Effectiveness of Exercise-Based Telerehabilitation in Adults with Chronic Stroke: A Systematic Review

Background: Stroke is a leading cause of long-term disability worldwide. Rehabilitation improves motor function, but geographical barriers, transportation difficulties, and resource constraints limit access to in-person services. Exercise-based telerehabilitation may offer an accessible alternative for chronic stroke survivors, but its effectiveness compared with conventional rehabilitation remains unclear. Methods: A systematic review of randomised controlled trials and feasibility studies was conducted. Electronic searches of MEDLINE and Embase were performed in English-language publications. Two independent reviewers screened 279 records. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Five studies (n=156; age 50–80 years) investigating exercise-based telerehabilitation in chronic stroke (>3 months post-stroke) were included. Interventions included virtual reality systems, mobile health applications, and hybrid models compared with conventional rehabilitation or usual care. Narrative synthesis was performed due to heterogeneity in study designs and outcomes. Results: All five studies were small pilot or feasibility trials (10–50 participants). No serious adverse events were reported. Balance and gait improved in both telerehabilitation and conventional groups, with no between-group differences. Mobile health interventions showed greater improvements in physical activity and walking speed than virtual reality. Walking speed improvements exceeded the minimal clinically important difference (0.21–0.27 m/s). Wearable devices achieved higher adherence (90.7%) than complex applications (56.3%). One study reported a 43.9% reduction in per-participant costs with home-based delivery, primarily due to reduced transportation costs. Only two studies included follow-up beyond three months. Discussion/Implication: Exercise-based telerehabilitation yields functional improvements comparable to those of conventional rehabilitation. Simpler technologies demonstrate better engagement than complex applications. Small sample sizes, short follow-up periods, and heterogeneity in interventions limit the evidence base. Larger trials with longer follow-up are essential to establish effectiveness and identify which patients benefit most from telerehabilitation.