Search Results (77)

Background: Despite strong guideline recommendations, participation in cardiac rehabilitation (CR) among patients with chronic heart failure (CHF) remains low due to logistical, geographical, and psychosocial barriers. Telerehabilitation may help overcome these limitations by offering remote, structured exercise programs supported by digital technologies. Objective: The TELEREHAB-HF study aims to evaluate the efficacy of an 8-week, home-based cardiac telerehabilitation program compared to standard in-person rehabilitation in patients with CHF. Methods: This is a prospective, controlled cohort study involving 220 adult patients with CHF (NYHA class I–III) clinically stable and on optimized therapy. Participants are assigned to either a telerehabilitation group (remote CR via a digital platform with wearable sensors and real-time physiotherapist supervision) or a standard in-person rehabilitation group. The primary outcome is the change in peak oxygen uptake (VO₂max) at 8 weeks. Secondary outcomes include quality of life, functional performance, biochemical and echocardiographic parameters, and cognitive function, assessed at baseline and at 4, 8, 16, and 24 weeks. Expected Results: We hypothesize that telerehabilitation will be non-inferior to standard CR in improving functional capacity and secondary outcomes, with additional benefits in accessibility and adherence. Data from remote monitoring may also support a translational “rehabilomics” approach to exploring exercise-induced biomarker changes. Conclusions: This study seeks to assess the clinical effectiveness, safety, and feasibility of a home-based telerehabilitation model for CHF, with the goal of informing future strategies for broader implementation and personalized rehabilitation. Trial Registration: ClinicalTrials.gov Identifier: NCT07023536 Full article

Background/Objectives: Patients with inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) exhibit complex clinical profiles due to autonomic dysfunction. While sinus node sparing (SNS) hybrid ablation is emerging as a promising therapy, there are no established guidelines worldwide for post-procedure patient management and care is mainly based on telemonitoring. In contrast, our hybrid cardiac rehabilitation (HCR) program integrates inpatient care and home-based telerehabilitation. We aim to evaluate the implementation of the HCR program, patient acceptance and adherence, and the effectiveness of the Malmö POTS scoring system in monitoring disease progression and rehabilitation outcomes. Methods: Patients underwent a personalized HCR program after SNS. The program included early mobilization, psychological support, respiratory therapy, and structured exercise. Clinical outcomes were assessed using symptom burden (Malmö POTS score), ECG parameters, exercise duration, perceived exertion, and rehabilitation adherence. Results: All patients completed the inpatient phase, and 87% completed the home-based phase. In the early postoperative period, pericarditis, anemia, and benign rhythm disturbances were mild and self-limiting. The Malmö POTS score decreased from 65.3 to 25.7. Lower perceived exertion early in the program correlated with clinical improvement. At the 2-month follow-up, 81% of patients no longer met the clinical criteria for IST/POTS without the use of medications. The program was evaluated as safe, feasible, and well-tolerated, with high patient satisfaction. Conclusions: A well-organized hybrid cardiac rehabilitation program after SNS is feasible, safe, and well-tolerated in IST/POTS patients. The Malmö POTS score may support outcome monitoring. The integration of individualized training and telemedicine represents a promising development for patients post-SNS ablation. While this study demonstrates feasibility and potential benefits, further controlled studies are needed to evaluate its impact on long-term recovery and symptom control. Full article

Introduction: Home-based cardiac telerehabilitation (HBCTR) is a multidisciplinary intervention aimed at optimizing functional, psychological, and social recovery in patients undergoing percutaneous coronary intervention (PCI). This rehabilitation model serves as an effective alternative to traditional center-based rehabilitation, providing a cost-effective and clinically advantageous approach. Methods: Following PRISMA guidelines, we conducted a systematic literature search across multiple databases (PubMed, CINAHL, Cochrane, Scopus, Web of Science). We included randomized controlled trials (RCTs), cohort, and observational studies assessing telerehabilitation in post-PCI patients. Primary outcomes focused on health-related quality of life (HRQoL) and adherence, while secondary outcomes included functional capacity (6 min walk test, VO₂max), cardiovascular risk factor control, and psychological well-being. Risk of bias was assessed using the Cochrane RoB 2.0 and ROBINS-I tools. Results: A total of 3575 articles were identified after removing duplicates, of which 877 were selected based on title and abstract, and 17 met the inclusion criteria, with strong RCT representation ensuring robust evidence synthesis. HBCTR was associated with significant improvements in exercise capacity, with increases in VO₂max ranging from +1.6 to +3.5 mL/kg/min and in 6 min walk distance from +34.7 to +116.6 m. HRQoL scores improved significantly, with physical and mental component scores increasing by +6.75 to +14.18 and +4.27 to +11.39 points, respectively. Adherence to telerehabilitation programs was consistently high, often exceeding 80%, and some studies reported reductions in hospital readmissions of up to 40%. Wearable devices and smartphone applications facilitated self-monitoring, enhancing adherence and reducing readmissions. Several studies also highlighted improvements in anxiety and depression scores ranging from 10% to 35%. Conclusions: HBCTR is a promising strategy for rehabilitation and quality-of-life improvement after PCI. It offers a patient-centered solution that leverages technology to enhance long-term outcomes. By integrating structured telerehabilitation programs, healthcare systems can expand accessibility, promote adherence, and improve equity in cardiovascular care. Full article

Background: Primary progressive aphasia (PPA) is a neurodegenerative disease characterised by progressive impairment of speech and language abilities. Intensive speech and language teletherapy combined with remotely supervised, self-administered transcranial direct current stimulation (tDCS) may be suited to remove barriers to accessing potentially effective treatments, but there is only limited evidence on the feasibility of this combined approach. Methods: This pilot case series investigated the feasibility, tolerability and preliminary efficacy of a novel telerehabilitation programme combined with home-based, self-administered tDCS for people with primary progressive aphasia (pwPPA). The intervention programme was co-developed with pwPPA and their caregivers, to reflect their priorities regarding treatment content and outcomes (i.e., naming, functional communication). Results: Two pwPPA successfully completed the telerehabilitation intervention with daily naming training and communicative-pragmatic therapy paired with tDCS, over 10 consecutive workdays. Caregivers assisted in the setup of equipment required for teletherapy and home-based tDCS. Participants successfully completed the programme with a 95% completion rate. Home-based tDCS was well tolerated. Both participants showed improvements in naming and communication, suggesting preliminary efficacy of the intervention. Conclusions: Overall, this study demonstrates the feasibility and potential benefit of a novel, easily accessible and patient-relevant telerehabilitation intervention for pwPPA, which requires confirmation in a future larger-scale exploratory trial. Full article

The REAtouch^® Lite device was recently developed to support motor skill learning-based interventions, integrating both games/activities and assessment tools to enable home-based telerehabilitation. Given the importance of hand functions in rehabilitation of patients with brain lesions, this study aimed to validate a virtual version of the Box and Block Test (vBBT) implemented in the REAtouch^® device. A total of 205 healthy participants, 37 post-stroke adults, and 37 children with cerebral palsy (CP) performed the standard BBT, various versions of the newly designed vBBT (with/without a separation wall; with 6, 4, and free zones) and the Tower of London test assessing executive function/planning abilities. Friedman’s ANOVA revealed significant differences between the BBT and all versions of the vBBT scores in healthy participants (all p < 0.001). However, the vBBT-4 zones showed the largest intraclass correlation coefficient (ICC) with the BBT in healthy participants (0.58) and even higher correlations in participants with CP and stroke (>0.8). Only the vBBT-6 zones version showed a significant correlation with patients’ planning abilities (p < 0.01; r = −0.28). These findings highlight the vBBT-4 zones as the most relevant version to assess hand dexterity directly with the REAtouch^® device, potentially within telerehabilitation modalities. Further normative data must be established. Full article

Background/Objectives: Individuals with chronic stroke often experience various impairments, including poor balance, reduced mobility, limited physical activity, and difficulty performing daily tasks. In the context of the COVID-19 pandemic, telerehabilitation (TR) can overcome the barriers of geographical and physical distancing, time, costs, and travel, as well as the anxiety about contracting COVID-19. In this retrospective case-control study, we aim to evaluate the motor and cognitive effects of balance TR training carried out with a sensor-based non-immersive virtual reality system compared to conventional rehabilitation in chronic stroke patients. Methods: Twenty chronic post-stroke patients underwent evaluation for inclusion in the analysis through an electronic recovery data system. The patients included in the study were divided into two groups with similar medical characteristics and duration of rehabilitation training. However, the groups differed in the type of rehabilitation approach used. The experimental group (EG) received TR with a sensor-based VR device, called VRRS—HomeKit (n. 10). In contrast, the control group (CG) underwent conventional home-based rehabilitation (n. 10). Results: At the end of the training, we observed significant improvements in the EG in the 10-m walking test (10MWT) (p = 0.01), Timed-Up-Go Left (TUG L) (p = 0.01), and Montreal Cognitive Assessment (MoCA) (p = 0.005). Conclusions: In our study, we highlighted the potential role of sensor-based virtual reality TR in chronic stroke patients for improving lower limb function, suggesting that this approach is feasible and not inferior to conventional home-based rehabilitation. Full article

Background: Post COVID-19 Condition is a recently recognized syndrome characterized by the persistence of various symptoms, including dyspnea, physical and mental fatigue, and post-exertional malaise. Currently, there is no established treatment or clear consensus on the effectiveness of rehabilitation, and given that patients could benefit from home-based rehabilitation, telerehabilitation, defined as remote rehabilitation using telematic systems, may be an option to reach more of the population with persistent COVID-19 symptoms. Therefore, it is necessary to show the efficacy of this telematic approach and the benefits of a multimodal rehabilitation strategy in these patients. Methods: Patients underwent home rehabilitation using a 12-week synchronous telerehabilitation system. The intervention included therapeutic education and physical and respiratory rehabilitation. The following variables were analyzed: Fatigue, quality of life, dyspnea, respiratory strength, aerobic capacity, and upper and lower limb strength. Conclusions: After 12 weeks, significant improvements were found in fatigue, aerobic capacity, and limb and respiratory strength. However, no improvement was found in dyspnea scores, which did not correlate with respiratory strength. Interestingly, a post-intervention correlation emerged between the distance covered in aerobic capacity and perceived fatigue, suggesting that asynchronous telerehabilitation could be a viable treatment strategy for these patients. Full article

(1) Left ventricular assist device (LVAD) implantation is increasingly used as a treatment option for patients with advanced heart failure (HF). There is a need to provide patients with LVAD with long-term care, preferably at home. The implementation of home-based telerehabilitation (HTR) and telecare offers new opportunities in this field. Purpose: The purpose of this study was to assess the feasibility and safety of HTR and telecare in HF patients with implanted LVAD and evaluate patients’ acceptance of and adherence to HTR. (2) The study enrolled 30 HF patients with recently implanted LVAD (21 Heart Mate III, 9 Heart Ware) (29 males, mean 59 years) who underwent a 12-week telecare and HTR program based on walking, respiratory, and resistance training, five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recordings and to transmit data via a mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise. The influence on physical capacity was assessed by comparing changes in peak oxygen consumption (pVO₂; [mL/kg/min]) and workload duration (t; [s]) during the cardiopulmonary exercise test. (3) HTR resulted in a significant physical capacity improvement in pVO₂ 12.5 ± 2.9 vs. 15.1 ± 3.0 (p < 0.001), and workload duration t 628 ± 204 vs. 728 ± 222 (p < 0.001) during the cardiopulmonary exercise test. There were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the medical team. All patients completed HTR. (4) HTR is a feasible and safe form of rehabilitation that is well-accepted by patients. The adherence to HTCR was high. Full article

Today, cardiovascular diseases contribute to approximately 17.9 million deaths annually worldwide. With reference to Europe, coronary artery disease (CAD) causes about 3.9 million deaths annually. Considering the positive physical and psychological outcomes of on-site exercise for CAD patients, this study aimed to expand the literature by examining the effects of a 6-month online exercise training program using wearable devices on CAD patients’ perceived well-being, measured with the PERMA profiler. Individual well-being is considered today as an important prerequisite for healthy societies. Thirty patients with a recent myocardial infarction (i.e., <4 weeks) were randomly assigned to either the online home-based or the community-based exercise group. Both groups followed the same 24-week exercise-based cardiac rehabilitation program three times per week. Each session consisted of a 30-min aerobic, followed by a 15-min strength workout, and then a 15-min balance and flexibility training. The results of the Mann–Whitney U tests and the z scores indicated that the Meaning of Life, Health, Accomplishment, Engagement, and Positive Relationship dimensions of the PERMA were statistically improved, and Negative Emotions were decreased. These findings support the importance of cardiac telerehabilitation for patients’ psychological health, demonstrating that online exercise using wearable devices can be a meaningful alternative to on-site exercise for patients with recent myocardial infarction. These results have policy implications as they provide arguments for providing online exercise for CAD patients as an alternative means for improving their psychological health. Full article

Objectives: Having achieved a consolidated in-hospital experience with enhanced recovery after cardiac surgery, we explored the feasibility of expanding our protocol to pre-admission and post-discharge periods. Methods: A multidisciplinary team including cardiac surgeons, anaesthetists/intensivists, physiatrists, physiotherapists, perfusionists, nurses, psychiatrists, and engineers, elaborated a new therapeutic offer, based on current ERAS evidence and using telerehabilitation, to enhance preoperative communication and education and improve pre- and postoperative health and psychological state. Results: An institutional web-based platform for remote rehabilitation will host digital content that covers three main areas, including information and communication, prehabilitation and rehabilitation with the offer of respiratory and muscular exercises and aerobic activities, and psychological and patient experience evaluations. These interventions will be achieved through purposely developed video tutorials that present the hospital environments, the relevant healthcare personnel, and their role during the in-hospital patient’s journey, and illustrate tailored prehabilitation activities. A series of questionnaires will be administered to evaluate and follow the patient’s psychological state and collect patient-reported experience measures. The platform was activated in September 2024 and this service will initially involve 100 patients undergoing minimally invasive mitral valve surgery. A first review of compliance and engagement will be carried out after four months and a complete review of the results after the first year. Conclusions: ERAS is associated with improved surgical outcomes. A person-centred treatment should also address the health and psychological difficulties that patients face before hospitalisation and after discharge. Telemedicine is a valid tool to expand treatment and monitoring outside the hospital. This experience may give new insights into the feasibility and effectiveness of providing home-based remote interventions aimed at a global improvement in results throughout the overall cardiac surgery journey. Full article

Background: Stroke is a leading cause of long-term disability, often resulting in upper extremity impairment. Telerehabilitation offers a promising approach to deliver therapy in home settings. This review aimed to evaluate the effects of home-based telerehabilitation interventions delivered to address upper extremity function in stroke patients. Methods: A systematic review was conducted following the Pyramid Review methodology. Quantitative and qualitative studies examining home-based telerehabilitation for upper extremity function in stroke patients were included. Data were synthesized using meta-analysis where possible and narrative synthesis. Results: Thirty studies (24 quantitative, four qualitative, and two mixed-methods studies) were included. Telerehabilitation interventions demonstrated improvements in upper extremity function for both subacute and chronic stroke patients, with varying effect sizes across intervention types. Constraint-induced movement therapy adaptations and some sensor-based approaches showed consistently positive results. Qualitative findings revealed generally positive effects, with convenience, gamification, and social support as key motivators for adherence. Conclusions: Home-based telerehabilitation shows promise for improving upper extremity function in stroke patients. However, heterogeneity in intervention designs and outcomes limits definitive conclusions. Future research should focus on larger trials, observational studies, standardized outcome measures, and long-term follow-up as well as qualitative studies with focus on perceived effectiveness to optimize telerehabilitation approaches for stroke recovery. Full article

The paper presents an innovative virtual reality (VR)-based environment for personalized telerehabilitation programs. This environment integrates a parallel robotic structure designed for the lower limb rehabilitation of patients with neuromotor disabilities and a virtual patient. The robotic structure is controlled via a user interface (UI) that communicates with the VR environment via the TCP/IP protocol. The robotic structure can also be operated using two controllers that communicate with a VR headset via the Bluetooth protocol. Through these two controllers, the therapist demonstrates to the patient various exercises that the robotic system can perform. With the right-hand controller, the therapist guides exercises for the hip and knee, while the left-hand controller manages ankle exercises. The therapist remotely designs a rehabilitation plan for patients at home, defining exercises, interacting with the rehabilitation robot in real-time via the VR headset and the two controllers, and initiating therapy sessions. The user interface allows monitoring of patient progress through video feedback, electromyography (EMG) sensors, and session recording. Full article

Background/Objectives: Despite the increase in home-based rehabilitation, outcome measures for telerehabilitation are still underdeveloped. The Fugl-Meyer Assessment (FMA) is one of the most widely used tools for evaluating post-stroke motor deficits, with the upper extremity component (FMA-UE) recommended for assessing motor deficits of the arm. This study aims to examine the intrarater and interrater reliability of the Italian version of the FMA-UE, administered remotely via video conferencing during a robotic telerehabilitation program. Methods: Twenty stroke patients participated and underwent 20 sessions of remote upper limb rehabilitation with a robotic device. In-person evaluations were conducted before (T0) and after (T1) treatment, with additional remote assessments throughout. The study evaluated both intrarater and interrater reliability using Intraclass Correlation Coefficients (ICC) and Bland–Altman plots, classifying reliability as excellent for scores above 0.90. Results: Bland–Altman analysis showed no systematic variance for both intrarater and interrater reliability of the FMA-UE scale. Excellent reliability was found with intrarater ICC = 0.972 and interrater ICC = 0.981. Sections A and C of the FMA-UE showed excellent intrarater reliability, while sections B and D had satisfactory results. Both intrarater and interrater reliability analysis of the total score of the FMA-UE scale also showed strong agreement with Cohen’s Kappa values above 0.70. Conclusions: The findings suggest that the remote administration of the FMA-UE scale is a reliable tool for assessing upper limb motor function in stroke patients, supporting its use in telerehabilitation settings. Full article

Background: Non-specific chronic neck pain is a prevalent musculoskeletal disorder with a significant impact on individuals’ quality of life. The lack of consensus on effective therapeutic management complicates the establishment of standardized treatment protocols. Home exercise programs have yielded positive results. This study aimed to assess the effectiveness of a telerehabilitation program distributed through videoconferencing for patients with non-specific chronic neck pain compared to a home-based exercise program. Methods: A randomized controlled trial was conducted involving 36 participants who were divided into two groups: the experimental group (n = 18) received manual therapy combined with telerehabilitation, while the home-based group (n = 18) received the same manual therapy treatment along with recommendations for home exercises. Key outcome measures, including neck-related disability, kynesiophobia, anxiety and depression, pain intensity, pressure pain threshold, quality of life, and adherence to self-treatment, were evaluated at baseline and post-treatment. Results: No statistically significant differences were observed between groups. However, both groups demonstrated improvements in all study variables except for the mental component of quality of life immediately post-treatment. Conclusions: After eight weeks of manual therapy and exercise, both the telerehabilitation and home-based exercise programs resulted in significant improvements in disability, pain, and kynesiophobia, indicating that telerehabilitation is as effective as home-based exercise. Full article

Background/Objectives: High-intensity training (HIT) has been shown to enhance physical fitness and reduce functional impairments in persons with moderately disabling chronic nonspecific low back pain (CNSLBP). However, sustaining these improvements post-rehabilitation remains a challenge. To address this, a home-based, technology-supported HIT program utilizing telerehabilitation can be implemented at home. This study assesses the feasibility and clinical effectiveness of a telerehabilitation HIT program for persons with CNSLBP. Methods: The pilot clinical trial (NCT05234008) recruited 15 persons with CNSLBP. Participants completed a 6-week multimodal HIT intervention with 12 bi-weekly sessions. The first four sessions were organized at REVAL Research Center, followed by eight home-based sessions using the Physitrack^® platform. Assessments were conducted at baseline (PRE), two weeks into the intervention (MID), and immediately post-intervention (POST). Outcome measures included maximal oxygen uptake (VO2max) testing, disease-related outcomes, feasibility, motivation assessed via questionnaires, and system usability and adherence tracked through Physitrack^® technology. Results: Fourteen participants (seven females; age: 45.9 years) successfully completed the program without adverse events. Based on PRE–POST comparisons, motivation levels remained high (Motivation Visual Analog Scale: −1.2 ± 0.9, p = 0.043) despite reduced motivation at POST. Improvements were also observed in pain (Numeric Pain Rating Scale: −1.8 ± 0.2, p = 0.026), disability (Modified Oswestry Disability Index: −12.1 ± 10.2, p = 0.002), fear-avoidance (Fear-Avoidance Components Scale: −10.1 ± 5.8, p = 0.005), and exercise capacity (VO2max: 4.4 ± 1.6, p = 0.048). Conclusions: The HITHOME study is the first to investigate the feasibility and effectiveness of a telerehabilitation HIT program for persons with CNSLBP. The results underscore the feasibility of implementing a home-based HIT program to support adherence to vigorous exercise programs and improve clinical outcomes in this population. Additionally, the findings emphasize technology’s potential importance in enhancing home-based exercise therapy and lay the groundwork for future studies on blended care and telerehabilitation using HIT in CNSLBP. Full article