Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke-A Scoping Review.

OBJECTIVES: The COVID-19 pandemic has seen a rapid shift to telehealth delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke. METHODS: Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weightbearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another and results synthesized narratively. RESULTS: Seven studies (two randomized trials, one mixed-methods and four pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment and two (29%) studies only included participants who walked independently. Adherence (reported in three studies) and satisfaction (reported in four studies) was good, and no serious adverse events (data from four studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance and in-person exercise prescription. However, there is limited high quality evidence of efficacy. CONCLUSIONS: We identified strategies used in research to date which can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services. IMPACT: The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers, and optimize safety and adherence for telehealth interventions involving activities in weightbearing or standing positions.