Efficacy of remote rehabilitation therapy for upper limb dysfunction following stroke: a systematic review and meta-analysis of randomised controlled clinical trials

BACKGROUND: Stroke is a leading cause of disability in adults, with approximately 80% of patients experiencing residual upper limb motor impairment that significantly impacts quality of life. Traditional rehabilitation models face constraints of time and space, alongside uneven distribution of resources. Telerehabilitation (TR) delivers rehabilitation services via the internet and smart technologies, yet its precise efficacy for upper limb function remains lacking in systematic evaluation.This study has been registered with the PROSPERO platform (ID: CRD420261279487). OBJECTIVE: Systematically evaluate the efficacy of remote rehabilitation on the recovery of upper limb motor function in stroke patients. METHODS: This study has been registered on the PROSPERO platform. Randomised controlled trials published in Chinese and English databases up to 6 January 2026 were systematically retrieved and screened according to the PICOS principle. Two researchers independently conducted literature screening, data extraction, and risk of bias assessment. Meta-analysis was conducted using RevMan 5.4 software. Continuous variables were expressed as mean differences or standardised mean differences. Fixed-effect or random-effects models were selected based on heterogeneity assessment results. Where significant heterogeneity was present (I²>50%, P < 0.10), subgroup analyses and sensitivity analyses were performed. RESULTS: A total of nine randomised controlled trials involving 600 patients were included. Meta‑analysis revealed that the TR group showed higher Fugl‑Meyer upper limb motor function scores compared with the conventional rehabilitation group, but the difference did not reach statistical significance(MD = 6.12, 95%CI[-3.66,15.90], P = 0.21). No statistically significant differences were observed between groups for the Modified Ashworth Scale, MAL-14 usage score, or Motion Study Arm Test (P > 0.05). Subgroup analysis suggested a positive trend towards improved motor function in studies with intervention cycles ≤ 4 weeks. Risk of bias assessment indicated that one study had low risk of bias across all domains (Grade A), while the remaining eight studies were rated as Grade B, mainly due to lack of blinding of participants and personnel. CONCLUSIONS: TR holds potential for improving upper limb motor function in stroke patients. However, the precise effect size remains uncertain, and its potential benefit in alleviating spasticity, promoting daily use, and facilitating task completion remains unclear. Nevertheless, given limitations in the number and quality of included studies, further large-scale, high-quality randomised controlled trials with extended follow-up periods are required to validate its therapeutic benefits. However, these findings should be interpreted with caution due to high heterogeneity and the limited number and quality of included studies.