Clinical Efficacy of Telerehabilitation in Children with Cerebral Palsy:A meta-analysis (Preprint)

BACKGROUND Cerebral Palsy (CP) is a group of disorders characterized by persistent central motor and postural developmental issues, activity limitations, and sensory, cognitive, communication, and behavioral impairments, as well as epilepsy and secondary muscle and bone problems, which occur before birth, during delivery, or in the early postnatal period due to non-progressive brain damage in developing fetuses or infants[1]. According to the latest epidemiological data, the global incidence of CP ranges from 1‰ to 5‰, with developed countries having an incidence rate of approximately 1.5‰–2.5‰. In China, the incidence of CP is approximately 2.48‰, with variations between urban and rural areas and different regions[2]. Patients with CP often require long-term systematic rehabilitation interventions; however, traditional rehabilitation models face challenges such as the uneven distribution of medical resources, inconvenience for patients traveling to hospitals, and poor continuity of rehabilitation. Teles rehabilitation is an innovative approach that leverages modern information and communication technologies to provide rehabilitation services. It enables remote interaction and assessment between rehabilitation professionals and patients through electronic devices, Internet platforms, and remote monitoring systems, allowing patients to receive professional rehabilitation guidance and supervision in their homes or communities[3]. As a new form of medical service, tele-rehabilitation offers significant advantages in improving medical accessibility, reducing costs, and expanding the service coverage. Since 2010, the use of tele-rehabilitation technology in cerebral palsy rehabilitation has grown steadily, especially during the COVID-19 pandemic, when it experienced explosive growth. Tele-rehabilitation has gained widespread attention because of its convenience and accessibility. Multiple studies[4-6] have shown that tele-rehabilitation positively impacts gross motor function, postural control, sensory integration, and cognitive development in patients with cerebral palsy. However, these studies are often small-scale or single-center and lack systematic evaluation and evidence synthesis. Previous studies have conducted meta-analyses on the impact of telerehabilitation on patients with cerebral palsy. For instance, Rodriguez-Costa et al. [7] found that telerehabilitation can significantly improve gross motor function, balance, and endurance in children and adolescents with cerebral palsy. However, this study primarily focused on gross motor function, with a limited evaluation of fine motor skills and developmental levels. Additionally, Sel et al. [8], while covering multiple functional dimensions, did not conduct a detailed analysis of different types of cerebral palsy patients, which limits the applicability of their findings. To address these limitations, this study used systematic literature searches and meta-analyses to comprehensively evaluate the clinical effects of telerehabilitation on various aspects of cerebral palsy in patients, including gross motor function, fine motor skills, and developmental levels. The aim is to provide evidence-based medical guidance for developing clinical practice guidelines for cerebral palsy rehabilitation, optimizing telerehabilitation service models, and designing future related studies. The innovation of this study lies in its first systematic evaluation of the multifaceted functional impacts of telerehabilitation on different types of cerebral palsy patients, offering practical guidance for clinical application. OBJECTIVE Objective: To compare the effects of telerehabilitation and traditional rehabilitation methods on the functional rehabilitation of patients with cerebral palsy and to analyze the effects of telerehabilitation. METHODS Method: This study evaluated the clinical effects of telerehabilitation models on gross motor function and developmental levels in patients with cerebral palsy using a meta-analysis approach. Following the PRISMA framework, we searched databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Data Knowledge Service Platform, and VIP Chinese Science and Technology Journal Database. We included nine randomized controlled trials. We collected randomized controlled trials that demonstrated the improvement of rehabilitation functions in patients with cerebral palsy through telerehabilitation, with searches conducted from database inception to September 2024. Two researchers independently screened the literature and extracted valid data according to the inclusion criteria and evaluated the quality of each study. Meta-analysis was performed using RevMan5.4 software. RESULTS Results: Based on the inclusion and exclusion criteria, nine randomized controlled trials were included, involving 381 patients with cerebral palsy, with 190 in the telerehabilitation group and 191 in the traditional rehabilitation group. The meta-analysis revealed that the telerehabilitation group showed a significant improvement in gross motor function (GMFM) compared to the traditional rehabilitation group (MD=5.34,95%CI:0.64-10.05, P=0.03), indicating that telerehabilitation significantly improved the gross motor function of patients with cerebral palsy. Additionally, the Gesell Development Scale (MD=10.86,95%CI:6.58-15.13, P<0.001) indicated that telerehabilitation positively influenced the overall development of patients. There was no significant difference in grip strength (MD=0.5,95%CI:-1.12-2.11, P=0.55) or hand function (MD=1.8,95%CI:-0.85-4.44, P=0.18). CONCLUSIONS Conclusion: Telerehabilitation has a positive effect on the gross motor function and overall development of patients with cerebral palsy, which is helpful for the development of family rehabilitation for patients with cerebral palsy.