Effect of a comprehensive eRehabilitation intervention alongside conventional stroke rehabilitation on disability and health-related quality of life: A pre–post comparison

Abstract

Objective To compare the effect on disability and quality of life, of conventional rehabilitation (control group) with individualized, tailored eRehabilitation intervention alongside conventional rehabilitation (Fast@home; intervention group), for people with stroke. METHODS Pre–post design. The intervention comprised cognitive (Braingymmer®) and physical (Telerevalidatie®/Physitrack®) exercises, activity-tracking (Activ8®) and psycho-education. Assessments were made at admission (T0) and after 3 (T3) and 6 months (T6). The primary outcome concerned disability (Stroke Impact Scale; SIS). Secondary outcomes were: health-related quality of life, fatigue, self-management, participation and physical activity. Changes in scores between T0–T3, T3–T6, and T0–T6 were compared by analysis of variance and linear mixed models. Results The study included 153 and 165 people with stroke in the control and intervention groups, respectively. In the intervention group, 82 (50%) people received the intervention, of whom 54 (66%) used it. Between T3 and T6, the change in scores for the SIS subscales Communication (control group/intervention group –1.7/–0.3) and Physical strength (–5.7/3.3) were significantly greater in the total intervention group (all mean differences< minimally clinically important differences). No significant differences were found for other SIS subscales or secondary outcomes, or between T0–T3 and T0–T6. Conclusion eRehabilitation alongside conventional stroke rehabilitation had a small positive effect on communication and physical strength on the longer term, compared to conventional rehabilitation only. LAY ABSTRACT Digital eRehabilitation, including cognitive/physical exercises, activity-tracking and psycho-education, is available for rehabilitation after stroke. In daily practice, these are used in parallel, and evidence regarding the effect of combining applications is scarce. The aim of this study was to investigate the effect of eRehabilitation in clinical practice. Outcomes for 153 people with stroke admitted to conventional rehabilitation only (control group) were compared with the outcomes for 165 people with stroke admitted when eRehabilitation was available (intervention group). A total of 82 people in the intervention group (50%) received the intervention, of whom 54 (66%) used it. In the first 3 months of rehabilitation, no differences were found between the groups. Between 3 and 6 months, the intervention group as a whole showed greater improvements regarding communication and physical strength. However, differences were below minimal clinical importance. In conclusion, adding eRehabilitation alongside conventional stroke rehabilitation had a small positive effect on communication and physical strength on the longer term, compared to conventional rehabilitation only.

Assessment of Process Evaluations of Complex Stroke Rehabilitation and Secondary Stroke Prevention Trials—A Scoping Review

“…Among the 24 articles, presentation of exclusively PE results (n = 9), exclusively main trial results (n = 6), combined trial results with PE results (n = 2), main trial protocols for understanding of the intervention (n = 5) and similar qualitative article of a trial (n = 2) were analyzed. 12–35 Two (0.2%) articles were disputed by the 2 reviewers as to their eligibility, but the nonconcurrence was settled with the help of the other 2 reviewers. The PRISMA flow diagram is presented in Figure 2.…”

“…13–17, 19, 22, 23, 27, 28 The trials were conducted in the developed countries (n = 5) like Sweden, Norway, Canada, Netherlands, and Australia, in middle-income countries (n = 4) like China and India, and in lower income country (n = 1) like Uganda, though the study and PE conducted in Uganda were entirely managed and sponsored by Sweden. 14–16, 20, 22–24, 26–28 Most of the trials were multicentered (n = 9), out of which AVERT was even a multicountry trial. 12–19, 28…”

Interactions Between EIP on AHA Reference Sites and Action Groups to Foster Digital Innovation of Health and Care in European Regions

“…ITALY.TELEREVALIDATIE.NL is a web-based solution for prescribing adapted physical activity to chronic disease patients and community-dwelling older adults. It provides tailored information and a personalised training programme with an instructional video and adherence monitoring tool 26 that has been integrated in the Adapted Physical Activity offer of the Sport Service of Federico II University Hospital.…”

“One Health” Approach for Health Innovation and Active Aging in Campania (Italy)

“…The Telerevalidatie.nl ® platform supports the physical activity of sedentary patients at their premises. It provides ICT-supported personalized training program with tutorial videos and at the same time allows to track their use of the platform ( 44 ). The Federico II University Hospital has activated a clinic for the physical activity on prescription (PAP), to ensure that patients discharged by a rehabilitation pathway are enrolled in a personalized physical activity program.…”