Integrated telerehabilitation approach in multiple sclerosis: A systematic review and meta-analysis

Introduction: Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system and a major cause of disability in young adults. Recently, there has been a growing interest in the development of innovative ways to deliver rehabilitation care outside of a hospital setting. The aim was to conduct a systematic review and a meta-analysis of the efficacy of an integrated telerehabilitation approach (ITA) on motor, cognitive and participation outcomes delivered to people with MS (pwMS). Methods: We systematically searched for original manuscripts regarding ITA in pwMS. Efficacy on motor, cognitive and participation outcomes was measured as the standardized mean difference (Hedges' g) of pre and post training. Results: Nine studies encompassing 716 pwMS diagnosis were included. The overall effect of ITA was: large for motor outcomes (g = 1.05; p = 0.013); small for cognitive performance outcomes (g = 0.16; p = 0.237); and small for participation outcomes (g = 0.15; p = 0.259). Domain-specific results showed that the effect on motor disability was large (g = 1.18), while on gait and balance was medium (g = 0.32 and g = 0.48, respectively). Moreover, all effects on single cognitive domains were small. Finally, among the single participation outcomes considered (depression, fatigue, daily functioning, quality of life and self-efficacy) only depression showed a nearly medium effect (g = 0.30). Conclusions: PwMS can benefit from ITA in the treatment of motor symptoms according to the current model of continuity of care. However, the low efficacy of ITA on cognition and participation domains suggests the necessity to develop intervention models that include a broader spectrum of needs and objectives.