Dr Steven CramerSteven C. Cramer, MD, MMSc
In a recent trial led by Steven C. Cramer, MD, MMSc, associate director, Institute for Clinical & Translational Science, and Professor of Neurology, University of California, Irvine, telerehabilitation showed similar efficacy in rehabilitating and improving motor status for patients who’d had a stroke when compared with traditional in-clinic rehabilitation. The 11-site, 124-patient randomized, assessor-blinded, noninferiority trial showed that the use of activity-based training produced substantial gains in arm motor function with home-based telerehab that was not significantly different (P = .96) from traditional in-clinic rehab .

The trial randomized 124 patients with a mean baseline Fugl-Meyer (FM) motor score of 43 points (standard deviation [SD], 8; maximum score of 66, higher scores mean better movement) to either the telerehab group or the in-clinic rehab group. They both received 36, 70-minute session of arm motor therapy plus stroke education, with equivalent intensity, duration, and frequency of therapy across groups.

After 30 days post-treatment, the mean FM score change from baseline was a gain of 8.36 points (SD, 7.04) and 7.86 points (SD, 6.68) for the in-clinic and telerehab groups, respectively (P <.001 for both). The mean covariate-adjusted FM score change was 0.06 points (95% CI, –2.14 to 2.26) higher for the telerehab group, which was not significantly different.

As well, the motor gains remained significant after separate examination of patients who enrolled early (<90 days) or late (≥90 days) after stroke. To find out more about what prompted the study, NeurologyLive® spoke with Cramer.

NeurologyLive®: What prompted this work?

Steven C. Cramer, MD, MMSc: My career has been devoted to reducing disability after stroke, with a focus on improving arm movement as a pathway towards this goal. An early focus was the use of robots to deliver standardized therapy at high doses in a consistent way. We found we could help, but patients had a hard time driving to my lab for robotic therapy every day. We came up with methods to drive high doses of arm rehab therapy in a manner that did not require patients to drive in each day. This was telerehab, which uses telehealth methods to drive high doses of arm rehab therapy in the home.

Where any of the findings or subgroup analyses surprising or unexpected in any way?

We were pleased by not surprised that we met our primary endpoint, showing that telehealth in the home has comparable efficacy as compared to direct occupational and physical therapy in the clinic. We were surprised to see that patients with language deficits due to aphasia had comparable gains (we worried that gains might be lower due to a language barrier).

How do these findings help inform the better use of telemedicine?

We now know that telemedicine can be used to successfully implement rehab therapy in the home after stroke. The benefits from this intervention in our study were substantial and equivalent to what was gained when patients drove to a clinic 3x/week.

Transcript edited for clarity.
REFERENCE
Cramer SC, Dodakian L, Le V, et al. Efficacy of home-based telerehabilitation vs. in-clinic therapy for adults after stroke: A randomized clinical trial. JAMA Neurol. Published online June 24, 2019. doi:10.1001/jamaneurol.2019.1604