Una applicazione pratica della telemedicina è quella relativa alla riabilitazione dell’ictus cerebrale, la più frequente causa di disabilità negli adulti. Di solito la riabilitazione viene fornita da operatori sanitari in regime di ricovero con oneri e disagi non indifferenti. Recenti studi hanno indagato se è possibile utilizzare tecnologie come il telefono o Internet per aiutare le persone a comunicare con gli operatori sanitari, senza dover lasciare la propria abitazione. All’argomento è stata dedicata una recente revisione Cochrane (link) che ha identificato 10 studi che hanno coinvolto 933 persone dopo l’ictus. Gli studi hanno utilizzato una vasta gamma di trattamenti, tra cui programmi di terapia volti a migliorare la funzionalità del braccio e la capacità di camminare e programmi volti a fornire consulenza e sostegno alle persone dopo aver lasciato l’ospedale. La eccessiva varietà di studi non ha consentito la formulazione di un giudizio definitivo per cui la revisione conclude che il numero di ricerche in materia è ancora insufficiente e che sono scarse anche le informazioni circa il rapporto costo-efficacia per cui sono necessari urgenti ulteriori studi.
A recent Cochrane review included in it 10 trials involving a total of 933 participants. The studies were generally small, and reporting quality was often inadequate, particularly in relation to blinding of outcome assessors and concealment of allocation. Selective outcome reporting was apparent in several studies. Study interventions and comparisons varied, meaning that in most cases, it was inappropriate to pool studies. Intervention approaches included upper limb training, lower limb and mobility retraining, case management and caregiver support. Most studies were conducted with people in the chronic phase following stroke. Primary outcome: no statistically significant results for independence in activities of daily living (based on two studies with 661 participants) were noted when a case management intervention was evaluated. Secondary outcomes: no statistically significant results for upper limb function (based on two studies with 46 participants) were observed when a computer programme was used to remotely retrain upper limb function. Evidence was insufficient to draw conclusions on the effects of the intervention on mobility, health-related quality of life or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation. No studies reported on the occurrence of adverse events within the studies. The authors conclude “We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach“.