PubMed: 25399997]	- Population not relevant to this review protocol Only 53% of people had a stroke
da Silva Ribeiro Nildo Manoel, Ferraz Daniel Dominguez, Pedreira Erika et al (2015) Virtual rehabilitation via Nintendo Wii R and conventional physical therapy effectively treat post-stroke hemiparetic patients. Topics in stroke rehabilitation 22(4): 299–305 [PubMed: 26258455]	- Study does not contain an intervention relevant to this review protocol Computer game supervised by a therapist for the whole procedure (therefore, not providing telerehabilitation as the therapist was present with the stroke survivor for the whole procedure)
Darekar A., McFadyen B.J., Lamontagne A. et al (2015) Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: A scoping review. Journal of NeuroEngineering and Rehabilitation 12(1): 35 [PMC free article: PMC4425869] [PubMed: 25957577]	- Systematic review used as source of primary studies
Dawson D., Bar Y., McEwen S. et al (2017) Enhancing participation in everyday life for people with stroke via telerehabilitation: A randomized controlled trial. International Journal of Stroke 12(4supplement1): 87–88	- Conference abstract
De Cock E., Batens K., Cocquyt E.M. et al (2019) The effect of a tablet-based aphasia therapy in the chronic phase after stroke. European Stroke Journal 4(supplement1): 808	- Conference abstract
De Cock E., Batens K., Feiken J. et al (2021) The feasibility, usability and acceptability of a tablet-based aphasia therapy in the acute phase following stroke. Journal of Communication Disorders 89: 106070 [PubMed: 33418143]	- Study design not relevant to this review protocol
De La Torre Costa J., Maier M., Rubio Ballester B. et al (2021) A combination of computer-based and wearable systems to remotely promote and monitor recovery and arm use post-stroke: Preliminary results of a randomised controlled trial. European Stroke Journal 6(1suppl): 303	- Conference abstract
De Luca R., Leonardi S., Maresca G. et al (2021) Virtual reality as a new tool for the rehabilitation of poststroke patients with chronic aphasia: an exploratory study. Aphasiology	- Study does not contain an intervention relevant to this review protocol Virtual reality therapy provided with the therapist in the room guiding the intervention the whole time (therefore not being telerehabilitation)
De Luca Rosaria, Aragona Bianca, Leonardi Simona et al (2018) Computerized Training in Poststroke Aphasia: What About the Long-Term Effects? A Randomized Clinical Trial. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 27(8): 2271–2276 [PubMed: 29880209]	- Study does not contain an intervention relevant to this review protocol Computer-based speech and language therapy where a therapist is present the whole time, therefore is not delivered over a distance and so is not telerehabilitation
De Paula Oliveira T., Souza Miranda C., Silva D'Alencar M. et al (2017) Balance training in virtual reality promotes superior generalization of gains in postural control to functionality in comparison conventional training-a randomized clinical trial. Cerebrovascular Diseases 43(supplement1): 57	- Full text paper not available
De Paula Oliveira T., Souza Miranda C., Xavier Muzzi De Gouvea J. et al (2016) Extensive training in virtual reality promotes an increase in the body function and activity, but not in participation domain according to 1CF: A randomized controlled trial. Cerebrovascular Diseases 41(suppl1): 309	- No relevant outcomes reported No protocol outcomes reported (only health behaviour scores and the modified Rankin scale were reported)
de Rooij Ilona J M; van de Port Ingrid G L; Meijer Jan-Willem G (2016) Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis. Physical therapy 96(12): 1905–1918 [PubMed: 27174255]	- Systematic review used as source of primary studies
de Rooij Ilona J M, van de Port Ingrid G L, Punt Michiel et al (2021) Effect of Virtual Reality Gait Training on Participation in Survivors of Subacute Stroke: A Randomized Controlled Trial. Physical therapy 101(5) [PMC free article: PMC8122468] [PubMed: 33594443]	- Study does not contain an intervention relevant to this review protocol Therapy was supervised
Deepa S. and Kumari P. (2020) Neurorehabilitation and technology - A systematic review and meta-analysis. International Journal of Research in Pharmaceutical Sciences 11(specialissue4): 1758–1765	- Population not relevant to this review protocol Not specific to people after stroke
Demaerschalk B.M. and Bobrow B.J. (2009) Stroke team remote evaluation using a digital observation camera (Stroke DOC) randomized, blinded, prospective trial in arizona: The initial mayo Clinic experience (Time). Cerebrovascular Diseases 27(suppl6): 148	- Study design not relevant to this review protocol
Demaerschalk B.M., Raman R., Ernstrom K. et al (2010) Efficacy of site independent telemedicine: Pooled analysis of the STRokE DOC and STRokE DOC-AZ telemedicine stroke trials. Stroke 41(4): e246	- Conference abstract
Demaerschalk Bart M., Switzer Jeffrey A., Jipan Xie et al (2013) Cost Utility of Hub-and-Spoke Telestroke Networks From Societal Perspective. American Journal of Managed Care 19(12): 976–10 [PubMed: 24512034]	- Study design not relevant to this review protocol
Demaerschalk Bart M, Aguilar Maria I, Ingall Timothy J et al (2022) Stroke Telemedicine for Arizona Rural Residents, the Legacy Telestroke Study. Telemedicine reports 3(1): 67–78 [PMC free article: PMC9052207] [PubMed: 35720454]	- Study design not relevant to this review protocol
Demaerschalk Bart M, Bobrow Bentley J, Raman Rema et al (2010) Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial. Stroke 41(6): 1251–8 [PMC free article: PMC2876204] [PubMed: 20431081]	- Study does not contain an intervention relevant to this review protocol Assessment only intervention. Looking at thrombolysis decision making
Demaerschalk Bart M, Raman Rema, Ernstrom Karin et al (2012) Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. Telemedicine journal and e-health: the official journal of the American Telemedicine Association 18(3): 230–7 [PMC free article: PMC3317394] [PubMed: 22400970]	- Study does not contain an intervention relevant to this review protocol Assessment only intervention. Looking at thrombolysis decision making
Deng Huiqiong, Durfee William K, Nuckley David J et al (2012) Complex versus simple ankle movement training in stroke using telerehabilitation: a randomized controlled trial. Physical therapy 92(2): 197–209 [PMC free article: PMC3269771] [PubMed: 22095209]	- Comparator in study does not match that specified in this review protocol Compares two types of telerehabilitation (one arm received tracking while the other doesn’t - this study was included in the Cochrane review)
Deutsch JE; Lewis JA; Burdea G (2007) Reality-Integrated Telerehabilitation System: Technical and Patient Performance Using a Virtual Preliminary Finding. IEEE Transactions on Neural Systems and Rehabilitation Engineering 15(1): 30–5 [PubMed: 17436873]	- Study design not relevant to this review protocol Single arm trial
Dodakian Lucy, McKenzie Alison L, Le Vu et al (2017) A Home-Based Telerehabilitation Program for Patients With Stroke. Neurorehabilitation and neural repair 31(1011): 923–933 [PMC free article: PMC5734923] [PubMed: 29072556]	- Study design not relevant to this review protocol
Doesborgh S.J. C., van de Sandt-Koenderman M.W. M. E., Dippel D.W. J. et al (2004) Cues on request: The efficacy of multicue, a computer program for wordfinding therapy. Aphasiology 18(3): 213–222	- Study does not contain an intervention relevant to this review protocol Computer-based tool with no communication back to the rehabilitation professional (only feedback to the stroke survivor)
Dominguez-Tellez Pablo, Moral-Munoz Jose A, Salazar Alejandro et al (2020) Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis. Games for health journal 9(1): 1–10 [PubMed: 32027185]	- Systematic review used as source of primary studies
Donoso Brown E.V., McCoy S.W., Fechko A.S. et al (2014) Preliminary investigation of an electromyography-controlled video game as a home program for persons in the chronic phase of stroke recovery. Archives of Physical Medicine and Rehabilitation 95(8): 1461–1469 [PMC free article: PMC4337946] [PubMed: 24657112]	- Study design not relevant to this review protocol
Dorsch, A., Thomas, S., Xu, C. et al (2014) Implementation of a multicenter, international, randomized clinical trial in subacute stroke patients using wireless health technology. Neurorehabilitation and Neural Repair 28(4): np17	- Conference abstract
Dorsch A., Thomas S., Xu C. et al (2013) Sirract: A multi-center, international, randomized clinical trial using wireless technology to affect outcomes during acute stroke rehabilitation. Neurology 80(1meetingabstracts)	- Conference abstract
Dorstyn D S; Mathias J L; Denson L A (2011) Psychosocial outcomes of telephone-based counseling for adults with an acquired physical disability: A meta-analysis. Rehabilitation psychology 56(1): 1–14 [PubMed: 21401281]	- Population not relevant to this review protocol People with conditions other than stroke in the majority of cases (one study includes people with stroke among other conditions with people with stroke not being a majority)
Dowlatshahi D., Mallet K.H., Ramsay T. et al (2019) RecoverNow: A multicenter Phase II randomized controlled trial of early mobile tablet-based speech therapy for acute stroke patients with aphasia. International Journal of Stroke 14(3supplement): 28	- Conference abstract
Duff A., Duarte E., Cuxart A. et al (2011) Rehabilitation Gaming System (RGS): The impact of virtual reality based training on upper limb recovery in the acute and chronic phase of stroke. Cerebrovascular Diseases 31(suppl2): 190	- Conference abstract
Eghdam Aboozar, Scholl Jeremiah, Bartfai Aniko et al (2012) Information and communication technology to support self-management of patients with mild acquired cognitive impairments: systematic review. Journal of medical Internet research 14(6): e159 [PMC free article: PMC3510771] [PubMed: 23165152]	- Systematic review used as source of primary studies
Ellis Fiona, Kennedy Niamh C, Hancock Nicola J et al (2021) Neurophysiological changes accompanying reduction in upper limb motor impairments in response to exercise-based virtual rehabilitation after stroke: systematic review. Physiotherapy 113: 141–152 [PubMed: 34625285]	- Systematic review used as source of primary studies
Emmerson Kellie B; Harding Katherine E; Taylor Nicholas F (2017) Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial. Clinical rehabilitation 31(8): 1068–1077 [PubMed: 27920262]	- Study does not contain an intervention relevant to this review protocol No two way communication - given home excises on tablet
Emuk Y.; Ozturk V.; Sengul Y. (2018) The effects of virtual reality systems on balance impairments in patients with chronic stroke: A single blinded randomized controlled study. European Stroke Journal 3(1supplement1): 597	- Conference abstract
English C., Patterson A., MacDonald-Wicks L. et al (2019) ENAbLE: Secondary prevention of stroke. A physical activity and diet trial protocol. International Journal of Stroke 14(1supplement): 12	- Conference abstract
English Coralie, Ceravolo Maria Gabriella, Dorsch Simone et al (2022) Telehealth for rehabilitation and recovery after stroke: State of the evidence and future directions. International journal of stroke: official journal of the International Stroke Society 17(5): 487–493 [PubMed: 34983266]	- Review article but not a systematic review
Escalante-Gonzalbo Ana María, Ramírez-Graullera Yoás Saimon, Pasantes Herminia et al (2021) Safety, Feasibility, and Acceptability of a New Virtual Rehabilitation Platform: A Supervised Pilot Study. Rehabilitation Process & Outcome: 1–13 [PMC free article: PMC8492031] [PubMed: 34987304]	- Study design not relevant to this review protocol
Faeta Julie; Tanksley Heather; Page Stephen (2016) Poststroke Reductions in Impairment and Functional Limitation Using a FaceTime-Based Upper-Extremity Protocol. American Journal of Occupational Therapy 70: 1–1	- Conference abstract
Faheem Filzah, Zafar Zaitoon, Razzak Aisha et al (2022) Implementing Virtual Care in Neurology - Challenges and Pitfalls. Journal of Central Nervous System Disease: 1–9 [PMC free article: PMC9252001] [PubMed: 35795886]	- Review article but not a systematic review
Faux S (2017) A telehealth transfer package to improve post stroke rehabilitation outcomes.	- Full text paper not available
Fitzgerald Susan (2011) Telemedicine for Stroke is Cost-Efficient Over the Long Haul. Neurology Today 11(19): 13–14	- Study design not relevant to this review protocol Report only
Flodgren G, Rachas A, Farmer AJ et al (2015) Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews [PMC free article: PMC6473731] [PubMed: 26343551]	- Systematic review used as source of primary studies
Fluet GG and Qui Q (2019) Utilizing gaming mechanics to optimize telerehabilitation adherence in persons with stroke.	- Full text paper not available
Forducey Pamela G, Glueckauf Robert L, Bergquist Thomas F et al (2012) Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting. Psychological services 9(2): 144–62 [PMC free article: PMC3375593] [PubMed: 22662729]	- No relevant outcomes reported
Gaboury Isabelle, Tousignant Michel, Corriveau Helene et al (2021) Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial. JMIR research protocols 10(10) e32134 [PMC free article: PMC8587325] [PubMed: 34709196]	- Study design not relevant to this review protocol Protocol only
Gamito Pedro, Oliveira Jorge, Coelho Carla et al (2017) Cognitive training on stroke patients via virtual reality-based serious games. Disability and rehabilitation 39(4): 385–388 [PubMed: 25739412]	- Study does not contain an intervention relevant to this review protocol Virtual reality therapy provided to inpatients (not providing rehabilitation over a distance)
Gao L., Tan E., Kim J. et al (2022) Telemedicine for Stroke: Quantifying the Long-Term National Costs and Health Benefits. Frontiers in Neurology 12: 804355 [PMC free article: PMC9265143] [PubMed: 35813183]	- Study design not relevant to this review protocol
Garcia Andres, Mayans Berta, Margeli Carles et al (2022) A feasibility study to assess the effectiveness of Muvity: A telerehabilitation system for chronic post-stroke subjects. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 31(11): 106791 [PubMed: 36156443]	- No relevant outcomes reported
Garcia-Esperon Carlos, Frode Soderhjelm Dinkelspiel, Miteff Ferdi et al (2020) Implementation of multimodal computed tomography in a telestroke network: Five-year experience. CNS neuroscience & therapeutics 26(3): 367–373 [PMC free article: PMC7052799] [PubMed: 31568661]	- Study design not relevant to this review protocol
Garcia-Esperon Carlos, Chew Beng Lim Alvin, Minett Fiona et al (2022) Impact of an outpatient telestroke clinic on management of rural stroke patients. Australian Journal of Rural Health 30(3): 337–342 [PubMed: 35412702]	- Study design not relevant to this review protocol Single-arm trial
Garzon J., Freire I., Diaz A. et al (2022) TELEMEDICINE EFFICACY IN MEDICATION ADHERENCE IN POST-ISCHEMIC STROKE PATIENTS: ONGOING CLINICAL TRIAL. European Stroke Journal 7(1suppl): 150	- Conference abstract
Georgeadis A.C., Brennan D.M., Barker L.M. et al (2004) Telerehabilitation and its effect on story retelling by adults with neurogenic communications disorders. Aphasiology 18(57): 639–652	- Population not relevant to this review protocol >20% had traumatic brain injury rather than a stroke
Giachero A, Calati M, Pia L et al (2020) Conversational Therapy through Semi-Immersive Virtual Reality Environments for Language Recovery and Psychological Well-Being in Post Stroke Aphasia. Behavioural neurology 2020: 2846046 [PMC free article: PMC7428879] [PubMed: 32831969]	- Study does not contain an intervention relevant to this review protocol Therapist present throughout
Gibson Jo, Fitzgerald Jane, McAdam Joanna et al (2013) Using telemedicine for acute stroke assessment. Nursing Times 109(35): 14–16 [PubMed: 24266238]	- Review article but not a systematic review
Gil-Pages Macarena, Solana Javier, Sanchez-Carrion Rocio et al (2018) A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial. Trials 19(1): 191 [PMC free article: PMC5863836] [PubMed: 29566766]	- Study design not relevant to this review protocol
Gillham Sarah and Endacott Ruth (2010) Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial. Clinical rehabilitation 24(9): 822–30 [PubMed: 20685723]	- Population not relevant to this review protocol Unclear how many people had a transient ischaemic attack
Gomez V.M., Shoaib M., Mahmoud N. et al (2022) The frontiers in stroke care: the disparities of telemedicine and telestroke in latin america. Stroke 53(suppl1)	- Conference abstract
Gong Enying, Gu Wanbing, Sun Cheng et al (2019) System-integrated technology-enabled model of care to improve the health of stroke patients in rural China: protocol for SINEMA-a cluster-randomized controlled trial. American heart journal 207: 27–39 [PubMed: 30408621]	- Study design not relevant to this review protocol Protocol only
Gong Enying, Sun Lixin, Long Qian et al (2021) The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation. Frontiers in public health 9: 774907 [PMC free article: PMC8635640] [PubMed: 34869187]	- Study design not relevant to this review protocol Single arm quantitative data
Goudarzian M (2018) The effect of tele-nursing through telephone counselling practices on depression and anxiety in informal caregivers of stroke survivors in Sabzevar.	- Study design not relevant to this review protocol
Goudarzian Maryam, Fallahi-Khoshknab Masoud, Dalvandi Asghar et al (2018) Effect of Telenursing on Levels of Depression and Anxiety in Caregivers of Patients with Stroke: A Randomized Clinical Trial. Iranian journal of nursing and midwifery research 23(4): 248–252 [PMC free article: PMC6034534] [PubMed: 30034482]	- Population not relevant to this review protocol
Gough N., Brkan L., Subramaniam P. et al (2020) Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS ONE 15(2): e0223029 [PMC free article: PMC7039434] [PubMed: 32092069]	- Systematic review used as source of primary studies
Govercin M., Missala I.M., Marschollek M. et al (2010) Virtual rehabilitation and telerehabilitation for the upper limb: A geriatric review. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry 23(2): 79–90	- Systematic review used as source of primary studies
Gracey F., Wilson B.A., Manly T. et al (2012) The effectiveness of brief goal management training (GMT) and sms text alerts on psychosocial functioning following brain injury: The assisted intention monitoring (AIM) trial?. Brain Impairment 13(1): 180–181	- Conference abstract
Grant Joan S, Elliott Timothy R, Weaver Michael et al (2002) Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke 33(8): 2060–5 [PubMed: 12154263]	- No relevant outcomes reported
Graven Lucinda J, Glueckauf Robert L, Regal Rachel A et al (2021) Telehealth Interventions for Family Caregivers of Persons with Chronic Health Conditions: A Systematic Review of Randomized Controlled Trials. International journal of telemedicine and applications 2021: 3518050 [PMC free article: PMC8164532] [PubMed: 34093704]	- Systematic review used as source of primary studies
Guillaumier Ashleigh, McCrabb Sam, Spratt Neil J et al (2019) An online intervention for improving stroke survivors' health-related quality of life: study protocol for a randomised controlled trial. Trials 20(1): 491 [PMC free article: PMC6688335] [PubMed: 31399140]	- Study design not relevant to this review protocol
Guillaumier Ashleigh, Spratt Neil J, Pollack Michael et al (2022) Evaluation of an online intervention for improving stroke survivors' health-related quality of life: A randomised controlled trial. PLoS medicine 19(4): e1003966 [PMC free article: PMC9017949] [PubMed: 35439246]	- Population not relevant to this review protocol >20% of participants had a transient ischaemic attack
Guo Yiting Emily, Togher Leanne, Power Emma et al (2017) Assessment of Aphasia Across the International Classification of Functioning, Disability and Health Using an iPad-Based Application. Telemedicine journal and e-health: the official journal of the American Telemedicine Association 23(4): 313–326 [PubMed: 27802112]	- Study does not contain an intervention relevant to this review protocol Investigates the use of telerehabilitation for assessment of aphasia rather that using telerehabilitation as an intervention (not included in the protocol for this review)
Gustafsson L., Cornwell P., Kuys S. et al (2020) Effectiveness of atelehealth self-management program for people with mild stroke: Results of a randomised controlled trial with longitudinal follow-up. International Journal of Stroke 15(1suppl): 159	- Conference abstract
Halbert Kelsey and Bautista Cynthia (2019) Telehealth Use to Promote Quality Outcomes and Reduce Costs in Stroke Care. Critical Care Nursing Clinics of North America 31(2): 133–139 [PubMed: 31047088]	- Review article but not a systematic review
Hall William J. (2012) 2012 - Telemonitoring did not reduce hospitalizations or ED visits in high-risk elderly patients. ACP Journal Club 157(6): 1–1 [PubMed: 22986400]	- Study design not relevant to this review protocol Commentary only
Hamel Renee (2018) Review of ViaTherapy Mobile Application for Upper Extremity Stroke Rehabilitation. Physical Therapy Reviews 23(45): 298–299	- Study design not relevant to this review protocol Report only
Handschu R, Scibor M, Nucke LM et al (2005) Telemedicine in acute stroke: remote video-examination vs telephone based consultation in acute stroke care - first experience from the STENO-Project. Cerebrovascular diseases (Basel, Switzerland) 19suppl2: 59	- Full text paper not available
Handschu R, Scibor M, Willaczeck B et al (2008) Telemedicine for stroke management - costs of service in different organisational models. Cerebrovascular diseases (Basel, Switzerland) 25(suppl2): 188	- Conference abstract
Handschu Rene, Scibor Mateusz, Wacker Angela et al (2014) Feasibility of certified quality management in a comprehensive stroke care network using telemedicine: STENO project. International journal of stroke: official journal of the International Stroke Society 9(8): 1011–6 [PubMed: 25088571]	- Study design not relevant to this review protocol
Harrison Madeleine; Palmer Rebecca; Cooper Cindy (2020) Factors Associated With Adherence to Self-Managed Aphasia Therapy Practice on a Computer-A Mixed Methods Study Alongside a Randomized Controlled Trial. Frontiers in neurology 11: 582328 [PMC free article: PMC7719711] [PubMed: 33329324]	- No relevant outcomes reported
Harvey S.; Baird A.; Meltzer J.A. (2015) Evaluation of TeleRehab effectiveness for post-stroke communication disorders. International Journal of Stroke 10(suppl4): 83	- Conference abstract
Hemphill Sydney, Rodriguez Samuel, Wang Ellen et al (2022) Virtual Reality Augments Movement During Physical Therapy: A Pragmatic Randomized Trial. American journal of physical medicine & rehabilitation 101(3): 229–236 [PubMed: 33935153]	- Population not relevant to this review protocol Includes adults and children with a range of indications (injury, postoperative, chronic pain and pre-existing conditions)
Hermens Hermie, Huijgen Barbara, Giacomozzi Claudia et al (2008) Clinical assessment of the HELLODOC tele-rehabilitation service. Annali dell'Istituto superiore di sanita 44(2): 154–63 [PubMed: 18660565]	- Population not relevant to this review protocol Only 20% of people had a stroke
Hernandez A., Kairy D., Higgins J. et al (2019) Maximizing upper-limb rehabilitation for chronic post-stroke patients using a remotely monitored virtual reality exergame: Preliminary results of a randomized clinical trial. International Journal of Stroke 14(3supplement): 39	- Conference abstract
Hernandez Alejandro, Bubyr Liudmila, Archambault Philippe S et al (2022) Virtual Reality-Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled Trial. JMIR serious games 10(3): e37506 [PMC free article: PMC9555337] [PubMed: 36166289]	- No relevant outcomes reported
Heron N., O'connor S.R., Kee F. et al (2021) Development of a digital lifestyle modification intervention for use after transient ischaemic attack or minor stroke: A person-based approach. International Journal of Environmental Research and Public Health 18(9): 4861 [PMC free article: PMC8124154] [PubMed: 34063298]	- Study design not relevant to this review protocol
Heron Neil, Kee Frank, Mant Jonathan et al (2019) Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. The British journal of general practice: the journal of the Royal College of General Practitioners 69(687): e706–e714 [PMC free article: PMC6733604] [PubMed: 31501165]	- No relevant outcomes reported
Hewitt Jonathan, Pennington Anna, Smith Alexander et al (2019) A multi-centre, UK-based, non-inferiority randomised controlled trial of 4 follow-up assessment methods in stroke survivors. BMC medicine 17(1): 111 [PMC free article: PMC6604353] [PubMed: 31262317]	- Study does not contain an intervention relevant to this review protocol Looking at assessment only
HISCOTT RE B E C C A (2015) Stroke: Low-Cost Mobile Telestroke System Found Reliable for Pre-Hospital Assessment. Neurology Today 15(9): 1–16	- Study design not relevant to this review protocol Report only
Ho H.J., Wu E.H.-K., Lee S.-F. et al (2020) Stroke patient accepted mobile rehabilitation system of improvement outcome based on unified theory of acceptance & use of technology-a randomized controlled trial. International Journal of Stroke 15(1suppl): 390–391	- Conference abstract
Ho H.J., Wu E.H.-K., Lee S.-F. et al (2020) Improving outcome of acute stroke patients by a mobile assistive rehabilitation system-a stroke center experience. International Journal of Stroke 15(1suppl): 256	- Conference abstract
Ho Hsiu-Yu, Chen Ming-De, Tsai Chiu-Chin et al (2022) Effects of computerized cognitive training on cognitive function, activity, and participation in individuals with stroke: A randomized controlled trial. NeuroRehabilitation 51(1): 79–89 [PubMed: 35311716]	- Study does not contain an intervention relevant to this review protocol Computer-based therapy but delivered with an occupational therapist present (therefore not telerehabilitation)
Hoffmann Tammy, McKenna Kryss, Worrall Linda et al (2007) Randomised trial of a computer-generated tailored written education package for patients following stroke. Age and ageing 36(3): 280–6 [PubMed: 17360794]	- Study does not contain an intervention relevant to this review protocol No communcation channel or feedback from patient
Hoffmann Tammy, Worrall Linda, Eames Sally et al (2010) Measuring outcomes in people who have had a stroke and their carers: can the telephone be used?. Topics in stroke rehabilitation 17(2): 119–27 [PubMed: 20542854]	- Study does not contain an intervention relevant to this review protocol Looking at assessment of stroke outcomes only
Holden MK, Dyar T, Schwamm L et al (2002) Telerehabilitation: development and initial testing of a remotely operated computerized motor training system to provide patients with home-based therapy via the Internet...Platform & poster presentations for CSM 2003. Neurology Report 26(4): 198–198	- Conference abstract
Holden MK; Dyar TA; Dayan-Cimadoro L (2007) Telerehabilitation Using a Virtual Environment Improves Upper Extremity Function in Patients With Stroke. IEEE Transactions on Neural Systems and Rehabilitation Engineering 15(1): 36–42 [PubMed: 17436874]	- Study design not relevant to this review protocol Single arm trial
Hosseini A., Sharifi N., Dehghanrad F. et al (2022) Effect of Telenursing on Caregiver Burden of Care and Incidence of some Complications in Patients with Acute Stroke Discharged from Neurological Wards: A Randomized Control Trial. Shiraz E Medical Journal 23(8): e123479	- No relevant outcomes reported
Hosseiniravandi M., Kahlaee A.H., Karim H. et al (2020) Home-based telerehabilitation software systems for remote supervising: A systematic review. International Journal of Technology Assessment in Health Care 36(2): 113–125 [PubMed: 32151291]	- Systematic review used as source of primary studies
Hsiao C.-C., Tsai J.-P., Sung K.-T. et al (2017) Telemedicine in cardiovascular disease. Journal of Internal Medicine of Taiwan 28(3): 133–139	- Review article but not a systematic review
Hubert Gordian J.; Corea Francesco; Schlachetzki Felix (2021) The role of telemedicine in acute stroke treatment in times of pandemic. Current Opinion in Neurology 34(1): 22–26 [PubMed: 33230037]	- Review article but not a systematic review
Hubert Gordian J; Muller-Barna Peter; Audebert Heinrich J (2014) Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries. International journal of stroke: official journal of the International Stroke Society 9(8): 968–73 [PubMed: 25381687]	- Study does not contain an intervention relevant to this review protocol Prehospital management and stroke unit treatment, or telestroke networking in developing countries
Hudson L., Corrales M., Moreno L. et al (2015) Cares (changing and advancing risk factor control through educations after stroke): A pilot trial of a transitions in care post-discharge telephone intervention for stroke patients. Neurology 84(suppl14)	- Conference abstract
Huijbregts M.P., Cameron J., Taylor D. et al (2010) Videoconference delivery of a stroke self-management program: A mixed methods waiting list randomized controlled trial. Stroke 41(4): e357	- Conference abstract
Huijbregts M, Taylor D, Cameron J et al (2007) Telehealth delivery of most, a stroke selfmanagement program to remote areas in northern Ontario: results of the pilot evaluation. Physiotherapy 93(suppl1): 543	- Conference abstract
Huijbregts Maria P J; McEwen; Taylor Denise (2009) Exploring the feasibility and efficacy of a telehealth stroke self-management programme: a pilot study. Physiotherapy Canada. Physiotherapie Canada 61(4): 210–20 [PMC free article: PMC2793695] [PubMed: 20808482]	- Study design not relevant to this review protocol Non-randomised study when there is sufficient randomised evidence for the review
Hung KN G. and Fong K.N. K. (2019) Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong Journal of Occupational Therapy 32(1): 3–21 [PMC free article: PMC6560836] [PubMed: 31217758]	- Systematic review used as source of primary studies
Hung N.-T., Paul V., Kovach T. et al (2021) Wearable myoelectric interface training for improving arm movement in chronic stroke. Stroke 52(suppl1)	- Conference abstract
Hwang; Park Ji-Su; Chang Moon-Young (2021) Telehealth Interventions to Support Self-Management in Stroke Survivors: A Systematic Review. Healthcare (Basel, Switzerland) 9(4) [PMC free article: PMC8071480] [PubMed: 33921183]	- Systematic review used as source of primary studies
HÃ¶hlig J., Czekanska A., HÃ¶hlig C. et al (2013) LB016-SUN TELEDYSPHAGIA FOR ACUTE STROKE PATIENTS USING A STANDARDIZED EXAMINATION KIT IN A TELESTROKE NETWORK. Clinical Nutrition 32: 229–s229	- Study design not relevant to this review protocol Report only
Irewall A.L., Johansson C., Stromvall A. et al (2014) Preventive stroke strategies nurse-led, telephone-based secondary preventive intervention after stroke or tia improves blood pressure after 12 months of follow-up. International Journal of Stroke 9(suppl3): 278–279	- Conference abstract
Irewall Anna-Lotta, Ogren Joachim, Bergstrom Lisa et al (2019) Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study. Trials 20(1): 52 [PMC free article: PMC6334622] [PubMed: 30646948]	- No relevant outcomes reported
Irewall Anna-Lotta, Ulvenstam Anders, Graipe Anna et al (2021) Nurse-based secondary preventive follow-up by telephone reduced recurrence of cardiovascular events: a randomised controlled trial. Scientific reports 11(1): 15628 [PMC free article: PMC8329238] [PubMed: 34341395]	- Study does not contain an intervention relevant to this review protocol No therapy provided and intervention examines secondary preventative advice follow up calls only
Isernia S., Pagliari C., Jonsdottir J. et al (2019) Efficiency and Patient-Reported Outcome Measures From Clinic to Home: The Human Empowerment Aging and Disability Program for Digital-Health Rehabilitation. Frontiers in Neurology 10: 1206 [PMC free article: PMC6882300] [PubMed: 31824398]	- Study design not relevant to this review protocol
Jackson D, Elsom S, Joubert L et al (2010) An exploration of the role of the nursing coordinator in a telemedicine based stroke secondary prevention model. International journal of stroke 5(1): 1	- Conference abstract
Jacobs M. and Ellis C. (2021) Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia. PLoS ONE 16(9september): e0257462 [PMC free article: PMC8448307] [PubMed: 34534254]	- No relevant outcomes reported
Jagos Harald, David Veronika, Haller Michael et al (2015) A Framework for (Tele-) Monitoring of Rehabilitation Progress in Stroke Patients. Studies in Health Technology & Informatics 212: 243–243 [PubMed: 25980890]	- Review article but not a systematic review
Jagos Harald, David Veronika, Reichel Martin et al (2015) Tele-Monitoring of the Rehabilitation Progress in Stroke Patients. Studies in Health Technology & Informatics 211: 311–313 [PubMed: 25980890]	- Study design not relevant to this review protocol Report only - insufficient information about the methods and the results
Jakobsson Stina, Huber Daniel, Bjorklund Fredrik et al (2016) Implementation of a new guideline in cardiovascular secondary preventive care: subanalysis of a randomized controlled trial. BMC cardiovascular disorders 16: 77 [PMC free article: PMC4851797] [PubMed: 27129980]	- Population not relevant to this review protocol
Janssen Frank, Awadallah Mohammed, Alhalabi Awed et al (2018) Telemedicine in general neurology: use of audiovisual consultation for on call back-up service in an acute care hospital. Journal of neurology 265(4): 880–884 [PubMed: 29427025]	- Population not relevant to this review protocol Not specific to stroke (relates to lots of conditions in a neurology service)
Jarbandhan Ameerani, Toelsie Jerry, Veeger DirkJan et al (2022) Feasibility of a home-based physiotherapy intervention to promote post-stroke mobility: A randomized controlled pilot study. PloS one 17(3): e0256455 [PMC free article: PMC8901054] [PubMed: 35255091]	- Study does not contain an intervention relevant to this review protocol Supervised home exercise program followed up by a telerehabilitation home exercise program, compared to a usual care that is not matched for treatment time and therefore is difficult to compare to
Jayabalan P., Kaplan R., Breisinger T. et al (2014) Video recording the gait of stroke patients during inpatient rehabilitation to improve motivation, satisfaction and outcome. PM and R 6(9suppl1): 170	- Conference abstract
Jhaveri D.; Larkins S.; Sabesan (2015) A systematic review to analyse the outcomes of active medical therapies delivered with telemedicine support to rural and remote populations. Internal Medicine Journal 45(supplement3): 12–13 [PubMed: 25680389]	- Conference abstract
Jhaveri Divita; Larkins Sarah; Sabesan Sabe (2015) Telestroke, tele-oncology and teledialysis: a systematic review to analyse the outcomes of active therapies delivered with telemedicine support. Journal of telemedicine and telecare 21(4): 181–8 [PubMed: 25680389]	- Systematic review used as source of primary studies
Jiang Xinchan; Ming Wai-Kit; You Joyce Hs (2019) The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular Diseases: Systematic Review. Journal of medical Internet research 21(6): e13166 [PMC free article: PMC6601257] [PubMed: 31210136]	- Systematic review used as source of primary studies
Jin W (2014) The Randomized Controlled Clinical Trial for Validity and Safety of Home Based Telerehabilitation in Ischemic Cerebral Stroke Disability Rehabilitation.	- Conference abstract
Jin Wei, Chen Jing, Shi Fangfang et al (2015) Home-based tele-supervising rehabilitation for brain infarction patients (HTRBIP): study protocol for a randomized controlled trial. Trials 16: 61 [PMC free article: PMC4346119] [PubMed: 25888520]	- Study design not relevant to this review protocol
Jiru-Hillmann S., Kraft P., Gabriel K. et al (2021) Improving secondary prevention by a dedicated telemedical consultation: The trans-regional telemedicine network for stroke intervention with telemedicine (transit-stroke). European Stroke Journal 6(1suppl): 194–195	- Conference abstract
Jiru-Hillmann Steffi, Gabriel Katharina M A, Schuler Michael et al (2022) Experiences of family caregivers 3-months after stroke: results of the prospective trans-regional network for stroke intervention with telemedicine registry (TRANSIT-Stroke). BMC geriatrics 22(1): 228 [PMC free article: PMC8934512] [PubMed: 35305580]	- Study design not relevant to this review protocol
Johansson Tim and Wild Claudia (2011) Telerehabilitation in stroke care--a systematic review. Journal of telemedicine and telecare 17(1): 1–6 [PubMed: 21097560]	- Systematic review used as source of primary studies
Johansson Tim and Wild Claudia (2010) Telemedicine in acute stroke management: systematic review. International journal of technology assessment in health care 26(2): 149–55 [PubMed: 20392317]	- Study not reported in English
Johnson Liam, Bird Marie-Louise, Muthalib Makii et al (2020) An Innovative STRoke Interactive Virtual thErapy (STRIVE) Online Platform for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial. Archives of physical medicine and rehabilitation 101(7): 1131–1137 [PubMed: 32283048]	- Study does not contain an intervention relevant to this review protocol Virtual reality therapy delivered by an in-person therapy
Johnston B, Wheeler L, Deuser J et al (2000) Outcomes of the Kaiser Permanente Tele-Home Health Research Project. Archives of family medicine 9(1): 40–5 [PubMed: 10664641]	- Population not relevant to this review protocol Only 6% of people had a stroke
Joosup Kim, Tan Elise, Lan Gao et al (2022) Cost-effectiveness of the Victorian Stroke Telemedicine program. Australian Health Review 46(3): 294–301 [PubMed: 35589669]	- No relevant outcomes reported
Joubert J., Christie A., Laing J. et al (2013) Telestroke: Long-term risk factor management - Part II. European Research in Telemedicine 2(2): 57–67	- Review article but not a systematic review
Joubert J, Joubert LB, Medeiros de Bustos E et al (2009) Telestroke in Stroke Survivors. Cerebrovascular diseases (Basel, Switzerland) 27(suppl4): 28–35 [PubMed: 19546539]	- Review article but not a systematic review
Julia P.E., Shahizan M.R., Mazlina M. et al (2012) Delivering therapy at home: A preliminary result. Neurorehabilitation and Neural Repair 26(6): 715	- Conference abstract
Kaambwa B., Bryan S., Jowett S. et al (2014) Telemonitoring and self-management in the control of hypertension (TASMINH2): A cost-effectiveness analysis. European Journal of Preventive Cardiology 21(12): 1517–1530 [PubMed: 23990660]	- Population not relevant to this review protocol
Kairy D (2018) Optimizing a home-based virtual reality exercise program for chronic stroke patients: a telerehabilitation approach.	- Full text paper not available Clinical trial record
Kairy D (2015) Post-stroke upper limb rehabilitation using telerehabilitation interactive virtual reality system in the patient's home. [PubMed: 26655433]	- Full text paper not available Clinical trial record
Kamal Ayeesha, Khoja Adeel, Usmani Bushra et al (2020) Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke). JMIR mHealth and uHealth 8(1): e12113 [PMC free article: PMC7013656] [PubMed: 32012080]	- Study does not contain an intervention relevant to this review protocol Only one way communication. No way for participants to feed back to professional
Kamoen Olivia, Maqueda V, Yperzeele L et al (2020) Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke. Acta neurologica Belgica 120(1): 91–97 [PubMed: 31701472]	- Study design not relevant to this review protocol
Kamwesiga Julius T, Eriksson Gunilla M, Tham Kerstin et al (2018) A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce TM, after stroke in Uganda. Globalization and health 14(1): 82 [PMC free article: PMC6094578] [PubMed: 30111333]	- Study design not relevant to this review protocol
Kang Yi-No, Shen Hsiu-Nien, Lin Chia-Yun et al (2019) Does a Mobile app improve patients' knowledge of stroke risk factors and health-related quality of life in patients with stroke? A randomized controlled trial. BMC medical informatics and decision making 19(1): 282 [PMC free article: PMC6925878] [PubMed: 31864348]	- Study does not contain an intervention relevant to this review protocol Only one way communication. No way for participants to feed back to the professional
Kilbride C., Warland A., Norris M. et al (2018) RHOMBUS: Rehabilitation via HOMe Based gaming exercise for the Upper limb post-stroke. International Journal of Stroke 13(3supplement1): 28	- Conference abstract
Kilbride Cherry, Warland Alyson, Stewart Victoria et al (2022) Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb post Stroke (RHOMBUS II): protocol of a feasibility randomised controlled trial. BMJ open 12(6): e058905 [PMC free article: PMC9174817] [PubMed: 35672074]	- Study design not relevant to this review protocol
Kim Esther S, Laird Laura, Wilson Carlee et al (2021) Implementation and Effects of an Information Technology-Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial. JMIR research protocols 10(7): e30621 [PMC free article: PMC8285741] [PubMed: 34255727]	- Study design not relevant to this review protocol
Kinast B.; Lutz M.; Schreiweis B. (2021) Telemonitoring of real-world health data in cardiology: A systematic review. International Journal of Environmental Research and Public Health 18(17): 9070 [PMC free article: PMC8431660] [PubMed: 34501659]	- Population not relevant to this review protocol
Kirkness C.J., Becker K.J., Cain K.C. et al (2015) Telephone versus in-person psychosocial behavioral treatment in post-stroke depression. Stroke 46(suppl1)	- Conference abstract
Knepley Kurt D, Mao Jennifer Z, Wieczorek Peter et al (2021) Impact of Telerehabilitation for Stroke-Related Deficits. Telemedicine journal and e-health: the official journal of the American Telemedicine Association 27(3): 239–246 [PubMed: 32326849]	- Systematic review used as source of primary studies
Koh Gerald Choon-Huat, Yen Shih Cheng, Tay Arthur et al (2015) Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial: protocol of a randomized clinical trial on tele-rehabilitation for stroke patients. BMC neurology 15: 161 [PMC free article: PMC4560876] [PubMed: 26341358]	- Study design not relevant to this review protocol
Koh Min Hyong, Yen Sheng-Che, Leung Lester Y et al (2021) Exploiting telerobotics for sensorimotor rehabilitation: a locomotor embodiment. Journal of neuroengineering and rehabilitation 18(1): 66 [PMC free article: PMC8059234] [PubMed: 33882949]	- Study does not contain an intervention relevant to this review protocol Intervention was delivered in person
Krpic Andrej; Savanovic Arso; Cikajlo Imre (2013) Telerehabilitation: remote multimedia-supported assistance and mobile monitoring of balance training outcomes can facilitate the clinical staff’s effort. International Journal of Rehabilitation Research 36(2) [PubMed: 23337324]	- Study does not contain an intervention relevant to this review protocol VR balance telerehabilitation involves 2 weeks hospital based treatment with assistance from the physiotherapist prior to being home based and only 1 week of the intervention is home based
Kulshrestha S., Agrawal M., Singh A.K. et al (2020) Post stroke rehabilitation using computer-based cognitive intervention (CBCI): A systematic review. Current Psychiatry Research and Reviews 16(2): 93–102	- Study does not contain an intervention relevant to this review protocol Computer-based intervention, not specifically telerehabilitation
Kuo Li-Chieh, Yang Kang-Chin, Lin Yu-Ching et al (2022) Internet of Things (IoT) Enables Robot-Assisted Therapy as a Home Program for Training Upper Limb Functions in Chronic Stroke: A Randomized Control Crossover Study. Archives of physical medicine and rehabilitation [PubMed: 36122608]	- Comparator in study does not match that specified in this review protocol Compares two home-based training programs (not a telerehabilitation program and an in person training program or usual care)
Lansberg Maarten G, Legault Catherine, MacLellan Adam et al (2022) Home-based virtual reality therapy for hand recovery after stroke. PM & R: the journal of injury, function, and rehabilitation 14(3): 320–328 [PubMed: 33773059]	- Study design not relevant to this review protocol Single arm trial
Latimer Nicholas R, Bhadhuri Arjun, Alshreef Abualbishr et al (2021) Self-managed, computerised word finding therapy as an add-on to usual care for chronic aphasia post-stroke: An economic evaluation. Clinical rehabilitation 35(5): 703–717 [PMC free article: PMC8073872] [PubMed: 33233972]	- Study design not relevant to this review protocol
Latimer Nicholas R; Dixon Simon; Palmer Rebecca (2013) Cost-utility of self-managed computer therapy for people with aphasia. International journal of technology assessment in health care 29(4): 402–9 [PubMed: 24290333]	- Study design not relevant to this review protocol
Laver K, George S, Thomas S et al (2012) Cochrane review: virtual reality for stroke rehabilitation. European journal of physical and rehabilitation medicine 48(3): 523–30 [PubMed: 22713539]	- Study does not contain an intervention relevant to this review protocol Discusses virtual reality, not explicitly telerehabilitation
Laver Kate; Walker Marion; Ward Nick (2022) Telerehabilitation for Stroke is Here to Stay. But at What Cost?. Neurorehabilitation and neural repair 36(6): 331–334 [PubMed: 35527716]	- Review article but not a systematic review
Lawson David W, Stolwyk Renerus J, Ponsford Jennie L et al (2020) Telehealth Delivery of Memory Rehabilitation Following Stroke. Journal of the International Neuropsychological Society: JINS 26(1): 58–71 [PubMed: 31983368]	- Study design not relevant to this review protocol Non-randomised study when there is a sufficient amount of randomised evidence
Lawson Sonia; Ziying Tang; Jinjuan Feng (2017) Supporting Stroke Motor Recovery Through a Mobile Application: A Pilot Study. American Journal of Occupational Therapy 71(3): 1–5 [PubMed: 28422641]	- Study design not relevant to this review protocol Single arm trial
Lazarus Gilbert, Permana Affan Priyambodo, Nugroho Setyo Widi et al (2020) Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta-analysis. Brain and behavior 10(10): e01787 [PMC free article: PMC7559631] [PubMed: 32812380]	- Systematic review used as source of primary studies
Lee Daegyun and Bae Youngsook (2022) Interactive Videogame Improved Rehabilitation Motivation and Walking Speed in Chronic Stroke Patients: A Dual-Center Controlled Trial. Games for health journal 11(4): 268–274 [PubMed: 35648053]	- Study does not contain an intervention relevant to this review protocol Computer-based tool delivered in hospital with therapist supervision (therefore not telerehabilitation)
Lee Jaime, Fowler Robert, Rodney Daniel et al (2010) IMITATE: An intensive computer-based treatment for aphasia based on action observation and imitation. Aphasiology 24(4): 449–465 [PMC free article: PMC2882655] [PubMed: 20543997]	- Study design not relevant to this review protocol
LeLaurin Jennifer H, Freytes I Magaly, Findley Kimberly E et al (2021) Feasibility and acceptability of a telephone and web-based stroke caregiver intervention: a pilot randomized controlled trial of the RESCUE intervention. Clinical rehabilitation 35(2): 253–265 [PubMed: 32907399]	- Comparator in study does not match that specified in this review protocol Compares a telephone and internet intervention to a telephone intervention (both telemedicine interventions)
Levy Tamina, Killington Maggie, Lannin Natasha et al (2021) Viability of using a computer tablet to monitor an upper limb home exercise program in stroke. Physiotherapy theory and practice 37(2): 331–341 [PubMed: 31172867]	- Study design not relevant to this review protocol Single arm substudy of a single arm cohort from a randomised controlled trial
Li Li, Huang Jia, Wu Jingsong et al (2020) A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial. JMIR mHealth and uHealth 8(5): e17219 [PMC free article: PMC7254286] [PubMed: 32401221]	- Comparator in study does not match that specified in this review protocol Compares two types of telerehabilitation (videoconference follow-up and telephone follow-up)
Li Z., Lei Y., Bui Q. et al (2022) A Technology-Augmented Intervention to Promote Self-Management Self-Efficacy among Persons with Stroke: A Pilot Feasibility Study. Archives of Physical Medicine and Rehabilitation 103(12): e195	- Conference abstract
Linder Susan M., Reiss Aimee, Buchanan Sharon et al (2013) Incorporating Robotic-Assisted Telerehabilitation in a Home Program to Improve Arm Function Following Stroke. Journal of Neurologic Physical Therapy 37(3): 125–132 [PMC free article: PMC4154939] [PubMed: 23872687]	- Study design not relevant to this review protocol
Linder Susan M, Rosenfeldt Anson B, Bay R Curtis et al (2015) Improving Quality of Life and Depression After Stroke Through Telerehabilitation. The American journal of occupational therapy: official publication of the American Occupational Therapy Association 69(2): 6902290020p1–10 [PMC free article: PMC4480056] [PubMed: 26122686]	- Study does not contain an intervention relevant to this review protocol Inpatients therapy not remotely delivered
Linder Susan M, Rosenfeldt Anson B, Reiss Aimee et al (2013) The home stroke rehabilitation and monitoring system trial: a randomized controlled trial. International journal of stroke: official journal of the International Stroke Society 8(1): 46–53 [PMC free article: PMC4362540] [PubMed: 23280269]	- Study design not relevant to this review protocol
Lio T.S., Uetake S., Bates T.R. et al (2021) An Australian stroke unit team's experience of recruitment to the AVERT DOSE trial during the COVID-19 pandemic. International Journal of Stroke 16(1suppl): 19	- Conference abstract
Liu X., Huang X., Lin J. et al (2018) Computer aided technology-based cognitive rehabilitation efficacy against patients' cerebral stroke. NeuroQuantology 16(4): 86–92	- Study does not contain an intervention relevant to this review protocol Inpatients therapy not remotely delivered
Lo Y.-P., Chiang S.-L., Lin C.-H. et al (2021) Effects of individualized aerobic exercise training on physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity: A randomized controlled trial. International Journal of Environmental Research and Public Health 18(1): 1–17 [PMC free article: PMC7794827] [PubMed: 33375668]	- Population not relevant to this review protocol
Lum PS, Uswatte G, Taub E et al (2006) A telerehabilitation approach to delivery of constraint-induced movement therapy. Journal of Rehabilitation Research and Development 43(3): 391–400 [PubMed: 17041824]	- Study design not relevant to this review protocol
Lundstrom E., Eriksson S., Holmback U. et al (2019) Effects of a short message service-guided training after acute stroke or TIA (STROKEWALK): A randomized controlled trial. European Geriatric Medicine 10(supplement1): 158–s159	- Conference abstract
Lutz Barbara J, Chumbler Neale R, Lyles Teresa et al (2009) Testing a home-telehealth programme for US veterans recovering from stroke and their family caregivers. Disability and rehabilitation 31(5): 402–9 [PubMed: 18720112]	- Study design not relevant to this review protocol Single arm trial
Lv Meina, Wu Tingting, Jiang Shaojun et al (2021) Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR mHealth and uHealth 9(6): e24116 [PMC free article: PMC8235282] [PubMed: 34114961]	- Systematic review used as source of primary studies
Lynch Elizabeth A, Jones Taryn M, Simpson Dawn B et al (2018) Activity monitors for increasing physical activity in adult stroke survivors. The Cochrane database of systematic reviews 7: cd012543 [PMC free article: PMC6513611] [PubMed: 30051462]	- Systematic review used as source of primary studies
Maasland E, Koudstaal P J, Habbema J D F et al (2007) Effects of an individualized multimedia computer program for health education in patients with a recent minor stroke or transient ischemic attack - a randomized controlled trial. Acta neurologica Scandinavica 115(1): 41–8 [PubMed: 17156264]	- Population not relevant to this review protocol Around 50% of people had a transient ischaemic attack
MacLeod G and Barlow I (2004) Tele-occupational therapy. Providing seating intervention in a rural setting through tele-health. Occupational Therapy Now 6(6): 3–5	- Study design not relevant to this review protocol Report only
Maddahi A, Bani Hani J, Asgari A et al (2021) Therapists' perspectives on a new portable hand telerehabilitation platform for home-based personalized treatment of stroke patients. European review for medical and pharmacological sciences 25(18): 5790–5800 [PubMed: 34604970]	- Population not relevant to this review protocol The population of interest were therapists
Maier Martina, Banuelos Nuria Leiva, Ballester Belen Rubio et al (2017) Conjunctive rehabilitation of multiple cognitive domains for chronic stroke patients in virtual reality. IEEE ... International Conference on Rehabilitation Robotics: [proceedings] 2017: 947–952 [PubMed: 28813943]	- Study does not contain an intervention relevant to this review protocol Discusses computer-based cognitive rehabilitation completed in hospital (therefore not telerehabilitation)
Mallet K., Shamloul R., Lecompte-Collin J. et al (2017) Telerehab for patients with post-stroke communication deficits using mobile technology: A randomized controlled trial. International Journal of Stroke 12(4supplement1): 18	- Conference abstract
Mallet Karen, Shamloul Rany, Pugliese Michael et al (2019) RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting. International journal of stroke: official journal of the International Stroke Society 14(2): 174–179 [PubMed: 30019633]	- Study design not relevant to this review protocol Single arm trial (collecting survey data)
Mallo-Lopez Ana, Fernandez-Gonzalez Pilar, Sanchez-Herrera-Baeza Patricia et al (2022) The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review. International journal of environmental research and public health 19(17) [PMC free article: PMC9517772] [PubMed: 36078665]	- Study does not contain an intervention relevant to this review protocol Assessment-based intervention
Manheim LM; Halper AS; Cherney L (2009) Patient-reported changes in communication after computer-based script training for aphasia. Archives of Physical Medicine and Rehabilitation 90(4): 623–7 [PubMed: 19345778]	- Study design not relevant to this review protocol Single arm trial
Marshall Jane, Caute Anna, Chadd Katie et al (2019) Technology-enhanced writing therapy for people with aphasia: results of a quasi-randomized waitlist controlled study. International journal of language & communication disorders 54(2): 203–220 [PubMed: 29749112]	- Study design not relevant to this review protocol
Marwaa Mille Nabsen, Guidetti Susanne, Ytterberg Charlotte et al (2022) Use of Mobile/Tablet and Web-Based Applications to Support Rehabilitation After Stroke: A Scoping Review. Journal of rehabilitation medicine 54: jrm00269 [PMC free article: PMC10348057] [PubMed: 35174871]	- Systematic review used as source of primary studies
Mawson SJ and Mountain GM (2011) The SMART rehabilitation system for stroke self-management: Issues and challenges for evidence-based health technology research. Journal of Physical Therapy Education 25(1): 48–53	- Review article but not a systematic review
Mayo NE, Nadeau L, Ahmed S et al (2008) Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke. Age and Ageing 37(1): 32–8 [PubMed: 18006510]	- Study does not contain an intervention relevant to this review protocol Study does not contain an intervention relevant to this review protocolStudy reported a passive case management intervention rather than a rehabilitation intervention which fell outside the scope of this review.(This study was included in the Cochrane review)
Mclaughlin M, Nam Y, Sanders S et al (2010) Virtual environments for stroke recovery: pilot clinicaltrials for user-centric patient/clinician distributionplatform with tele-rehabilitation application usinghaptics devices. International journal of stroke	- Full text paper not available
Mingming Ye, Bolun Zhao, Zhijian Liu et al (2022) Effectiveness of computer-based training on poststroke cognitive rehabilitation: A systematic review and meta-analysis. Neuropsychological rehabilitation 32(3): 481–497 [PubMed: 33092475]	- Study does not contain an intervention relevant to this review protocol Computer-based training not specific to telerehabilitation
Mirelman A (2007) Comparison of robotic-virtual reality lower extremity training with robotic lower extremity training alone for rehabilitation of gait of individuals post-stroke. Comparison of Robotic-virtual Reality Lower Extremity Training With Robotic Lower Extremity Training Alone for Rehabilitation of Gait of Individuals Post-stroke: 218p–218p	- Full text paper not available Dissertation, not available for order
Mirelman Anat; Bonato Paolo; Deutsch Judith E (2009) Effects of training with a robot-virtual reality system compared with a robot alone on the gait of individuals after stroke. Stroke 40(1): 169–74 [PubMed: 18988916]	- No relevant outcomes reported
Mitchell Claire, Bowen Audrey, Tyson Sarah et al (2018) ReaDySpeech for people with dysarthria after stroke: protocol for a feasibility randomised controlled trial. Pilot and feasibility studies 4: 25 [PMC free article: PMC5520339] [PubMed: 28748108]	- Study design not relevant to this review protocol
Moniche F, De La Torre Laviana FJ, Palomino García A et al (2012) Evaluation of telephone assessment in stroke and TIA recurrence. Neurologia (Barcelona, Spain) 27(2): 97–102 [PubMed: 21565432]	- Study design not relevant to this review protocol
Moulaei Khadijeh, Sheikhtaheri Abbas, Nezhad Mansour Shahabi et al (2022) Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods. Archives of public health = Archives belges de sante publique 80(1): 196 [PMC free article: PMC9400266] [PubMed: 35999548]	- Systematic review used as source of primary studies
Naqvi Imama A, Cheung Ying Kuen, Strobino Kevin et al (2022) TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting. Pilot and feasibility studies 8(1): 81 [PMC free article: PMC8995696] [PubMed: 35410312]	- Study design not relevant to this review protocol
Obembe A.; Odole A.; Akinnawo A. (2021) The role of telehealth physical therapy in stroke: A systematic review. International Journal of Stroke 16(2suppl): 149	- Conference abstract
Ora Hege Prag, Kirmess Melanie, Brady Marian C et al (2020) Technical Features, Feasibility, and Acceptability of Augmented Telerehabilitation in Post-stroke Aphasia-Experiences From a Randomized Controlled Trial. Frontiers in neurology 11: 671 [PMC free article: PMC7411384] [PubMed: 32849176]	- Data not reported in an extractable format or a format that can be analysed
Ortiz-Fernandez Leire, Sagastagoya Zabala Joana, Gutierrez-Ruiz Agustin et al (2019) Efficacy and Usability of eHealth Technologies in Stroke Survivors for Prevention of a New Stroke and Improvement of Self-Management: Phase III Randomized Control Trial. Methods and protocols 2(2) [PMC free article: PMC6632173] [PubMed: 31200541]	- Study design not relevant to this review protocol
Ostrowska Paulina Magdalena, Sliwinski Maciej, Studnicki Rafal et al (2021) Telerehabilitation of Post-Stroke Patients as a Therapeutic Solution in the Era of the Covid-19 Pandemic. Healthcare (Basel, Switzerland) 9(6) [PMC free article: PMC8229171] [PubMed: 34072939]	- Systematic review used as source of primary studies
Paik S.M. and Cramer S.C. (2021) Patients most likely to benefit from home-based telerehabilitation after stroke. Stroke 52(suppl1)	- Conference abstract
Penaloza Claudia, Scimeca Michael, Gaona Angelica et al (2021) Telerehabilitation for Word Retrieval Deficits in Bilinguals With Aphasia: Effectiveness and Reliability as Compared to In-person Language Therapy. Frontiers in neurology 12: 589330 [PMC free article: PMC8172788] [PubMed: 34093382]	- Comparator in study does not match that specified in this review protocol Compares treatment delivered using a computer based model that determines the optimal language to use for therapy compared to the same computer based model but using the non-optimal language for therapy instead
Pfeiffer Klaus, Beische Denis, Hautzinger Martin et al (2014) Telephone-based problem-solving intervention for family caregivers of stroke survivors: a randomized controlled trial. Journal of consulting and clinical psychology 82(4): 628–43 [PubMed: 24911421]	- Study does not contain an intervention relevant to this review protocol Telephone intervention but not rehabilitation (more a problem solving intervention) therefore not telerehabilitation
Pignolo L., Arabia G., Contrada M. et al (2021) Clinical efficacy of cognitive stimulation in aged subjects with mild and moderate cognitive impairment. European Geriatric Medicine 12(suppl1): 114	- Conference abstract
Poulsen M.B., Badawey J., Anhoj M. et al (2016) Early web-based tele-rehabilitation in stroke patients: A randomised controlled pilot study. European Journal of Neurology 23(suppl2): 460	- Conference abstract
Qu Y (2015) Effectiveness, safety and cost efficiency of telerehabilitation for stroke patients in hospital and home.	- Full text paper not available Clinical trial record
Ramage E.R., Fini N.A., Lynch E.A. et al (2021) Supervised exercises in standing positions delivered via telehealth for people with stroke to provide access to therapy in the context of COVID-19. Solution or compromise?. International Journal of Stroke 16(1suppl): 25–26	- Conference abstract
Redzuan Nor Shahizan, Engkasan Julia P, Mazlan Mazlina et al (2012) Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial. Archives of physical medicine and rehabilitation 93(12): 2177–83 [PubMed: 22789773]	- Study does not contain an intervention relevant to this review protocol No two way communication channel for patient to communicate with therapist
Rochette A., Korner-Bitensky N., Bishop D. et al (2013) The YOU CALL-WE CALL randomized clinical trial impact of a multimodal support intervention after a mild stroke. Circulation: Cardiovascular Quality and Outcomes 6(6): 674–679 [PubMed: 24221841]	- Study does not contain an intervention relevant to this review protocol Telephone intervention but not specifically rehabilitation (not education) therefore this was not deemed to be a rehabilitation intervention so fell outside the scope of this review.(This study was included in the Cochrane review)
Saal Susanne, Becker Christiane, Lorenz Silke et al (2015) Effect of a stroke support service in Germany: a randomized trial. Topics in stroke rehabilitation 22(6): 429–36 [PubMed: 25920942]	- Study does not contain an intervention relevant to this review protocol Telephone intervention but not specifically rehabilitation (more case management support) therefore this was not deemed to be a rehabilitation intervention so fell outside the scope of this review.(This study was included in the Cochrane review)
Sakakibara Brodie M, Lear Scott A, Barr Susan I et al (2022) Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach. International journal of stroke: official journal of the International Stroke Society 17(4): 455–464 [PubMed: 33949270]	- Comparator in study does not match that specified in this review protocol Compares two different types of telerehabilitation (both approaches involve telephone follow up and intervention of different forms, which are not relevant comparisons for this review)
Saposnik Gustavo, Chow Chi-Ming, Gladstone David et al (2014) iPad technology for home rehabilitation after stroke (iHOME): a proof-of-concept randomized trial. International journal of stroke: official journal of the International Stroke Society 9(7): 956–62 [PubMed: 25042159]	- Study design not relevant to this review protocol
Say Well N.; Vandal A.C.; Taylor D. (2017) Augmented community telerehabilitation intervention to improve outcomes for people with stroke AKTIV-a randomised controlled trial. Cerebrovascular Diseases 43(supplement1): 166	- Conference abstract
Saywell Nicola, Vandal Alain C, Brown Paul et al (2012) Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial. Trials 13: 233 [PMC free article: PMC3543302] [PubMed: 23216861]	- Study design not relevant to this review protocol
Schroder Jonas, van Criekinge Tamaya, Embrechts Elissa et al (2019) Combining the benefits of telerehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness. Disability and rehabilitation. Assistive technology 14(1): 2–11 [PubMed: 30318952]	- Systematic review used as source of primary studies
Shamloul R (2015) TeleRehab for Stroke Patients Using Mobile Technology.	- Full text paper not available Clinical trial record
Shin Doo-Chul (2020) Smartphone-based visual feedback trunk control training for gait ability in stroke patients: A single-blind randomized controlled trial. Technology and health care: official journal of the European Society for Engineering and Medicine 28(1): 45–55 [PubMed: 31104034]	- Study does not contain an intervention relevant to this review protocol Technology-based intervention, but not telerehabilitation as conducted in hospital rather than over a distance and conducted with healthcare professional involvement
Srinivasan V., Maruthey N., Suganthirababu P. et al (2022) Efficacy of self-monitoring virtual feedback exercises for upper motor neuron facial palsy. A double blinded randomized control study. European Journal of Molecular and Clinical Medicine 9(8): 471–479	- Study does not contain an intervention relevant to this review protocol Computer-based therapy but the app does not allow for communication with a therapist during therapy or for feedback from a therapist during the process
Szturm T, Imran Z, Gandhi DB C et al (2018) Telerehabilitation using a game-assisted repetitive task practice platform to improve upper extremity function after stroke: feasibility study. International journal of stroke 13(2supplement1): 50	- Conference abstract
Tan CO (2020) Is remote rehabilitation after stroke as effective as conventional therapy?. Neurology 95(17): e2462–e2464 [PubMed: 33106363]	- Study design not relevant to this review protocol
Taylor D., Saywell N., Mudge S. et al (2018) Telerehabilitation can improve outcomes after stroke; but only if you do it. International Journal of Stroke 13(2supplement1): 235	- Conference abstract
Tenforde Adam S., Zafonte Ross, Hefner Jaye et al (2020) Evidence-Based Physiatry: Efficacy of Home-Based Telerehabilitation Versus In-Clinic Therapy for Adults After Stroke. American Journal of Physical Medicine & Rehabilitation 99(8): 764–765 [PubMed: 32433244]	- Study design not relevant to this review protocol
Thompson-Butel A.; Woodbridge G.; Faux S. (2017) A telehealth transfer package to improve upperlimb rehabilitation post-stroke - The protocol. International Journal of Stroke 12(3supplement1): 58	- Conference abstract
Torrisi Michele, Maresca Giuseppa, Cola De, Cristina Maria et al (2019) Using telerehabilitation to improve cognitive function in post-stroke survivors: is this the time for the continuity of care?. International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 42(4): 344–351 [PubMed: 31464812]	- No relevant outcomes reported
Tousignant M (2013) A Randomized, Non-inferiority Clinical Trial of CVA Telerehabilitation Treatments - TelePhysioTaiChi.	- Full text paper not available
Tousignant M.; Macoir J.; Martel-Sauvageau V. (2016) In-home telerehabilitation for speech therapy with patients presenting chronic post-stroke aphasia: Are the patients satisfied with the treatment received?. Cerebrovascular Diseases 41(suppl1): 308	- Conference abstract
Tousignant Michel, Corriveau Helene, Kairy Dahlia et al (2014) Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial. Trials 15: 42 [PMC free article: PMC3912257] [PubMed: 24479760]	- Study design not relevant to this review protocol Protocol only
Vallentin T., Packham T., Fleck R. et al (2018) Integrating telepractice into post-stroke hospital-based outpatient rehabilitation: A pilot study. International Journal of Stroke 13(2supplement1): 173	- Conference abstract
van den Berg Maayken, Crotty Maria Prof, Liu Enwu et al (2016) Early Supported Discharge by Caregiver-Mediated Exercises and e-Health Support After Stroke: A Proof-of-Concept Trial. Stroke 47(7): 1885–92 [PubMed: 27301941]	- Study does not contain an intervention relevant to this review protocol Intervention began in hospital with career and only completed remotely if patients were DC
Vauth F., Richter J., Scibor M. et al (2016) Tele online therapy in patients with aphasia after stroke. 35: 119–124	- Study not reported in English Included in the cochrane review but no useable outcomes reported
Wan Li-Hong, Zhang Xiao-Pei, Mo Miao-Miao et al (2016) Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 25(9): 2259–70 [PubMed: 27371106]	- No relevant outcomes reported Reports modified Rankin scale and health behaviour scores (no relevant outcomes to the protocol) This study was included in the Cochrane review
Whelan B.-M., Theodoros D., Cahill L. et al (2022) Feasibility of a Telerehabilitation Adaptation of the Be Clear Speech Treatment Program for Non-Progressive Dysarthria. Brain Sciences 12(2): 197 [PMC free article: PMC8870717] [PubMed: 35203960]	- Study design not relevant to this review protocol
Woolf Celia, Caute Anna, Haigh Zula et al (2016) A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: a quasi-randomised controlled feasibility study. Clinical rehabilitation 30(4): 359–73 [PubMed: 25911523]	- Study design not relevant to this review protocol
Worthen-Chaudhari, Lise (2015) Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial. Archives of physical medicine and rehabilitation 96(8): 1544 [PubMed: 26216402]	- Study design not relevant to this review protocol
Yosef A.B., Jacobs J.M., Shames J. et al (2022) A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study. Brain Sciences 12(2): 213 [PMC free article: PMC8870671] [PubMed: 35203976]	- No relevant outcomes reported
Zhang L., Yan Y.-N., Sun Z.-X. et al (2022) Effects of Coaching-Based Teleoccupational Guidance for Home-Based Stroke Survivors and Their Family Caregivers: A Pilot Randomised Controlled Trial. International Journal of Environmental Research and Public Health 19(23): 16355 [PMC free article: PMC9739622] [PubMed: 36498427]	- Comparator in study does not match that specified in this review protocol Compares two different types of telerehabilitation
Zhang Li, Yan Yanning, Sun Zengxin et al (2022) Coaching-Based Teleoccupational Guidance for Home-Based Stroke Survivors and Their Family Caregivers: Study Protocol for a Superior Randomized Controlled Trial. Evidence-based complementary and alternative medicine: eCAM 2022: 9123498 [PMC free article: PMC9423950] [PubMed: 36045653]	- Study design not relevant to this review protocol

J.2. Health Economic studies

Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.

Table 17Studies excluded from the health economic review

Reference	Reason for exclusion
None.

Appendix K. Recommendation for research – full details

K.1. Recommendation for research

What is the impact of telerehabilitation on cognition and mood for people after stroke?

K.1.1. Why this is important

Telerehabilitation as a method of delivering stroke rehabilitation services is becoming increasingly used in clinical practice. This was in part due to the COVID-19 pandemic with many stroke services now employing this method of delivery as standard practice. Evidence from this review showed that telerehabilitation delivered in various formats and by different members of the multidisciplinary team can be just as effective as face-to-face rehabilitation. However, there was an unexplained increase in depression reported by several outcomes in people who participated in telerehabilitation. Additionally, there appeared to be a lack of efficacy in a number of cognitive outcomes for people receiving cognitive therapy. The committee agreed that research examining the effect of these interventions on mood and cognition is required. They also suggested that qualitative research to capture the experiences of the person after stroke and those involved in their life would be beneficial.

K.1.2. Rationale for the recommendation for research

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K.1.3. Modified PICO table

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Final version

Evidence reviews underpinning recommendations 1.3.1 to 1.3.3 and recommendations for research in the NICE guideline

This evidence review was developed by NICE

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.

Bookshelf ID: NBK600502PMID: 38377266

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Evidence reviews for the clinical and cost-effectiveness of telerehabilitation for adults after a stroke: Stroke rehabilitation in adults (update): Evidence review G. London: National Institute for Health and Care Excellence (NICE); 2023 Oct. (NICE Guideline, No. 236.)
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Evidence reviews for the clinical and cost-effectiveness of telerehabilitation for adults after a stroke

1. Telerehabilitation

1.1. Review question

1.1.1. Introduction

1.1.2. Summary of the protocol

1.1.3. Methods and process

1.1.4. Effectiveness evidence

1.1.4.1. Included studies

Intervention factors

Population factors

Inconsistency

1.1.4.2. Excluded studies

1.1.5. Summary of studies included in the effectiveness evidence

1.1.6. Summary of the effectiveness evidence

1.1.6.1. Telerehabilitation compared to in person rehabilitation and usual care

1.1.6.2. Combination of telerehabilitation and in person rehabilitation compared to in person rehabilitation and usual care

1.1.7. Economic evidence

1.1.7.1. Included studies

1.1.7.2. Excluded studies

1.1.8. Summary of included economic evidence

1.1.9. Economic model

1.1.10. Unit costs

1.1.11. Evidence statements

1.1.11.2. Economic

1.1.12. The committee’s discussion and interpretation of the evidence

1.1.12.1. The outcomes that matter most

1.1.12.2. The quality of the evidence

1.1.12.3. Benefits and harms

Telerehabilitation compared to in person rehabilitation and usual care

Combined telerehabilitation compared to in person rehabilitation and usual care

1.1.12.4. Cost effectiveness and resource use

1.1.12.5. Other factors the committee took into account

1.1.13. Recommendations supported by this evidence review

1.1.14. References

Appendices

Appendix A. Review protocols

A.1. Review protocol for the clinical and cost effectiveness of telerehabilitation

A.2. Health economic review protocol

Appendix B. Literature search strategies

B.1. Clinical search literature search strategy

B.2. Health Economics literature search strategy

Appendix C. Effectiveness evidence study selection

Appendix D. Effectiveness evidence

Appendix E. Forest plots

Appendix F. GRADE tables

Appendix G. Economic evidence study selection

Appendix H. Economic evidence tables

Appendix I. Health economic model

Appendix J. Excluded studies

J.1. Clinical studies

Table 16Studies excluded from the clinical review

J.2. Health Economic studies

Table 17Studies excluded from the health economic review

Appendix K. Recommendation for research – full details

K.1. Recommendation for research

K.1.1. Why this is important

K.1.2. Rationale for the recommendation for research

K.1.3. Modified PICO table

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