Huijgen 2008

Methods	RCT
Participants	Recruited from a rehabilitation service in The Netherlands Inclusion criteria: age > 18 years; established diagnosis of multiple sclerosis, stroke or traumatic brain injury; taking more than 25 seconds to perform the Nine‐Hole Peg Test, ability to move at least 1 peg in 180 seconds during the Nine‐Hole Peg Test, sufficient autonomous functioning, Internet connection or telephone line and reachable Internet provider, stable clinical status, living at home Exclusion criteria: disturbed upper limb function not related to multiple sclerosis, traumatic brain injury or stroke; serious cognitive and/or behavioural problems, major visual problems, communication problems, medical complications; other problems, possibly contraindicating autonomous exercise at home Age, years: telerehabilitation group mean = 69 (SD 8), control group mean = 71 (SD 7) Gender: telerehabilitation group 18% males, control group 80% males Time poststroke: telerehabilitation group mean 3 (SD 2) years, control group mean 1.8 (SD 0.8) years
Interventions	Telerehabilitation intervention: 1 month of usual care followed by approximately 4 training sessions with the Home Care Activity Device (HCAD) system in the hospital and intervention using the HCAD for 1 month. The system comprised a hospital‐based server and the portable unit installed at the participant's home. The portable unit consisted of 7 sensorised tools; a key, a light bulb, a book, a jar, writing, checkers and keyboard. The unit also had 2 Webcams that allowed videoconferencing and recording. It was recommended that participants use the HCAD at least 5 days per week for 30 minutes Control intervention: usual care and generic exercises prescribed by the physician
Outcomes	Timing of outcome assessment: baseline and post‐intervention Measures: Barthel Index, participant satisfaction assessed using visual analogue scale, SF‐36, Action Research Arm Test, Nine‐Hole Peg Test, Wolf Motor Function Test, grip strength, Abilhand
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Randomisation scheme generated using 2:1 allocation ratio. Participants allocated to the study when the intervention was available
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropouts were reported and ITT analyses conducted
Selective reporting (reporting bias)	High risk	Some study data not reported in the published paper
Other bias	High risk	Small sample size Differences between groups at baseline