Study rationale

Several systematic reviews have examined the impacts of TR [10, 12, 13]. For example, one of these reviews provided the effectiveness of TR for patients with stroke [10]. However, this report also included interventions in the absence of a therapists, such as exercise videos through an electronic tablet, virtual training programs, exercise from a digital video disc, and the combination of physical exercise programs through the internet and gamification [10]. In other words, the types of TR techniques vary considerably, and no specific definitions have been established. The key components of rehabilitation include not only physical training, but also the interactions between the therapist and the participants, such as goal setting based on shared decision making [14]. Therefore, it could be important that the therapist interacts with the participants in real-time using a telecommunication device (e.g., telephone, videophone, and audio-video conference) in TR.

On the other hand, another study has reported the effects of TR using direct video or voice telecommunication, though it encompasses articles published solely up to the year 2017 [12]. The domain of TR should be updated with the most recent articles, considering the numerous studies published in recent years.

Based on the above, in order to establish a methodology of TR, it is necessary to focus on real-time intervention between the therapist and participants and investigate the effects of TR. In addition, stricter inclusion criteria for types of intervention may lead to a more definitive demonstration of the effectiveness of TR. This study aims to summarize and synthesize the impacts of TR based on real-time intervention between therapist and participants for patients with stroke.

Review objectives

1. To summarize the outcomes of TR based on real-time intervention between therapist and participants for patients with stroke.
2. To synthesize the evidence on real-time intervention between healthcare professionals and stroke patients.

Protocol and registration

This systematic review was preregistered in the PROSPERO database (registration number: CRD420234265527). The review methodology will follow the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) [15, 16]. The systematic review results will be reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2020 statement) [17].

Eligibility criteria

Participants will include individuals over 20 years of age who have been diagnosed with a stroke who received a TR based on real-time interaction between therapist and patients.

Search strategy for identification of relevant studies

Our search will encompass electronic databases such as MEDLINE, Pubmed, Web of Science, PsycINFO and CINAHL, with a focus on literature spanning from their inception up to November 2023. The search strategy was designed according to previous studies [10] and with the assistance of an experienced researcher. The search strategy (S1 File) was composed of blocks of key terms related to the target population, telerehabilitation, outcome, and study design. Furthermore, we plan to conduct a manual examination of relevant literature cited within the studies we identify.

Study selection and data selection process

The authors, RF and YN, will independently carry out the screening process and detailed analysis of the full text, without concealing details like the publisher, author, or year of publication. In cases of disagreement, another author, TM, will serve as a mediator. Following this thorough evaluation of the full texts, the articles that meet our criteria will be selected, and a flow diagram will be created in accordance with the PRISMA checklist.

Assessment of methodological quality

The evaluation of argument quality in our study will be conducted using the PEDro score, a specifically designed instrument for assessing the methodological quality [18, 19]. The established score will be presented for comparative analysis. If no score is available, two independent reviewers (RF and YN) will assign a score. Any disagreements will be resolved through mediation by a third author, TM). We will provide a summary of the risk of bias (RoB) for each outcome in each individual study and furnish a table detailing the RoB. PEDro score of ≥6 was classified as moderate-quality to high-quality studies [18].

Data extraction

The data extraction and entry into a Microsoft Excel spreadsheet will be carried out by a single reviewer, RF. The forms will include (1) first author and year of publication; (2) study types; (3) study design; (4) settings and mode of administration (such as telephone, videoconferencing, and sensors); (5) length of intervention; (6) sample size at the beginning and end of the study; (7) age group; (8) analysis; (9) main results or findings; and (10) reporting of adverse events.

Data synthesis and analysis

A narrative synthesis will be carried out, which will provide texts and tables to synthesize and discuss the data of the studies and methodological characteristics, as previously described in the data extraction section.