Telerehabilitation: a comprehensive approach to functionality and quality of life in stroke, multiple sclerosis, and Parkinson's disease

In the context of the rapidly advancing field of neurological rehabilitation, where technological and methodological advancements are pioneering new frontiers, telerehabilitation (TR) stands out as an innovative and promising solution. Stroke, Multiple Sclerosis (MS), and Parkinson's disease (PD) are prevalent neurological conditions that significantly impact individuals' quality of life (QoL). Traditional therapy plays a crucial role in managing these conditions, but access to in-person therapy can be limited due to geographical barriers, transportation challenges, and physical limitations. TR offers a promising alternative by delivering therapy remotely using telecommunication technologies. This thesis investigated the development and evaluation of a TR model for neurological rehabilitation, specifically targeting individuals affected by stroke, MS, and PD. The research comprised three main studies: 1) a systematic review and meta-analysis on the perceived QoL following physiotherapy treatments delivered via TR; 2) a longitudinal pilot study assessing the effects of a multimodal TR protocol with various clinical treatments; and 3) a pilot randomized controlled trial (RCT) evaluating the clinical impact on balance improvement, along with satisfaction and usability assessments. The first study, a comprehensive systematic review and meta-analysis, were conducted to assess the effectiveness of TR on motor function and QoL in neurological patients. Out of 1,092 initially identified articles, 28 articles underwent qualitative analysis, and 16 were included for quantitative analysis. TR appeared safe, feasible, and comparable to face-to-face interventions. Post-TR, a significant improvement in QoL was observed in stroke patients [SMD (95% C.I) = 0.41 (0.12, −0.70), I² = 68%]. Analyses for satisfaction and technology acceptance outcomes were hindered by insufficient data. For PD and MS, TR shows comparable efficacy to in-person treatment. The second study, examined the potential benefits of an integrated TR system for stroke survivors, evaluating its impact on motor function, speech and language and cognitive function. A total of 84 stroke survivors participated in the study, with data from 74 ultimately included for analysis. Each participant received 20 individualized therapy sessions per treatment domain, specifically designed to address their unique impairments and cater to their specific needs. Positive correlations were found between initial motor function, cognitive status, independence in activities of daily living (ADLs), and motor function improvement after TR. A lower initial health-related quality of life (HRQoL) perception hindered progress, but improved ADL independence and overall health status, and reduced depression correlated with a better QoL. Furthermore, post-treatment improvements were observed in the entire sample in terms of fine motor skills, upper-limb functionality, balance, independence, and cognitive impairment. This multi-modal approach demonstrated promise in augmenting stroke rehabilitation outcomes. These findings highlight the potential of TR to address the complex needs of stroke survivors through the implementation of a comprehensive support system and interdisciplinary collaboration, tailored to each individual's specific requirements. The third study, a pilot-RCT with a single-blind design, investigated the efficacy of TR in improving balance and explored patient perspectives on TR in individuals with chronic neurological diseases. Forty-one consecutive participants with MS (n=19), stroke (n=9), or PD (n=13) were enrolled and randomly assigned to either the TR group (EG) or the control group (CG). The CG performed self-administered exercises at home based on physiotherapist instructions. Both groups received 20 one-hour sessions over four weeks. The study observed a statistically significant improvement in overall balance within the EG group, as measured by the Mini-BESTest (MBT) Total score (W=161; p=0.037). Due to sample size limitations, not all planned subgroup analyses were possible, preventing statistically significant comparisons across all variables. However, significant improvements in physical role (V=87.5; p=0.028) and general health (V=118.5; p=0.049) domains of the SF-36 health survey were also observed in the overall sample, favouring the EG group. User Experience (UX): High System usability scale (SUS) scores (90.3) indicated user satisfaction and positive UX. Users reported the system as easy to use, well-integrated, and expressed confidence and willingness for frequent use. Correlations between perceived usefulness and perceived acceptance highlighted their importance for TR system adoption. Given the relatively small sample size and the high heterogeneity due to the inclusion of individuals with different pathologies, these data, while promising and positive, should be interpreted with caution. This thesis provides encouraging evidence that TR may be an effective approach to neurological rehabilitation. However, further research with larger and more diverse samples is needed to confirm these findings and establish the generalizability of TR across different neurological conditions.