title: Effectiveness of telerehabilitation interventions in persons with multiple sclerosis: A systematic review.
abstract: BACKGROUND
  Telerehabilitation, a service delivery model using telecommunications technology to provide therapy at a distance, is used in persons with multiple sclerosis (pwMS), but evidence for their effectiveness is yet to be determined.
  
  
  OBJECTIVE
  To investigate the effectiveness and safety of telerehabilitation intervention pwMS.
  
  
  METHODS
  A comprehensive literature search was conducted using medical and health science electronic databases. Three reviewers selected potential studies and independently assessed the methodological quality. A meta-analysis was not possible due to heterogeneity amongst included trials, and a qualitative analysis was performed for best evidence synthesis.
  
  
  RESULTS
  Ten RCTs and 2 observational studies (n=564 participants) investigated a wide variety of telerehabilitation intervention in pwMS, which included: physical activity; educational, behavioural and symptom management programmes. All studies scored "low to moderate" on the methodological quality assessment implying high risk of bias. Overall, the review found low level evidence for the effectiveness of telerehabilitation on reducing short-term disability and reducing and/or improving symptoms, such as fatigue. There was low level evidence suggesting some benefit of telerehabilitation in improving functional activities; improving symptoms in the longer-term; and psychological outcomes and quality of life. There is limited data on safety, process evaluation and no data on cost-effectiveness of telerehabilitation.
  
  
  CONCLUSIONS
  A wide range of telerehabilitation is used in pwMS, however, the quality of evidence on these interventions was low. More robust trials are needed to build evidence about these interventions.
authors.affiliation: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: bhasker.amatya@mh.org.au.
authors.forename: B
authors.initials: B
authors.lastname: Amatya
authors.affiliation: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia. Electronic address: m.galea@unimelb.edu.au.
authors.forename: M P
authors.initials: MP
authors.lastname: Galea
authors.affiliation: Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland. Electronic address: J.Kesselring@klinik-valens.ch.
authors.forename: J
authors.initials: J
authors.lastname: Kesselring
authors.affiliation: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia. Electronic address: fary.khan@mh.org.au.
authors.forename: Fary
authors.initials: F
authors.lastname: Khan
mesh_terms: D006801:Humans; D009103:Multiple Sclerosis / Q000534:rehabilitation*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D000069350:Telerehabilitation / Q000379:methods
keywords: Disability; Impairment; Multiple sclerosis; Participation; Telerehabilitation