Telerehabilitation for Hand Function in Stroke Patients (TeleStroke-PK)

June 18, 2026 updated by: Anbreena Rasool, University of Faisalabad

Effects of Conventional Outpatient Rehabilitation With and Without Adjunctive Telerehabilitation on Hand Function and Motor Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

Stroke is a leading cause of adult disability worldwide, with upper limb impairment significantly reducing independence. Traditional outpatient rehabilitation poses challenges for patients with mobility limitations, financial constraints, or those living in remote areas. This randomized controlled trial compares the effects of conventional outpatient rehabilitation with and without adjunctive telerehabilitation on hand function and motor recovery in subacute stroke patients. Forty-eight participants will be randomly assigned to two groups: Group A receives conventional outpatient rehabilitation plus home-based telerehabilitation via WhatsApp video calls (30 minutes daily, 5 days/week for 6 weeks), while Group B receives conventional outpatient rehabilitation alone (same dose and content). Outcome measures include the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), and Physical Activity Enjoyment Scale (PACES), assessed at baseline and after 6 weeks.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Stroke persists as the most prevalent cause of disability in adults worldwide, with upper limb disability significantly diminishing the level of independence in stroke survivors. Traditional post-stroke rehabilitation typically requires frequent visits to outpatient facilities, which can be inconvenient for patients with mobility impairments, those facing high transportation costs, or individuals living in remote areas. Telerehabilitation, delivered through digital communication platforms, offers a promising alternative that may expand access to rehabilitation services while maintaining treatment intensity and quality.

This study employs a randomized controlled trial design to investigate whether adding home-based telerehabilitation to conventional outpatient care produces superior outcomes compared to conventional care alone. The study will be conducted at three hospitals in Pakistan: Nusrat Fateh Ali Khan Hospital, Aziz Fatima Trust Hospital, and Madina Teaching Hospital. A total of 48 subacute stroke patients will be enrolled using convenience sampling, with sample size calculated using OpenEpi version 3 based on previous published data (Chen, 2020) with 95% confidence interval and 80% power.

Eligibility Criteria: Participants must have a Fugl-Meyer Assessment for Upper Extremity score between 22-56, a Box and Block Test score of at least 1 block in 60 seconds at screening, and no other major neurological or psychotic diseases, cognitive impairment, or pregnancy.

Randomization and Blinding: Participants will be randomly allocated using a computer-generated sequence. Allocation will be concealed, and outcome assessments will be performed by physiotherapists who remain blinded to group assignment.

Interventions: Both groups receive identical exercise content and dosage. Group A (Experimental) receives conventional outpatient rehabilitation plus home-based telerehabilitation via live WhatsApp video chats supervised by a physiotherapist. Each session lasts 30 minutes, five days per week for six weeks. During video sessions, the therapist observes participant setup, provides online verbal assistance, checks movement quality and safety, and modifies compensatory strategies. Participants receive essential equipment (small objects, balls, TheraBand) and an internet data bundle to support connectivity.

Group B (Control) receives conventional outpatient rehabilitation only, with on-site supervised sessions in neuro-physiotherapy outpatient departments. Sessions are 30 minutes each, five days per week for six weeks, using the same exercise content, dosage, equipment, and repetitions as the telerehabilitation group. A physiotherapist provides direct hands-on supervision, checks accuracy, and adjusts difficulty levels in real-time.

Outcome Measures: Assessments occur at baseline (pre-intervention) and after the 6-week intervention period using: (1) Fugl-Meyer Assessment for Upper Extremity to measure motor recovery; (2) Box and Block Test to measure manual dexterity; and (3) Physical Activity Enjoyment Scale to measure patient enjoyment of physical activity.

Statistical Analysis: Data will be analyzed using SPSS software. Normality testing will precede hypothesis testing to determine appropriate parametric or non-parametric statistical methods. Between-group differences will be analyzed using independent t-tests or Mann-Whitney U tests as appropriate, with significance level set at p < 0.05.

Study Type

Interventional

Enrollment (Actual)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Faisalābad, Punjab Province, Pakistan, 3800
        • The University of Faisalabad

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Subacute stroke patients (time since stroke: 1-6 months)\n
  • Fugl-Meyer Assessment for Upper Extremity score between 22-56\n
  • Box and Block Test score of at least 1 block in 60 seconds at the Screening Visit\n
  • Ability to provide informed consent\n
  • Access to a smartphone with WhatsApp capability (for Group A)

Exclusion Criteria:

  • Any other major existing neurological or psychotic disease (e.g., Parkinson's disease, multiple sclerosis)\n
  • Pregnancy\n
  • Any disease apart from index stroke that noticeably affects arm function of paretic limb\n
  • Cognitive impairment that prevents understanding of instructions\n
  • Upper extremity acute orthopedic conditions\n
  • Medically unstable patients

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Telerehabilitation + Conventional Outpatient Rehabilitation
Participants receive conventional outpatient rehabilitation (on-site, 30 min/day, 5 days/week, 6 weeks) PLUS home-based telerehabilitation via WhatsApp video calls (same dose). Therapy includes warm-up/proximal activation exercises (shoulder shrugs, scapular retraction, trunk forward lean), task-oriented and strengthening exercises (reaching tasks, grasp and release, object transfers). Equipment includes small objects, balls, and TheraBand.
Other: Telerehabilitation with Conventional Therapy
Telerehabilitation is delivered via live WhatsApp video chats supervised by a physiotherapist. Each session lasts 30 minutes, five days per week for six weeks. The therapist observes participant setup, provides online verbal assistance, checks movement quality and safety, and modifies compensatory strategies. Participants receive essential equipment (small objects, balls, TheraBand) and an internet data bundle to support connectivity. The therapy protocol is standardized using the Upper Extremity Task Specific Training after Stroke by Lang and Birkenmeier and the Accelerated Skill Attainment Program (Cramer et al., 2019).
Other: Conventional Outpatient Rehabilitation
Conventional outpatient rehabilitation is delivered on-site at neuro-physiotherapy outpatient departments of participating hospitals. Sessions run 30 minutes each, five days per week for six weeks, using the same exercise content, dosage, and progression criteria as the telerehabilitation group. Exercise components include: warm-up and proximal activation (shoulder shrugs, scapular retraction, trunk forward lean weight bearing) for 5 minutes, followed by task-oriented and strengthening exercises (reaching tasks, grasp and release, transfer of objects) for 20 minutes. A physiotherapist provides direct hands-on supervision, checks movement accuracy, and adjusts difficulty levels in real-time based on participant progress.
Active Comparator: Conventional Outpatient Rehabilitation Alone
Participants receive conventional outpatient rehabilitation only (on-site, 30 min/day, 5 days/week, 6 weeks). Therapy content is identical to the experimental group: warm-up/proximal activation exercises, task-oriented and strengthening exercises. A physiotherapist provides direct hands-on supervision, checks accuracy, and adjusts difficulty levels in real time based on participant progress.
Other: Conventional Outpatient Rehabilitation
Conventional outpatient rehabilitation is delivered on-site at neuro-physiotherapy outpatient departments of participating hospitals. Sessions run 30 minutes each, five days per week for six weeks, using the same exercise content, dosage, and progression criteria as the telerehabilitation group. Exercise components include: warm-up and proximal activation (shoulder shrugs, scapular retraction, trunk forward lean weight bearing) for 5 minutes, followed by task-oriented and strengthening exercises (reaching tasks, grasp and release, transfer of objects) for 20 minutes. A physiotherapist provides direct hands-on supervision, checks movement accuracy, and adjusts difficulty levels in real-time based on participant progress.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Upper Extremity Motor Function
Time Frame: Baseline (pre-intervention) and 6 weeks (post-intervention)
Measured using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). The FMA-UE is a stroke-specific, performance-based impairment index. It assesses motor functioning of the upper extremity. Scores range from 0 to 66, with higher scores indicating better motor function.
Baseline (pre-intervention) and 6 weeks (post-intervention)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Manual Dexterity
Time Frame: Baseline (pre-intervention) and 6 weeks (post-intervention)
Measured using the Box and Block Test (BBT). The BBT quantifies gross manual dexterity by counting the number of blocks a participant can move from one compartment of a box to another in 60 seconds. Higher scores indicate better manual dexterity.
Baseline (pre-intervention) and 6 weeks (post-intervention)
Change in Physical Activity Enjoyment
Time Frame: Baseline (pre-intervention) and 6 weeks (post-intervention)
Measured using the Physical Activity Enjoyment Scale (PACES). The scale consists of 16 items rated on a 7-point bipolar Likert scale (1 = "I enjoy it" to 7 = "I hate it" for some items, reverse-scored for others). Total scores range from 16 to 112, with higher scores indicating greater enjoyment of physical activity.
Baseline (pre-intervention) and 6 weeks (post-intervention)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Faisalabad

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 19, 2026

Primary Completion (Estimated)

June 28, 2026

Study Completion (Estimated)

July 10, 2026

Study Registration Dates

First Submitted

June 18, 2026

First Submitted That Met QC Criteria

June 18, 2026

First Posted (Actual)

June 24, 2026

Study Record Updates

Last Update Posted (Actual)

June 24, 2026

Last Update Submitted That Met QC Criteria

June 18, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TUF/EIRB/ 200 /26

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Stroke

Clinical Trials on Telerehabilitation with Conventional Therapy

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Turkmenistan

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe