Comparison of synchronous telerehabilitation and home-based upper limb resistance exercise programs in people with paraplegia: A randomized, controlled, double-blind study

Objective: To evaluate the effectiveness of synchronous telerehabilitation-based resistance exercises on upper limb function in people with paraplegia. Setting: Rehabilitation interventions were conducted either synchronously via telerehabilitation or through unsupervised home-based programs in participants’ residential environments. Participants: Twenty-one people with paraplegia, aged 18–60, who were partially or fully wheelchair-dependent and had sufficient upper limb function and access to online communication tools. Interventions: Both groups followed the same resistance exercise program (3 times/week for 6 weeks). The telerehabilitation group performed exercises under real-time remote supervision of a physiotherapist, while the control group completed an unsupervised home-based exercise program. Outcome Measures: Primary outcomes included upper limb muscle strength assessed via handheld dynamometry, physical performance measured by the 20-Meter Wheelchair Push Test, and physical activity levels evaluated using the Physical Activity Scale for Individuals with Physical Disabilities. Results: Significant within-group improvements were observed in the Study Group for shoulder and wrist strength, mobility performance, and physical activity levels (P < 0.01). However, no statistically significant between-group differences were observed post-intervention (P > 0.05). Conclusion: Synchronous telerehabilitation-based resistance exercises significantly enhanced upper limb strength, mobility, and activity levels in people with paraplegia. Comparable post-treatment outcomes between groups suggest that structured home-based exercise programs may also be effective when appropriately designed and supported. Trial registration: ClinicalTrials.gov identifier: NCT07115693.