TEleRehabilitation Nepal (TERN) to improve quality of life of people with spinal cord injury and acquired brain injury. A proof-of-concept study

Abstract

BackgroundSpinal Cord Injury (SCI) and Acquired Brain Injury (ABI) lead to unemployment, poverty, increased mortality, and decreased quality of life in low-and middle-income countries (LMICs). Telemedicine is increasingly facilitating access to healthcare, in LMICs. This prospective cohort intervention study aims to investigate feasibility and acceptability of telerehabilitation to provide long-term follow-up of individuals with SCI and ABI, in Nepal, post-discharge from hospital.MethodsTERN was delivered by Spinal Injury Rehabilitation Centre, Nepal, in collaboration with University of Leeds, UK. A home visit connected participants to the Multidisciplinary Team (MDT), through a specialised video conference system. The MDT performed a comprehensive assessment before recommending personalised interventions. Outcome measures assessed functional independence in performing activities of daily living, health-related quality of life and emotional disturbances using Modified Barthel Index, EuroQoL-5D, and Depression, Anxiety, Stress Scale, respectively. A subset of participants was interviewed, exploring acceptability of telerehabilitation.FindingsBetween January and December 2020, 97 participants with SCI (n = 82) and ABI (n = 15) were enrolled. After receiving telerehabilitation, significant improvement to self-reported functional independence (p<.001) and quality of life were found, (p<.001). Self-reported severity of depression, anxiety and stress significantly decreased (p<.001). Qualitative interviews (n = 18) revealed participants accepted telerehabilitation, they valued regular contact with professionals without costly, difficult travel.InterpretationThis is the first study to test telerehabilitation in Nepal. This approach can be safely delivered for long-term follow-up for individuals with SCI or ABI, overcoming geographical barriers to healthcare access. A larger-scale controlled study is required to further explore clinical and cost-effectiveness.