Internet-based information provision to families of stroke patients in a rehabilitation hospital during the COVID-19 pandemic: A case-control study (Preprint)

Abstract

BACKGROUND The spread of COVID-19 has affected stroke rehabilitation. Given that inpatient visits are restricted in most institutions, alternative ways of providing information to family members are imperative. Informing families about patients’ rehabilitation progress via the Internet may help involve families in the rehabilitation process, enhance patients’ motivation to continue rehabilitation, and contribute overall to improvement of activities of daily living (ADL) in patients. OBJECTIVE We aimed to investigate the feasibility of an Internet-based rehabilitation information provision (IRIP) intervention for families of stroke patients at a rehabilitation hospital and to examine the effect of IRIP on patients’ ADL improvement. METHODS In this case-control study, participants were inpatients at a rehabilitation hospital between March 2020 and April 2021. The intervention group (ICT group) included patients and families who requested IRIP, which consisted of a progress report on patients’ rehabilitation using text, photos, and movies. Those who did not receive Internet-based information were included in the non-ICT group. The control group, matched with the ICT group based on a 1:1 propensity score, was selected from the non-ICT group. The covariates for calculating the propensity score were patients’ age, sex, and motor and cognitive scores on the Functional Independence Measure (FIM) at admission. The main outcome was the degree of ADL improvement during hospitalization. Multiple regression analysis (forced entry method) was performed to confirm the impact of ICT use on ADL improvement. The independent variables were the presence of intervention, length of hospital stay, and the number of days from onset to hospitalization. RESULTS Sixteen groups of patients and families participated in the IRIP. The mean age of patients was 78.6±7.2 and 78.6±8.2 years in the ICT and control groups, respectively. The median total FIM difference was 28.5 (interquartile range 20.3-53.0) and 11.0 (2.8-30.0) in the ICT and control groups, respectively, and the ICT group showed significant improvement in ADL function (p=0.019). In the multiple regression analysis of the ICT and control groups, the unstandardized regression coefficients and 95% confidence intervals were 11.97 (0.09 to 23.84) for ICT use. These results indicate that ICT use was independently and significantly associated with improvement in ADL. CONCLUSIONS This study examined the effect of IRIP for family members to improve ADL of hospitalized stroke patients. The results showed that IRIP promotes improvement of patients’ ADL regardless of their age, sex, and motor and cognitive functions at admission, and length of hospital stay. CLINICALTRIAL This study was approved by the Research Ethics Committee at Osaka Prefecture University (2018-118).