| Sumario: | Importance: With the increasing reliance on telehealth and the barriers to accessing rehabilitation services poststroke, understanding the efficacy of telerehabilitation is crucial for adapting health care delivery models to modern needs. Objective: To assess and synthesize the current evidence regarding the efficacy of telerehabilitation in enhancing activities of daily living (ADLs) and occupation-based outcomes for stroke survivors. Data Sources: PubMed, Scopus, IEEE Xplore, Web of Science, and MEDLINE (via EBSCO) were searched in two rounds: the initial on October 3, 2023, and a second on September 5, 2024. Study Selection and Data Collection: This systematic review is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Included studies were randomized controlled trials (RCTs) or pilot RCTs that evaluated telerehabilitation interventions with stroke survivors compared with in-person rehabilitation, other forms of telerehabilitation delivery, or no rehabilitation in enhancing ADLs and occupation-based outcomes, written in English and published from January 2009 to December 2023. Findings: Nine articles (six Level 1b and three Level 2b) with 465 participants were included. The studies exhibited significant diversity in the interventions implemented, the information and communication technologies applied, the control interventions, and the outcomes evaluated. The variability observed in participant characteristics and intervention designs across these studies highlights critical challenges in establishing standardized protocols for telerehabilitation of stroke patients. Conclusions and Relevance: This systematic review found moderate-certainty evidence that telerehabilitation provides outcomes for ADLs that are broadly comparable with those of conventional in-person rehabilitation for stroke survivors. However, confidence in these findings is limited by high risks of bias in many included studies and the variability in control conditions. Plain-Language Summary: This systematic review assessed and synthesized the current evidence regarding the efficacy of telerehabilitation as compared with in-person rehabilitation, other forms of telerehabilitation delivery, or no rehabilitation in improving activities of daily living of stroke survivors. The authors found moderate evidence that telerehabilitation is a feasible alternative for rehabilitation provision. Implications include the need for occupational therapy research to identify effective telerehabilitation methods, explore how remote sessions affect daily tasks, and examine occupation-based outcomes specifically relevant to stroke survivors. This systematic review assessed and synthesized current evidence regarding the efficacy of telerehabilitation as compared with in-person rehabilitation, other forms of telerehabilitation, or no rehabilitation in improving activities of daily living among stroke survivors.
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