The aim of this rapid review and opinion paper is to present the state of the current evidence and present future directions for telehealth research and clinical service delivery for stroke rehabilitation.
Methods:
We conducted a rapid review of published trials in the field. We searched Medline using key terms related to stroke rehabilitation and telehealth or virtual care. We also searched clinical trial registers to identify key ongoing trials.
Results:
The evidence for telehealth to deliver stroke rehabilitation interventions is not strong and is predominantly based on small trials prone to Type 2 error. To move the field forward, we need to progress to trials of implementation that include measures of adoption and reach, as well as effectiveness. We also need to understand which outcome measures can be reliably measured remotely, and/or develop new ones. We present tools to assist with the deployment of telehealth for rehabilitation after stroke.
Conclusion:
The current, and likely long-term, pandemic means that we cannot wait for stronger evidence before implementing telehealth. As a research and clinical community, we owe it to people living with stroke internationally to investigate the best possible telehealth solutions for providing the highest quality rehabilitation.
Stroke Association. Stroke recoveries at risk. How the COVID-19 pandemic has affected stroke survivors’ lives and lives. Rebuilding lives after stroke. London: Stroke Association, 2020.
2.
CadilhacDAKimJTodEK, et al. COVID-19 pandemic impact on care for stroke in Australia: emerging evidence from the Australian Stroke Clinical Registry. Front Neurol2021; 12: 621495.
CramerSCDodakianLLeV, et al. Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after Stroke. A randomized clinical trial. JAMA Neurol2019; 76: 1079–1087.
6.
SeronPOliverosM-JGutierrez-AriasR, et al. Effectiveness of telerehabilitation in physical therapy: a rapid overview. Phys Ther2021; 101: 1–9.
7.
Suso-MartíLToucheRLHerranz-GómezAAngulo-Díaz-ParreñoSParis-AlemanyACuenca-MartínezF.Effectiveness of telerehabilitation in physical therapist practice: an umbrella and mapping review with meta–meta-analysis. Phys Ther2021; 101: pzab075.
8.
YangC-LWatersonSEngJJ. Implementation and evaluation of the virtual Graded Repetitive Arm Supplementary Program (GRASP) for individuals with stroke during the COVID-19 pandemic and beyond. Phys Ther2021; 101: 1–9.
9.
HarrisJEEngJJMillerWCDawsonAS. A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient rsroke rehabilitation. A multi-site randomized controlled trial. Stroke2009; 40: 2123–2128.
10.
KwanBMMcGinnesHLOryMGEstabrooksPAWaxmonskyJAGlasgowRE. RE-AIM in the real world: use of the RE-AIM framework for program planning and evaluation in clinical and community settings. Front Neurol2019; 7: 345.
11.
LynchEAMudgeAKnowlesSKitsonALHunterSCHarveyG. There is nothing so practical as a good theory: a pragmatic guide for selecting theoretical approaches for implementation projects. BMC Health Serv Res2018; 18: 857.
12.
HoffmannTCGlasziouPPBoutronI, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ2014; 348: g168720140313.
13.
EnglishCPattersonAMacDonald-WicksL, et al. ENAbLE: secondary prevention of stroke. A physical activity and diet trial protocol. Int J Stroke2019; 14: 12.
14.
KwakkelGLanninNABorschmannK, et al. Standardized measurement of sensorimotor recovery in stroke trials: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair2017; 31: 784–792.
15.
AmanoSUmejiAUchitaA, et al. Reliability of remote evaluation for the Fugl–Meyer assessment and the action research arm test in hemiparetic patients after stroke. Top Stroke Rehabil2018; 25: 432–437.
16.
PetersSBoteroMEversA, et al. Development and feasibility of a modified Fugl-Meyer lower extremity assessment for telerehabilitation: a pilot study. Pilot Feasibility Stud2021; 7: 121.
17.
KuriaAJacobsBMLeddyS, et al. Evaluation of remote assessments for multiple sclerosis in an in-home setting. Mult Scler Relat Disord2021; 54: 103125.
18.
YangC-LSimposonLAEngJ. Remote evaluation of upper extremity motor function following stroke: the Arm Capacity and Movement Test (ArmCAM), https://preprints.jmir.org/preprint/26044
19.
FellNTrueHHAllenB, et al. Functional measurement post-stroke via mobile application and body-worn sensor technology. mHealth2019; 5: 1–7.
20.
BallesterBLatheADuarteEDuffAVerschurePFMJ. A wearable bracelet device for promoting arm use in stroke patients. In: Proceedings of the 3rdinternational congress on neurotechnology, electronics and informatics (NEUROTECHNIX 2015), 2015, pp. 24–31, https://www.scitepress.org/papers/2015/56623/56623.pdf
21.
WinsteinCJSteinJArenaR, et al. Guidelines for adult stroke rehabilitation and recovery. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke2016; 47: e98–e169.
CaughlinSMehtaSCorriveauH, et al. Implementing telerehabilitation after stroke: lessons learned from Canadian trials. Telemed J E Health2020; 26: 710–719.
24.
LawsonDWStolwykRJPonsfordJLBakerKSTranJWongD. Acceptability of telehealth in post-stroke memory rehabilitation: a qualitative analysis. Neuropsychol Rehabil. Epub ahead of 17July2020. DOI: 10.1080/09602011.2020.1792318.
25.
VarsiCNesLSKristjansdottirOB, et al. Implementation strategies to enhance the implementation of eHealth programs for patients with chronic illnesses: realist systematic review. JMIR2019; 21: e14255.
26.
MahmoodANayakPEnglishC, et al. Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: a randomized controlled trial. Top Stroke Rehabil. Epub ahead of print 28June2021. DOI: 10.1080/10749357.2021.1940800.
27.
LevyTChristieLJKillingtonMLaverKCrottyMLanninNA. “Just that four letter word, hope”: stroke survivors’perspectives of participation in an intensive upperlimb exercise program; a qualitative exploration. Physiother Theory Pract2021. DOI: 10.1080/09593985.2021.1875525.
28.
WernekeMWDeutscherDGrigsbyDTuckerCAMioduskiJEHayesD. Telerehabilitation during the COVID-19 pandemic in outpatient rehabilitation setttings: a descriptive study. Phys Ther2021; 101: pzab110.
29.
StrowdREStraussLGrahamR, et al. Rapid implementation of outpatient teleneurology in rural appalachia: barriers and disparities. Neurol Clin Pract2021; 11: 232–241.
30.
SarfoFSAdamuSAwuahDSarfo-KantankaOOvbiageleB. Potential role of tele-rehabilitation to address barriers to implementation of physical therapy among West African stroke survivors: a cross-sectional survey. J Neurol Sci2017; 381: 203–208.
31.
DantasLOGonçalvesBarretoRPJorgeFerreiraCH. Editorial. Digital physical therapy in the COVID-19 pandemic. Braz J Phys Ther2020; 24: 381–383.
KamwesigaJTErikssonGMThamK, et al. A feasibility study of a mobile phonesupported family-centred ADL intervention, F@ce™, after stroke in Uganda. Global Health2018; 14: 82.
34.
SarfoFSAduseiNAmpofoMKpemeFKOvbiageleB. Pilot trial of a tele-rehab intervention to improve outcomes after stroke in Ghana: a feasibility and user satisfaction study. J Neurol Sci2018; 387: 94–97.
35.
GargDDhamijaRK. Teleneurorehabilitation for Parkinson’s disease: a panacea for the times to come?Ann Indian Acad Neurol2020; 23: 592–597.
36.
BernhardtJUrimubenshiGGandhiDBCEngJJ. Stroke rehabilitation in low-income and middle-income countries: a call to action. Lancet2020; 396: 1452–1462.
37.
The ATTEND Collaborative Group. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet2017; 390: 588–599.
38.
ZhouBZhangJZhaoY, et al. Caregiver-delivered stroke rehabilitation in rural China. The RECOVER randomized controlled trial. Stroke2019; 50: 1825–1830.
39.
SuryaNSrivastavaANagdaTPalandeDSomeshwarH. Education, training, and practices of neurorehabilitation in India during the COVID-19 pandemic. Front Neurol2021; 12: 626399.
40.
GandhiDBCKamalakannanSChockalingamM, et al. Expert consensus for in-hospital neurorehabilitation during the COVID-19 pandemic in low- and middle-income countries. Wellcome Open Res2021; 6: 130.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
