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.
Stroke either ischemic or hemorrhagic clinically diagnosed or confirmed by MRI or CT.
Stroke duration between 3 and 24 months.
Age between 40 and 70 years.
FMA score of 23-56 out of 66 points on the hemiplegic side.
- Presence of aphasia or apraxia or unilateral neglect.
Unable to understand or remember or follow commands.
Modified ashworth scale score greater than 3 for spasticity.
History of other brain diseases or brain surgery.
Parallel
Maximum supervision telerehabilitation
Procedure/SurgeryParticipants 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.
Minimum Supervision Telerehabilitation
Procedure/SurgeryParticipants 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.
Coordination
Comprehensive coordination scale will be used to asses upper limb coordination with higher scores indicating better coordination.
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.
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.
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.
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