Meta-analysis of synchronous physiotherapy tele-assessment accuracy in adult stroke patients
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Key Takeaway
Note that synchronous tele-assessment may be a valid alternative to in-person physiotherapy for balance in stroke patients.
This meta-analysis synthesized data from 6 studies involving 270 stroke patients to compare synchronous physiotherapy tele-assessment via videoconferencing with in-person physiotherapy evaluation. The scope of the analysis included diagnostic accuracy, interrater reliability, and feasibility, with secondary focus on balance, sensorimotor, and functional capacity outcomes.
Regarding balance outcomes, the analysis showed strong agreement with in-person evaluation (Hedges' g=0.03; 95% CI, -0.26 to 0.32; I²=0%). For functional capacity, a small, nonsignificant effect was observed in favor of tele-assessment (g=0.21; 95% CI, -0.76 to 1.18; I²=98.8%). Sensorimotor outcomes demonstrated high heterogeneity (g=-0.02; 95% CI, -0.56 to 0.51; I²=94.2%).
The authors note that further studies are required to standardize protocols and validate effectiveness across a broader range of functional outcomes. Limitations include the need for more standardized assessment frameworks.
For clinicians, synchronous tele-assessment via videoconferencing appears to be a valid, reliable, and feasible alternative to in-person evaluation in stroke patients, particularly for balance assessment. However, the findings for sensorimotor and functional outcomes should be interpreted with caution due to high heterogeneity and lack of statistical significance.
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View Original Abstract ↓
OBJECTIVE: To evaluate the scientific evidence on the diagnostic accuracy, reliability, and feasibility of synchronous physiotherapy tele-assessment via videoconferencing compared with in-person evaluation in individual's post-stroke.
DATA SOURCES: A systematic search was performed in 5 electronic databases (MEDLINE, Scopus, Web of Science, CINAHL, and Physiotherapy Evidence Database).
STUDY SELECTION: Studies were eligible if they compared synchronous tele-assessment with in-person physiotherapy evaluation in adult stroke patients, reporting outcomes on diagnostic accuracy, interrater reliability, or feasibility. Seven studies met the inclusion criteria for the systematic review; 6 studies (n=270 stroke patients) provided sufficient data to be included in the meta-analysis.
DATA EXTRACTION: Two independent reviewers extracted data on study characteristics, outcomes, and assessment tools. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and Quality Appraisal Tool for Studies of Diagnostic Reliability. Discrepancies were resolved through consensus by the research team.
DATA SYNTHESIS: A random-effects meta-analysis was conducted. Tele-assessment showed strong agreement with in-person evaluation for balance outcomes (Hedges' g=0.03; 95% CI, -0.26 to 0.32; I²=0%). Sensorimotor outcomes demonstrated high heterogeneity (g=-0.02; 95% CI, -0.56 to 0.51; I²=94.2%). Functional capacity showed a small, nonsignificant effect in favor of tele-assessment (g=0.21; 95% CI, -0.76 to 1.18; I²=98.8%).
CONCLUSIONS: Synchronous tele-assessment via videoconferencing appears to be a valid, reliable, and feasible alternative to in-person physiotherapy evaluation in stroke patients, particularly for balance assessment. These findings support the integration of tele-assessment protocols into rehabilitation services, especially when face-to-face access is limited. Further studies are needed to standardize protocols and validate their effectiveness across a broader range of functional outcomes.
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