RESEARCH/Original article
The status of telerehabilitation in neurological applications
Journal of Telemedicine and Telecare 19(6) 307–310 ! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1357633X13501775 jtt.sagepub.com
David Hailey1, Risto Roine2, Arto Ohinmaa3,4 and Liz Dennett3
Summary We systematically reviewed the evidence for the effectiveness of tele-neurorehabilitation (TNR) applications. The review included recent reports on rehabilitation for any disability associated with a neurological deficit or condition. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each application had been successful, and whether further data were needed to establish the application as suitable for routine use. Nineteen credible studies that reported patient outcomes or administrative changes were identified. These studies related to 13 conditions. The focus of rehabilitation included Internet-supported treatments for management of fatigue, pain and depression; promotion of physical activity; and speech therapy. Sixteen studies were of high or good quality and three were fair to good, with some limitations. In 13 of the 19 studies the TNR application was successful in providing at least equivalent outcomes to conventional approaches. Additional work would be needed on eight applications to establish suitability for routine use, and would be desirable in five. Thus the recent literature provides further support for TNR applications, showing the promise of this field in a number of areas. However, the database of credible studies remains small. Accepted: 26 June 2013
Introduction Telerehabilitation is the provision of rehabilitation services at a distance using telecommunications as the delivery medium.1 In a previous review we found that telerehabilitation showed promise in many fields, although strong evidence of benefit was limited, and few studies considered how these approaches might be integrated into health care systems.2 Studies dealing with tele-neurological rehabilitation (TNR) were the most numerous of those we reviewed. Reviews of telerehabilitation have noted the promise in this field, and the limited available evidence of benefit. Kairy et al. concluded that high-quality evidence regarding the effect of telerehabilitation on resource allocation and costs is still needed to support clinical and policy decision-making.3 Rogante et al. have referred to a lack of comprehensive studies providing evidence for supporting decision and policy-makers in adopting technologies in clinical practice.4 The theme of promise but limited evidence has also been taken up with respect to TNR in care of stroke survivors.5 The aim of the present study was to obtain an overview of progress in TNR. As in our previous review, our focus was on papers that reported health-related outcomes for patients and/ or caregivers.
Initial screening of identified articles was based on the information obtained from their abstracts, which were read independently by at least two reviewers. Further selection of relevant articles was agreed by consensus. When an abstract did not give sufficiently precise information about the study, the article was obtained for further review. Each full-text article obtained was evaluated independently by at least two reviewers, who reached a consensus on whether an article should be included in the final review. Data were extracted independently from each of the selected publications and any disagreements resolved by consensus. Information extracted included the study objectives, design, type of comparison with the TNR intervention, setting and duration, patient numbers and characteristics, and reported outcomes. Literature searches were performed using the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL databases to January 2012. There was no 1 School of Information Systems and Technology, University of Wollongong, Australia 2 Helsinki and Uusimaa Hospital Group, Helsinki, Finland 3 Institute of Health Economics, Edmonton, Alberta, Canada 4 Department of Public Health Sciences, University of Alberta, Edmonton, Canada
Methods We developed a protocol for the review following approaches taken in previous telemedicine reviews.
Corresponding author: Dr David Hailey, 22 Sinclair Street, Kambah, ACT 2902, Australia. Email: dhailey@ ozemail.com.au
308
Journal of Telemedicine and Telecare 19(6)
language restriction. The complete search strategy is available from the authors. Articles were selected which described, in a scientifically valid manner, studies reporting clinical or administrative outcomes for patients or caregivers using telerehabilitation applications in the management of neurological disorders. We included articles describing controlled studies in which TNR was compared with a non-TNR alternative, and those on non-controlled series in which there were 20 or more subjects. We excluded studies in which the only outcome measures were related to satisfaction with TNR, reports on technical development or feasibility of a rehabilitation technology and studies identified in the previous review. Strength of evidence was assessed with an approach used in previous telemedicine reviews that takes account of both study design and study performance. This provides five ratings of study quality and implications for decision Table 1. Study quality and implications for decision making.6 Study quality
Implications for decision making
A. High B. Good C. Fair to good
High degree of confidence in study findings Some uncertainty regarding study findings Some limitations that should be considered in any implementation of study findings Substantial limitations in the study, findings should be used cautiously Unacceptable uncertainty for study findings
D. Poor to fair E. Poor
makers.6 Study designs included large randomized controlled trials (RCTs) with at least 50 subjects in each arm, smaller RCTs, prospective non-randomized studies, retrospective comparative studies and non-comparative series. For study performance, the areas considered were patient selection, description of the interventions, specification and analysis of the study, patient disposition and reported outcomes. On the basis of scores for study design and performance, each study was assigned to one of five categories to indicate the reliability of its findings (Table 1). Judgements were made on whether the reviewed publications indicated that the TNR applications had been successful. Success was defined in terms of whether the application had performed at least as well as a similar alternative intervention. The principal summary measure was the difference in means of intervention outcomes. For comparative studies, where the interventions in each group were similar, TNR was considered successful when it provided better or equivalent outcomes to those for the comparator. In studies where the TNR intervention included additional resources to those of the comparator intervention, it was considered successful when it provided better outcomes. For each paper, we judged whether additional data to those reported were needed to establish the TNR method as suitable for routine use. ‘Yes’ indicated substantial limitations in the available evidence. ‘Desirable’ referred to studies of adequate quality, with reasonable evidence of success, where further work was required to confirm the findings. ‘No’ indicated either studies that had provided a
Table 2. Study design, quality and outcome status. Authors
Condition or symptom
Study design and quality *
Successful?
Further study?
Chumbler et al., 20127 Pierce et al., 20098 Bell et al., 20119 Fish et al., 200710 Soong et al., 200511 Bombardier et al., 200812 Mohr et al., 200713 Motl et al., 201114 Kowalczewski et al., 201115 Gitlin et al., 201016 Andersson et al., 200317 Dilorio et al., 200918 Constantinescu et al., 201119 Carey et al., 201020 Kosterink et al., 201021 Knoop et al., 200822 Ghahari et al., 201023 Vitacca et al., 201024 Maher et al., 201025
Stroke
RCT, A RCT, B RCT, A Within-subject comparison, B RCT, C RCT, A RCT, A RCT, A RCT crossover, A RCT, A RCT, B Observational, B RCT, A RCT, A RCT, C RCT, A RCT, C Observational, B RCT, B
Yes Yes No Yes No Yes Yes Yes Yes Yes No Unclear Yes Yes Yes Yes No Yes Unclear
Desirable No - established No – not effective Yes Yes Yes Desirable Yes Yes No - established No-not effective Yes Desirable No - established Yes Desirable No – not effective Desirable Yes
Brain injury
Multiple sclerosis
Spinal cord injury Dementia Headache Epilepsy Speech disorder Neck and shoulder pain Fatigue Amyotrophic lateral sclerosis Cerebral palsy
*RCT: randomized controlled trial; Study quality: A ¼ High, B ¼ Good, C ¼ Fair to good.
Hailey et al. strong indication that TNR was suitable for routine use, and for those where an intervention was clearly unsuccessful. Factors considered included the success and clinical significance of the TNR application, its stage of development, the size and composition of the population that was studied and the length of follow up following initiation of rehabilitation.
Results From 1850 publications identified in the literature search, 693 had been considered in the previous review2 and included the articles on TNR that were identified in that work; these were not considered in the present study. Of the remainder, 106 were retrieved for closer inspection. Nineteen papers that were not in the previous review met the selection criteria and were included in the review.7–25 Sixteen of the studies (84%) were of high or good quality and three were fair to good (Table 2). An overview of judgements for the reviewed TNR studies is also given in Table 2. Thirteen of the applications were successful, for two the status was unclear and four were unsuccessful. Further study was judged to be required for eight of the TNR applications and desirable for five. For three applications further study was not needed as there was sufficiently strong supporting evidence. For another three, additional research appeared unnecessary as the interventions were clearly not effective. Further details of the reviewed studies are given in Table 3 (see online archive). Most of them reported clinical outcomes, including physical improvement, mental health and social measures. Three studies were concerned with influence on the use of health services, and two studies included a focus on caregivers. Telephonebased applications were considered in 47% of the studies. Two of the Internet-based interventions used specialised functional electrical stimulation and myofeedback approaches.
Discussion Our previous review included 18 TNR studies on management of stroke, brain injury and multiple sclerosis.2 Using broad selection criteria, which included all types of study design, we located 19 more recent studies on all areas of TNR, which dealt with 13 different conditions. Thus the database for studies that provide useful information on clinical outcomes is still small. As found in our previous review, telephone-based interventions were used in many of the studies that were identified, most of the rest using the Internet. Use of virtual reality approaches may be an important future development in TNR. We identified several studies on the use of virtual reality in neurorehabilitation, but none of these were in a telemedicine context, with remote diagnosis or
309 treatment of patients by means of telecommunications technology. In most of the comparative studies the intervention provided through TNR was more elaborate than that in the comparator. Typically, patients were contacted more frequently or provided with additional services. Such studies may demonstrate benefits that are related to use of a more elaborate intervention, rather than to the method of delivery. Overall, we judged that TNR had been shown to be successful in 13 (68%) of the studies. Further work would be needed for eight of the applications to establish their suitability for routine use, and would be desirable for a further five. The recent literature provides further support for teleneurorehabilitation applications, showing the promise of this field in a number of areas. Additional, good quality longer term studies are needed to establish the performance of TNR methods in routine practice and provide a stronger information base for providers and funders of rehabilitation services. References 1. Russell TG. Physical rehabilitation using telemedicine. J Telemed Telecare 2007;13:217–20. 2. Hailey D, Roine R, Ohinmaa A, Dennett L. Evidence of benefit from telerehabilitation in routine care: a systematic review. J Telemed Telecare 2011;17:281–7. 3. Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009;31:427–47. 4. Rogante M, Grigioni M, Cordella D, Giacomozzi C. Ten years of telerehabilitation: A literature overview of technologies and clinical applications. NeuroRehabilitation 2010;27:287–304. 5. Johansson T, Wild C. Telerehabilitation in stroke care – a systematic review. J Telemed Telecare 2011;17:1–6. 6. Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare 2004;10:318–24. 7. Chumbler NR, Quigley P, Li X, et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke 2012;43:2168–74. 8. Pierce LL, Steiner VL, Khuder SA, Govoni AL, Horn LJ. The effect of a Web-based stroke intervention on carers’ well-being and survivors’ use of healthcare services. Disabil Rehabil 2009;31:1676–84. 9. Bell KR, Brockway JA, Hart T, et al. Scheduled telephone intervention for traumatic brain injury: a multicenter randomized controlled trial. Arch Phys Med Rehabil 2011;92:1552–60. 10. Fish J, Evans JJ, Nimmo M, Martin E, Kersel D, Bateman A, Wilson BA, Manly T. Rehabilitation of executive dysfunction following brain injury: ‘‘content-free’’ cueing improves everyday prospective memory performance. Neuropsychologia 2007;45:1318–30. 11. Soong YLW. Evaluating the effect of an on-line computer assisted cognitive rehabilitation programme. PhD thesis. Hong Kong Polytechnic University, 2004.
310 12. Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, Kraft GH. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil 2008;89:1849–56. 13. Mohr DC, Hart S, Vella L. Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy. Health Psychol 2007;26:554–63. 14. Motl RW, Dlugonski D, Wo´jcicki TR, McAuley E, Mohr DC. Internet intervention for increasing physical activity in persons with multiple sclerosis. Mult Scler 2011;17:116–28. 15. Kowalczewski J, Chong SL, Galea M, Prochazka A. Inhome tele-rehabilitation improves tetraplegic hand function. Neurorehabil Neural Repair 2011;25:412–22. 16. Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA 2010;304:983–91. 17. Andersson G, Lundstro¨m P, Stro¨m L. Internet-based treatment of headache: does telephone contact add anything? Headache 2003;43:353–61. 18. DiIorio C, Escoffery C, McCarty F, et al. Evaluation of WebEase: an epilepsy self-management Web site. Health Educ Res 2009;24:185–97. 19. Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson’s disease online: a randomized
Journal of Telemedicine and Telecare 19(6)
20.
21.
22.
23.
24.
25.
controlled non-inferiority trial. Int J Lang Commun Disord 2011;46:1–16. Carey B, O’Brian S, Onslow M, Block S, Jones M, Packman A. Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program. Int J Lang Commun Disord 2010;45:108–20. Kosterink SM, Huis in ‘t Veld RM, Cagnie B, Hasenbring M, Vollenbroek-Hutten MM. The clinical effectiveness of a myofeedback-based teletreatment service in patients with non-specific neck and shoulder pain: a randomized controlled trial. J Telemed Telecare 2010;16:316–21. Knoop H, van der Meer JW, Bleijenberg G. Guided selfinstructions for people with chronic fatigue syndrome: randomised controlled trial. Br J Psychiatry 2008;193:340–1. Ghahari S, Packer TL, Passmore AE. Effectiveness of an online fatigue self-management programme for people with chronic neurological conditions: a randomized controlled trial. Clin Rehabil 2010;24:727–44. Vitacca M, Comini L, Tentorio M, et al. A pilot trial of telemedicine-assisted, integrated care for patients with advanced amyotrophic lateral sclerosis and their caregivers. J Telemed Telecare 2010;16:83–8. Maher CA, Williams MT, Olds T, Lane AE. An internetbased physical activity intervention for adolescents with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2010;52:448–55.
The status of telerehabilitation in neurological applications
Journal of Telemedicine and Telecare 19(6) 307–310 ! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1357633X13501775 jtt.sagepub.com
David Hailey1, Risto Roine2, Arto Ohinmaa3,4 and Liz Dennett3
Summary We systematically reviewed the evidence for the effectiveness of tele-neurorehabilitation (TNR) applications. The review included recent reports on rehabilitation for any disability associated with a neurological deficit or condition. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each application had been successful, and whether further data were needed to establish the application as suitable for routine use. Nineteen credible studies that reported patient outcomes or administrative changes were identified. These studies related to 13 conditions. The focus of rehabilitation included Internet-supported treatments for management of fatigue, pain and depression; promotion of physical activity; and speech therapy. Sixteen studies were of high or good quality and three were fair to good, with some limitations. In 13 of the 19 studies the TNR application was successful in providing at least equivalent outcomes to conventional approaches. Additional work would be needed on eight applications to establish suitability for routine use, and would be desirable in five. Thus the recent literature provides further support for TNR applications, showing the promise of this field in a number of areas. However, the database of credible studies remains small. Accepted: 26 June 2013
Introduction Telerehabilitation is the provision of rehabilitation services at a distance using telecommunications as the delivery medium.1 In a previous review we found that telerehabilitation showed promise in many fields, although strong evidence of benefit was limited, and few studies considered how these approaches might be integrated into health care systems.2 Studies dealing with tele-neurological rehabilitation (TNR) were the most numerous of those we reviewed. Reviews of telerehabilitation have noted the promise in this field, and the limited available evidence of benefit. Kairy et al. concluded that high-quality evidence regarding the effect of telerehabilitation on resource allocation and costs is still needed to support clinical and policy decision-making.3 Rogante et al. have referred to a lack of comprehensive studies providing evidence for supporting decision and policy-makers in adopting technologies in clinical practice.4 The theme of promise but limited evidence has also been taken up with respect to TNR in care of stroke survivors.5 The aim of the present study was to obtain an overview of progress in TNR. As in our previous review, our focus was on papers that reported health-related outcomes for patients and/ or caregivers.
Initial screening of identified articles was based on the information obtained from their abstracts, which were read independently by at least two reviewers. Further selection of relevant articles was agreed by consensus. When an abstract did not give sufficiently precise information about the study, the article was obtained for further review. Each full-text article obtained was evaluated independently by at least two reviewers, who reached a consensus on whether an article should be included in the final review. Data were extracted independently from each of the selected publications and any disagreements resolved by consensus. Information extracted included the study objectives, design, type of comparison with the TNR intervention, setting and duration, patient numbers and characteristics, and reported outcomes. Literature searches were performed using the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL databases to January 2012. There was no 1 School of Information Systems and Technology, University of Wollongong, Australia 2 Helsinki and Uusimaa Hospital Group, Helsinki, Finland 3 Institute of Health Economics, Edmonton, Alberta, Canada 4 Department of Public Health Sciences, University of Alberta, Edmonton, Canada
Methods We developed a protocol for the review following approaches taken in previous telemedicine reviews.
Corresponding author: Dr David Hailey, 22 Sinclair Street, Kambah, ACT 2902, Australia. Email: dhailey@ ozemail.com.au
308
Journal of Telemedicine and Telecare 19(6)
language restriction. The complete search strategy is available from the authors. Articles were selected which described, in a scientifically valid manner, studies reporting clinical or administrative outcomes for patients or caregivers using telerehabilitation applications in the management of neurological disorders. We included articles describing controlled studies in which TNR was compared with a non-TNR alternative, and those on non-controlled series in which there were 20 or more subjects. We excluded studies in which the only outcome measures were related to satisfaction with TNR, reports on technical development or feasibility of a rehabilitation technology and studies identified in the previous review. Strength of evidence was assessed with an approach used in previous telemedicine reviews that takes account of both study design and study performance. This provides five ratings of study quality and implications for decision Table 1. Study quality and implications for decision making.6 Study quality
Implications for decision making
A. High B. Good C. Fair to good
High degree of confidence in study findings Some uncertainty regarding study findings Some limitations that should be considered in any implementation of study findings Substantial limitations in the study, findings should be used cautiously Unacceptable uncertainty for study findings
D. Poor to fair E. Poor
makers.6 Study designs included large randomized controlled trials (RCTs) with at least 50 subjects in each arm, smaller RCTs, prospective non-randomized studies, retrospective comparative studies and non-comparative series. For study performance, the areas considered were patient selection, description of the interventions, specification and analysis of the study, patient disposition and reported outcomes. On the basis of scores for study design and performance, each study was assigned to one of five categories to indicate the reliability of its findings (Table 1). Judgements were made on whether the reviewed publications indicated that the TNR applications had been successful. Success was defined in terms of whether the application had performed at least as well as a similar alternative intervention. The principal summary measure was the difference in means of intervention outcomes. For comparative studies, where the interventions in each group were similar, TNR was considered successful when it provided better or equivalent outcomes to those for the comparator. In studies where the TNR intervention included additional resources to those of the comparator intervention, it was considered successful when it provided better outcomes. For each paper, we judged whether additional data to those reported were needed to establish the TNR method as suitable for routine use. ‘Yes’ indicated substantial limitations in the available evidence. ‘Desirable’ referred to studies of adequate quality, with reasonable evidence of success, where further work was required to confirm the findings. ‘No’ indicated either studies that had provided a
Table 2. Study design, quality and outcome status. Authors
Condition or symptom
Study design and quality *
Successful?
Further study?
Chumbler et al., 20127 Pierce et al., 20098 Bell et al., 20119 Fish et al., 200710 Soong et al., 200511 Bombardier et al., 200812 Mohr et al., 200713 Motl et al., 201114 Kowalczewski et al., 201115 Gitlin et al., 201016 Andersson et al., 200317 Dilorio et al., 200918 Constantinescu et al., 201119 Carey et al., 201020 Kosterink et al., 201021 Knoop et al., 200822 Ghahari et al., 201023 Vitacca et al., 201024 Maher et al., 201025
Stroke
RCT, A RCT, B RCT, A Within-subject comparison, B RCT, C RCT, A RCT, A RCT, A RCT crossover, A RCT, A RCT, B Observational, B RCT, A RCT, A RCT, C RCT, A RCT, C Observational, B RCT, B
Yes Yes No Yes No Yes Yes Yes Yes Yes No Unclear Yes Yes Yes Yes No Yes Unclear
Desirable No - established No – not effective Yes Yes Yes Desirable Yes Yes No - established No-not effective Yes Desirable No - established Yes Desirable No – not effective Desirable Yes
Brain injury
Multiple sclerosis
Spinal cord injury Dementia Headache Epilepsy Speech disorder Neck and shoulder pain Fatigue Amyotrophic lateral sclerosis Cerebral palsy
*RCT: randomized controlled trial; Study quality: A ¼ High, B ¼ Good, C ¼ Fair to good.
Hailey et al. strong indication that TNR was suitable for routine use, and for those where an intervention was clearly unsuccessful. Factors considered included the success and clinical significance of the TNR application, its stage of development, the size and composition of the population that was studied and the length of follow up following initiation of rehabilitation.
Results From 1850 publications identified in the literature search, 693 had been considered in the previous review2 and included the articles on TNR that were identified in that work; these were not considered in the present study. Of the remainder, 106 were retrieved for closer inspection. Nineteen papers that were not in the previous review met the selection criteria and were included in the review.7–25 Sixteen of the studies (84%) were of high or good quality and three were fair to good (Table 2). An overview of judgements for the reviewed TNR studies is also given in Table 2. Thirteen of the applications were successful, for two the status was unclear and four were unsuccessful. Further study was judged to be required for eight of the TNR applications and desirable for five. For three applications further study was not needed as there was sufficiently strong supporting evidence. For another three, additional research appeared unnecessary as the interventions were clearly not effective. Further details of the reviewed studies are given in Table 3 (see online archive). Most of them reported clinical outcomes, including physical improvement, mental health and social measures. Three studies were concerned with influence on the use of health services, and two studies included a focus on caregivers. Telephonebased applications were considered in 47% of the studies. Two of the Internet-based interventions used specialised functional electrical stimulation and myofeedback approaches.
Discussion Our previous review included 18 TNR studies on management of stroke, brain injury and multiple sclerosis.2 Using broad selection criteria, which included all types of study design, we located 19 more recent studies on all areas of TNR, which dealt with 13 different conditions. Thus the database for studies that provide useful information on clinical outcomes is still small. As found in our previous review, telephone-based interventions were used in many of the studies that were identified, most of the rest using the Internet. Use of virtual reality approaches may be an important future development in TNR. We identified several studies on the use of virtual reality in neurorehabilitation, but none of these were in a telemedicine context, with remote diagnosis or
309 treatment of patients by means of telecommunications technology. In most of the comparative studies the intervention provided through TNR was more elaborate than that in the comparator. Typically, patients were contacted more frequently or provided with additional services. Such studies may demonstrate benefits that are related to use of a more elaborate intervention, rather than to the method of delivery. Overall, we judged that TNR had been shown to be successful in 13 (68%) of the studies. Further work would be needed for eight of the applications to establish their suitability for routine use, and would be desirable for a further five. The recent literature provides further support for teleneurorehabilitation applications, showing the promise of this field in a number of areas. Additional, good quality longer term studies are needed to establish the performance of TNR methods in routine practice and provide a stronger information base for providers and funders of rehabilitation services. References 1. Russell TG. Physical rehabilitation using telemedicine. J Telemed Telecare 2007;13:217–20. 2. Hailey D, Roine R, Ohinmaa A, Dennett L. Evidence of benefit from telerehabilitation in routine care: a systematic review. J Telemed Telecare 2011;17:281–7. 3. Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009;31:427–47. 4. Rogante M, Grigioni M, Cordella D, Giacomozzi C. Ten years of telerehabilitation: A literature overview of technologies and clinical applications. NeuroRehabilitation 2010;27:287–304. 5. Johansson T, Wild C. Telerehabilitation in stroke care – a systematic review. J Telemed Telecare 2011;17:1–6. 6. Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare 2004;10:318–24. 7. Chumbler NR, Quigley P, Li X, et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke 2012;43:2168–74. 8. Pierce LL, Steiner VL, Khuder SA, Govoni AL, Horn LJ. The effect of a Web-based stroke intervention on carers’ well-being and survivors’ use of healthcare services. Disabil Rehabil 2009;31:1676–84. 9. Bell KR, Brockway JA, Hart T, et al. Scheduled telephone intervention for traumatic brain injury: a multicenter randomized controlled trial. Arch Phys Med Rehabil 2011;92:1552–60. 10. Fish J, Evans JJ, Nimmo M, Martin E, Kersel D, Bateman A, Wilson BA, Manly T. Rehabilitation of executive dysfunction following brain injury: ‘‘content-free’’ cueing improves everyday prospective memory performance. Neuropsychologia 2007;45:1318–30. 11. Soong YLW. Evaluating the effect of an on-line computer assisted cognitive rehabilitation programme. PhD thesis. Hong Kong Polytechnic University, 2004.
310 12. Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, Kraft GH. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil 2008;89:1849–56. 13. Mohr DC, Hart S, Vella L. Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy. Health Psychol 2007;26:554–63. 14. Motl RW, Dlugonski D, Wo´jcicki TR, McAuley E, Mohr DC. Internet intervention for increasing physical activity in persons with multiple sclerosis. Mult Scler 2011;17:116–28. 15. Kowalczewski J, Chong SL, Galea M, Prochazka A. Inhome tele-rehabilitation improves tetraplegic hand function. Neurorehabil Neural Repair 2011;25:412–22. 16. Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA 2010;304:983–91. 17. Andersson G, Lundstro¨m P, Stro¨m L. Internet-based treatment of headache: does telephone contact add anything? Headache 2003;43:353–61. 18. DiIorio C, Escoffery C, McCarty F, et al. Evaluation of WebEase: an epilepsy self-management Web site. Health Educ Res 2009;24:185–97. 19. Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson’s disease online: a randomized
Journal of Telemedicine and Telecare 19(6)
20.
21.
22.
23.
24.
25.
controlled non-inferiority trial. Int J Lang Commun Disord 2011;46:1–16. Carey B, O’Brian S, Onslow M, Block S, Jones M, Packman A. Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program. Int J Lang Commun Disord 2010;45:108–20. Kosterink SM, Huis in ‘t Veld RM, Cagnie B, Hasenbring M, Vollenbroek-Hutten MM. The clinical effectiveness of a myofeedback-based teletreatment service in patients with non-specific neck and shoulder pain: a randomized controlled trial. J Telemed Telecare 2010;16:316–21. Knoop H, van der Meer JW, Bleijenberg G. Guided selfinstructions for people with chronic fatigue syndrome: randomised controlled trial. Br J Psychiatry 2008;193:340–1. Ghahari S, Packer TL, Passmore AE. Effectiveness of an online fatigue self-management programme for people with chronic neurological conditions: a randomized controlled trial. Clin Rehabil 2010;24:727–44. Vitacca M, Comini L, Tentorio M, et al. A pilot trial of telemedicine-assisted, integrated care for patients with advanced amyotrophic lateral sclerosis and their caregivers. J Telemed Telecare 2010;16:83–8. Maher CA, Williams MT, Olds T, Lane AE. An internetbased physical activity intervention for adolescents with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2010;52:448–55.
