This single-blinded randomized controlled trial aims to compare the effectiveness of maximum versus minimum therapist supervision during home-based telerehabilitation for improving upper limb motor function, task performance, coordination, and proprioception in stroke survivors. The study will be conducted at MDL Rehabilitation FUCP and participants' home settings. A total of 30 stroke survivors aged 40-70 years with mild to moderate upper limb impairment (Fugl-Meyer Assessment of the Upper Extremity \[FM-UE\] score 23-56) and a stroke duration of 3-24 months will be recruited through purposive sampling and randomly allocated to either the maximum- or minimum-supervision group.Participants in the maximum-supervision group will receive three 45-minute videoconference-based telerehabilitation sessions per week, for a total of 24 sessions over eight weeks. Exercises will be individualized according to baseline FM-UE scores. The minimum-supervision group will perform an independent home-based exercise program at the same frequency and duration, supplemented by weekly therapist check-ins and a self-maintained exercise log. Both groups will receive standardized instructional materials, including an exercise booklet and demonstration videos, and will perform exercises within individual fatigue limits.The primary outcomes will be assessed using the Fugl-Meyer Upper Extremity Assessment, Wolf Motor Function Test, Comprehensive Coordination Scale, and Thumb Localization Test, evaluating upper limb motor recovery, functional task performance, coordination, and proprioception.The study is expected to determine whether greater therapist supervision provides superior or comparable outcomes and to contribute evidence for developing effective, scalable, and cost-efficient home-based telerehabilitation models for stroke rehabilitation.
This single-blinded randomized controlled trial will compare the effects of maximum versus minimum therapist supervision during home-based telerehabilitation in stroke survivors with upper limb impairment. The study will examine whether the intensity of therapist supervision influences improvements in upper limb motor function, functional task performance, coordination, and proprioception. The study will be conducted over one year at MDL Rehabilitation FUCP and in participants' home settings. With the increasing demand for accessible and home-based stroke rehabilitation, this study aims to determine whether frequent therapist supervision provides additional benefits or whether a less supervised model can achieve comparable functional recovery. A total of 30 stroke survivors aged 40-70 years will be recruited through purposive sampling. Participants will have experienced a stroke 3-24 months before enrollment and will demonstrate mild to moderate upper limb impairment, defined by a Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score between 23 and 56. Eligible participants will undergo baseline assessment before being randomly allocated into either the maximum-supervision or minimum-supervision group. Randomization will help ensure an appropriate comparison between the two intervention approaches. The rehabilitation intervention will be developed from a standardized pool of 50 pre-designed therapeutic exercises. This exercise pool will provide a structured range of activities addressing different components of upper limb recovery while allowing the program to be individualized according to each participant's baseline motor ability. Exercise selection and progression will be guided by the participant's initial FMA-UE performance and response to treatment. The intervention will follow a progressive sequence over the eight-week treatment period. During the first two weeks, exercises will primarily focus on range of motion (ROM), mobility, and controlled movement of the affected upper limb. As participants progress, the exercises will gradually incorporate more functional and challenging activities. During weeks 3 and 4, the program will progress toward bimanual activities requiring coordinated use of both upper limbs. In weeks 5 and 6, greater emphasis will be placed on grasp-and-release activities to improve hand control, object manipulation, and functional use of the affected limb. During the final two weeks, exercises will advance toward fine motor activities requiring greater precision, dexterity, coordination, and selective hand movements. This staged progression from basic movement to increasingly complex functional activities is intended to provide an appropriate therapeutic challenge while supporting gradual improvement in motor control and task performance. Exercises will be selected from the established 50-exercise pool based on individual ability rather than applying an identical exercise sequence to every participant. Participants in the maximum-supervision group will receive three 45-minute videoconference sessions per week for eight weeks, providing a total of 24 therapist-supervised sessions. During these sessions, the therapist will monitor exercise performance, provide verbal and visual feedback, correct compensatory movement patterns, and modify activities when appropriate. The therapist will also ensure that exercises remain suitable for the participant's functional level and fatigue tolerance. In contrast, participants in the minimum-supervision group will perform their prescribed 45-minute home exercise sessions independently three times per week for the same eight-week period. They will receive weekly therapist check-ins to review progress, address difficulties, and support adherence. Both groups will therefore complete an equivalent overall exercise schedule, while differing primarily in the amount of direct therapist supervision. To maintain consistency between groups, all participants will receive the same exercise booklet and demonstration videos. They will be instructed to perform exercises within their individual fatigue limits and to follow the prescribed progression. Participants in the minimum-supervision group will maintain an exercise log to record their home practice, while therapist monitoring in the maximum-supervision group will provide more frequent oversight of exercise performance and adherence. The effects of the intervention will be evaluated using established outcome measures. The Fugl-Meyer Upper Extremity Assessment will assess upper limb motor impairment and recovery. The Wolf Motor Function Test will evaluate functional task performance and upper limb use. Coordination will be assessed using the Comprehensive Coordination Scale, while proprioceptive function will be evaluated using the Thumb Localization Test. These measures will allow assessment of changes across motor recovery, functional performance, coordination, and sensory-motor control. The study is expected to determine whether intensive therapist supervision results in superior outcomes compared with a minimally supervised home-based program. The findings may help establish an appropriate supervision model for telerehabilitation after stroke and support the development of practical, scalable, and cost-efficient rehabilitation programs that can provide structured upper limb training within the home environment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
Participants in the maximum supervision group will receive physiotherapist-supervised home-based telerehabilitation comprising three 45-minute real-time videoconference sessions per week so 24 sessions over eight weeks. An individualized upper limb exercise program will be prescribed from a standardized exercise pool based on each participant's baseline Fugl-Meyer Assessment-Upper Extremity score and functional abilities. Exercises will progress from range of motion for week 1-2 to bimanual tasks for week 3-4 to grasp and release activities for week 5-6 and fine motor activities for week 7-8 with progression tailored to performance and performed within fatigue limits. Participants will receive an exercise booklet and demonstration videos for support.
Participants in the minimum-supervision group will perform their prescribed 45-minute home exercise sessions independently three times per week for the same eight-week period. The individualized upper limb exercise program will be selected from a standardized exercise pool according to each participant's baseline Fugl-Meyer Assessment-Upper Extremity score and functional abilities. Exercises will progress from range-of-motion activities during weeks 1-2, to bimanual tasks during weeks 3-4, grasp-and-release activities during weeks 5-6, and fine motor activities during weeks 7-8 with progression tailored to performance and performed within fatigue limits. Participants will receive an exercise booklet and demonstration videos to facilitate independent exercise performance. Physiotherapists will conduct weekly remote check-ins to monitor adherence, address difficulties, and provide guidance, while participants will maintain a self-reported exercise log.
Foundation University College of Physical Therapy
Islamabad, Pakistan
RECRUITINGCoordination
Comprehensive coordination scale will be used to asses upper limb coordination with higher scores indicating better coordination.
Time frame: 8 Weeks
Upper-limb motor function
Upper limb motor function refers to the ability of the affected upper extremity to perform voluntary, controlled, and coordinated movements following stroke. It will be assessed using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Participants with baseline FMA-UE scores of 23-56 will be included, indicating mild to moderate upper limb impairment. The FMA-UE will be measured at baseline (pre-intervention) and immediately after the 8-week intervention (post-intervention) to determine changes in motor function.
Time frame: 8 Weeks
Upper limb task performance
Upper limb task performance refers to the ability of the affected upper extremity to perform functional movements and goal-directed tasks required for daily activities. It will be assessed using the Wolf Motor Function Test (WMFT), which evaluates functional upper limb movements through standardized tasks. Performance is scored on a 0-5 functional ability scale, with higher scores indicating better function, and task completion time is also recorded.. The WMFT will be measured at baseline (pre-intervention) and immediately after the 8-week intervention (post-intervention) to determine changes in upper limb task performance.
Time frame: 8 weeks
Proprioception
Proprioception refers to the ability to perceive the position and movement of the affected upper limb without relying on visual input. It will be assessed using the Thumb Localization Test, which evaluates the participant's ability to accurately identify the position of the affected thumb. It will be measured at baseline (pre-intervention) and immediately after the 8-week intervention (post-intervention) to determine changes in proprioceptive function.
Time frame: 8 Weeks
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.