Effects of Telerehabilitation on Physical Function and Disability for Stroke Patients

Abstract

Background and Purpose— To determine the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on physical function, and secondarily on disability, in veterans poststroke. Methods— We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers. Veterans with a stroke in the preceding 24 months were randomized to the STeleR intervention or usual care. The STeleR intervention consisted of 3 home visits, 5 telephone calls, and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies. Usual care participants received routine rehabilitation care as prescribed by their physicians. The primary outcome measures were improvement in function at 6 months, measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument. Results— The 2 complementary primary outcomes (Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure) improved at 6 months for the STeleR group and declined for the usual care group, but the differences were not statistically significant ( P =0.25, Late-Life Function and Disability Instrument; P =0.316). Several of secondary outcomes were statistically significant. At 6 months, compared with the usual care group, the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P <0.05), and approached significance in 1 of the 3 Function component subscales ( P =0.06). Conclusions— The STeleR intervention significantly improved physical function, with improvements persisting up to 3 months after completing the intervention. STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited resources available for in-home rehabilitation for stroke survivors. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00384748.

Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes

“…It can also serve as an alternative to "homecare" rehabilitation, which requires the treating therapist or clinician to travel to the patient's home. By reducing or eliminating barriers relating to travel time and travel-related costs, telerehabilitation has the potential to improve access to rehabilitative care for stroke survivors [6][7]. Improving access to rehabilitative care may reduce disparities for stroke survivors and caregivers facing financial or transportation-related challenges.…”

“…Improving access to rehabilitative care may reduce disparities for stroke survivors and caregivers facing financial or transportation-related challenges. While research on telerehabilitation is limited, there is increasing evidence supporting the need for telerehabilitation services, the development of telerehabilitation interventions, and support for people with disabling conditions that potentially limit access to rehabilitation services [6][7][8][9][10][11][12][13][14].…”

Improving Quality of Life and Depression After Stroke Through Telerehabilitation

“…Telerehabilitation is an emerging method of rehabilitation that consists of the remote delivery and monitoring of rehabilitation services (McCue, Fairman, & Pramuka, 2010) and has the potential to provide health care services to underserved areas with potential cost and travel savings (Chumbler et al, 2010;Gamble, Savage, & Icenogle, 2004). Several studies have supported the efficacy of telerehabilitation in facilitating motor recovery and activities of daily living (ADL) performance after stroke (Chumbler et al, 2012;Lum, Uswatte, Taub, Hardin, & Mark, 2006;Rogante, Grigioni, Cordella, & Giacomozzi, 2010); however, the research devoted to telerehabilitation and QOL outcomes has been limited.…”

Tele-rehabilitation to Promote Exercise in Veterans Post-Stroke: An Observational Pilot Study

“…Technology applications such as telehealth, which is the use of electronic information and telecommunication technologies to facilitate long-distance clinical healthcare and patient related education [18], provides a promising option for providing this support [19]. While others have reported on telehealth applications, none, to our knowledge, have reported the use of tele-rehabilitation to promote exercise adherence and progression in people with post stroke.…”

“…Furthermore, in a randomized controlled trial, Chumbler et al [19] reported improved physical function in Veterans participating in a post-stroke tele-rehabilitation program (STeleR) which included instruction for functionally-based exercises and adaptive strategies. The authors concluded that the STeleR program might be a useful supplement to traditional post-stroke in-home care [19].…”