Xijun Wei

Background: Telerehabilitation programs use information and communications technologies to facilitate exercise training, self-management education, and health behavior modifications for nonhospitalized patients. In recent years, 2 systematic reviews have examined the effectiveness of telerehabilitation in the recovery of patients with hip fractures but have yielded inconsistent results. This is a significant gap because tools to assess clinical domains such as pain, range of motion, and deformity are crucial for patient outcomes. Moreover, the long-term effects of telerehabilitation on postoperative functional recovery in patients with hip fractures have not been investigated. Objective: To address the abovementioned research gap, this systematic review aimed to evaluate the short- and long-term effects of telerehabilitation on postoperative functional recovery in patients with hip fractures. Methods: We searched the PubMed, Cochrane Library, Embase, and Web of Science databases from inception to March 31, 2025. Randomized controlled trials investigating the effect of postoperative telerehabilitation in patients with hip fractures were included in this systematic review. Outcomes of interest included hip function measured using the Harris Hip Score; functional mobility measured using the Short Physical Performance Battery and the timed up and go test; and ability to perform basic activities of daily living measured using the Functional Independence Measure, Barthel index, or modified Barthel index. Meta-analyses were performed using the RevMan software (version 5.3). Results: A thorough literature search conducted in April 2025 yielded a total of 8 studies involving 740 patients for inclusion in this systematic review. Meta-analysis showed that telerehabilitation was effective for improving the Harris Hip Score at the intervention end point (2 included studies involving 156 participants; mean difference [MD] 7.42, 95% CI 5.61-9.23; P <.001; I ² =3%), the Short Physical Performance Battery score at the end point (4 included studies involving 430 participants; MD 1.34, 95% CI 1.14-1.55; P <.001; I ² =33%) and at follow-up (2 included studies involving 292 participants; MD 1.17, 95% CI 1.00-1.34; P <.001; I ² =0%), the timed up and go score at the end point (4 included studies involving 156 participants; MD –8.45, 95% CI −11.28 to −5.62; P <.001; I ² =0%) and at follow-up (2 included studies involving 63 participants; MD −7.66, 95% CI −13.78 to −1.53; P =.01; I ² =0%), and ability to perform basic activities of daily living at the end point (5 included studies involving 354 participants; standardized MD 1.65, 95% CI 0.78-2.51; P <.001; I ² =91%) and at follow-up (standardized MD 0.43, 95% CI 0.05-0.81; P =.03; I ² =48%). Conclusions: Our review found that postoperative telerehabilitation may benefit short- and long-term functional recovery in patients with hip fractures compared to conventional rehabilitation. However, the evidence was weak due to the limited number and insufficient quality of the included studies and the heterogeneity across the studies.

Accurate classification of muscle activation patterns is crucial for advancing rehabilitation, as it enables objective and physiologically informed patient grouping. Nevertheless, this approach remains underutilized in lower extremity rehabilitation due to the lack of standardized evaluation methods and robust implementation frameworks. To address this gap, we developed and clinically validated an interpretable, multi-granularity unsupervised grouping methodology using an integrated smart compression stocking system for objective monitoring of lower extremity muscle activation in healthy young adults. Twelve subjects performed maximal voluntary isometric contractions (MVIC) of the ankle plantar flexor muscles, generating a dataset of alpha values, each calculated as the ratio of normalized muscle torque measured by the Humac NORM equipment to the normalized, synchronized readout from the smart system, and indicating lower extremity muscle strength, density, and quality. The dataset used here was publicized in our previous study. Dimensionality reduction methods, including Principal Component Analysis (PCA) and t-distributed Stochastic Neighbor Embedding (t-SNE), were applied to visualize the data, revealing implicit distinctions in muscle activation patterns between sex groups. Clustering methods, including K-Means, Density-Based Spatial Clustering of Applications with Noise (DBSCAN), and Agglomerative Hierarchical Clustering (AHC), consistently identified two optimal clusters, achieving a 0.2890 silhouette score and a 4.9997 Calinski–Harabasz (CH) index. The results demonstrated 75% accuracy and an 80% F1 score in distinguishing masculine and feminine activation groups, substantially outperforming the baseline dummy model. Sex emerged as the primary implicit factor influencing muscle activation patterns, with body mass index (BMI) as a secondary implicit factor. These findings highlight the potential of integrating smart wearable systems with unsupervised machine learning to support more personalized and accessible rehabilitation interventions.

Virtual reality (VR) is a versatile technology with a wide range of applications in rehabilitation, encompassing diverse assessments and treatment modalities. In the context of resource scarcity, telerehabilitation has emerged as a viable solution to augment traditional rehabilitation practices. However, current telerehabilitation strategies largely overlook the integration of VR. The advent of six-degrees-of-freedom (6DOF) all-in-one VR headsets highlights the substantial potential for incorporating this technology into telerehabilitation. This chapter aims to consolidate existing research and incorporate insights from our pilot research and development endeavors, with the objective of delineating a framework for the utilization of VR in telerehabilitation. The psychometric properties and efficacy of VR-based assessments and treatments primarily hinge on human–computer interactions and data extraction during patients’ engagement with VR rehabilitation systems. Many contemporary systems are anchored in established theories and knowledge. Nonetheless, the elements within virtual environments offer unparalleled manipulability compared to real-world scenarios. Consequently, it is prudent to scrutinize current findings with a degree of caution.

BACKGROUND Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable, and interactive alternative. However, the effect of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored. OBJECTIVE This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke. METHODS This systematic review followed the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Eligible studies involved patients with stroke with upper extremity dysfunction who received home-based VR interventions. Data extraction was performed by 2 independent reviewers, and study quality was assessed using the Physiotherapy Evidence Database scale. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed instead of a meta-analysis. RESULTS A total of 8 RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols and small sample sizes limited the validity of results. The effect of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients. CONCLUSIONS This systematic review shows that home-based VR training has a positive impact on upper extremity rehabilitation for patients with stroke, particularly in those with varying degrees of dysfunction. However, heterogeneity in study design and differences in outcome measures affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. Future research should explore how VR technology can be integrated into comprehensive rehabilitation programs, focusing on patient-centered approaches that incorporate sustainable, personalized technology, and support services to optimize recovery outcomes. CLINICALTRIAL PROSPERO CRD42024526650; https://tinyurl.com/5dny5bhp

Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable and interactive alternative. However, the effect of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored. This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Eligible studies involved stroke patients with upper extremity dysfunction who received home-based VR interventions. Data extraction was performed by two independent reviewers, and study quality was assessed using the PEDro scale. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed instead of a meta-analysis. Eight RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols and small sample sizes limited the validity of results. The effect of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients. This systematic review shows that home-based VR training has a positive impact on upper extremity rehabilitation for stroke patients, particularly in those with varying degrees of dysfunction. However, heterogeneity in study design and differences in outcome measures affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. Future research should explore how VR technology can be integrated into comprehensive rehabilitation programs, focusing on patient-centered approaches that incorporate sustainable, personalized technology and support services to optimize recovery outcomes. PROSPERO CRD42024526650; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024526650.

Background: Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. Objective: This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Methods: Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. Results: The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI (ρ=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment (ρ=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment (ρ=−0.58; P=.08). Conclusions: Considering the small sample size used in this study and the study’s limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments.

Continuous monitoring of lower extremity muscles is necessary, as the muscles support many human daily activities, such as maintaining balance, standing, walking, running, and jumping. However, conventional electromyography and physiological cross-sectional area methods inherently encounter obstacles when acquiring precise and real-time data pertaining to human bodies, with a notable lack of consideration for user comfort. Benefitting from the fast development of various fabric-based sensors, this paper addresses these current issues by designing an integrated smart compression stocking system, which includes compression garments, fabric-embedded capacitive pressure sensors, an edge control unit, a user mobile application, and cloud backend. The pipeline architecture design and component selection are discussed in detail to illustrate a comprehensive user-centered STIMES design. Twelve healthy young individuals were recruited for clinical experiments to perform maximum voluntary isometric ankle plantarflexion contractions. All data were simultaneously collected through the integrated smart compression stocking system and a muscle force measurement system (Humac NORM, software version HUMAC2015). The obtained correlation coefficients above 0.92 indicated high linear relationships between the muscle torque and the proposed system readout. Two-way ANOVA analysis further stressed that different ankle angles (p = 0.055) had more important effects on the results than different subjects (p = 0.290). Hence, the integrated smart compression stocking system can be used to monitor the muscle force of the lower extremities in isometric mode.

Instrumental activities of daily living (IADL) training is critical in clinical practice of occupational therapy (OT) for stroke patients. In the conventional approaches, the therapists simulate various occupational tasks in their healthcare settings or reach their nearby real circumstances for the training. As an alternative technology, immersive virtual reality (IVR) has been used widely in stroke rehabilitation for years; however, limited research has compared occupational performances between virtual and real environments. Our team has established a novel IVR shopping training system for stroke rehabilitation. We recruited 10 stroke patients from our department to test the system. All patients attempted to implement shopping tasks in the virtual and real environments respectively. The Wilcoxon test showed no significant differences between virtual and real environments in memory capacity and time-consuming for implementing tasks, and memory capacities in virtual and real environments presented excellent correlations with the IADL assessment. This study suggests that IVR shopping tasks can be used as an alternative approach in rehabilitation when there is limited resource for implementing shopping training in a real environment, while the psychometric property, clinical effect and the effect transferred to the real environment induced by virtual training require further study.

Objectives: To investigate the effectiveness of home-based interventions in improving the ability to do basic activities of daily living in patients who had a stroke. Methods: Randomised controlled trials were searched through MEDLINE, Embase and CINAHL from their inception to 31 December 2021. We included studies involving home-based intervention prescribed by professionals and implemented at patients’ homes. The characteristics of these studies were collected. Risk of bias of individual study was assessed by Physiotherapy Evidence Database scale. Meta-analyses were performed where studies reported comparable interventions and outcomes. Results: In total, 49 studies were included in the systematic review and 16 studies had sufficient data for meta-analyses. The short-term effect of home-based intervention showed no significant difference when compared with institution-based intervention (standardised mean difference (SMD)=0.24, 95% CI −0.15 to 0.62, I ² =0%). No significant difference was found between home-based intervention and usual care for long-term effect (SMD=0.02; 95% CI −0.17 to 0.22; I ² =0%). Home-based rehabilitation combined with usual care showed a significant short-term effect on the ability to do basic daily activities, compared with usual care alone (SMD=0.55; 95% CI 0.22 to 0.87; p=0.001; I ² =3%). Conclusion: Home-based rehabilitation with usual care, which varied from no therapy to inpatient or outpatient therapy, may have a short-term effect on the ability to do basic activities of daily living for patients who had a stroke compared with usual care alone. However, the evidence quality is low because of the limited number of studies and participants included in the meta-analysis and the possible publication bias. Future research is needed to investigate the effectiveness of home-based rehabilitation in groups with stratification by stroke severity and time since stroke onset, with elaboration of details of the home-based and the control interventions. Moreover, more high-quality studies are required to prove the cost-effectiveness of newly developed strategies like caregiver-mediated rehabilitation and telerehabilitation. The primary source of funding: The Medical Research Fund of Guangdong Province (No: A2021041).