EFFECTS OF AN INTEGRATED TELEREHABILITATION MODEL FOR POST-STROKE CONTINUITY OF CARE: A MULTICENTRE FEASIBILITY STUDY

S. Federico¹, L. Cacciante¹, M. Agostini², J. Jonsdottir³, R. De Icco⁴, F. Cecchi⁵, M. Franceschini⁶, R. Gatti⁷, G. Maggioni⁸, R.S. Calabrò⁹, L. Maistrello¹⁰, C. Pagliari³, A. Turolla^11,12

¹Hospital San Camillo IRCCS, Laboratory of Rehabilitation Technology, Venice, Italy, ²University of Padua, Neurophysiology and Movement Rehabilitation Group, Padua, Italy, ³IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy, ⁴IRCCS Mondino Foundation, Headache Science and Neurorehabilitation Center, Pavia, Italy, ⁵IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy, ⁶IRCCS San Raffaele Roma, Department of Neurological and Rehabilitation Sciences, Rome, Italy, ⁷IRCCS Humanitas Research Hospital, Physiotherapy Unit, Rozzano, Italy, ⁸Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Neurorehabilitation Division, Novara, Italy, ⁹IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy, ¹⁰Hospital San Camillo IRCCS, Venezia, Italy, ¹¹University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy, ¹²IRCCS Azienda Ospedaliero-Universitaria di Bologna, Division of Occupational Medicine, Bologna, Italy

Background: Telehealth approaches are receiving great attention due to the possibility of providing high doses of rehabilitation therapy in a simple, efficient, and accessible manner, with comparable effectiveness of face-to-face interventions. However, the use of telerehabilitation (TR) services is still limited and uneven, additionally, there is a lack of mixed-method studies investigating the feasibility of this methodology, failing to focus on user acceptance, usability and user satisfaction.

Purpose: To evaluate the feasibility of an Integrated Telerehabilitation System, allowing to provide motor, speech and cognitive treatments to people with stroke, after hospital discharge. Moreover, data for cost-effectiveness analysis, acceptability and usability was collected.

Methods: A single group feasibility study was conducted on stroke survivors discharged at home, receiving 20 remote rehabilitation sessions, delivered by a healthcare professional, 1h/day, 5 times/week for 4 weeks. Each patient received rehabilitation at least in one domain (motor, speech, cognitive) according individual impairments. The treatment was based on the remote control of a special VRRS-TR® workstation (Khymeia Group Ltd., Noventa Padovana, Italy) connected via Internet and placed at patient’s home. Client Satisfaction Measure, System Usability Scale (SUS), Technology Acceptance Model (TAM) Questionnaire, were the primary outcome measures, to assess the quality of service provided and average scores were analysed with Shewart charts. Secondary outcomes included Fugl-Meyer Upper Extremity (FM-UE), Nine hole pegboard test, Box & Block, Ashworth, Montreal Cognitive Assesment (MoCA), Bells Test, Modified Barthel Index (MBI), SF-36, Beck Depression Inventory, Aachener Aphasia Test (AAT), EuroQoL-5D-3L(EQ-5D).

Results: Overall, 84 subjects were enrolled in the study and good levels of patient satisfaction [Client Satisfaction Measure mean(sd) = 74.31(77.5)], as well as usability of the TR system [SUS mean(sd) = 19.57 (3.66)] were reported. On the other hand, Technology Acceptance showed easiness of use [mean(sd) = 6.56 (6.27)], usefulness to get in touch with healthcare professionals [mean(sd)= 6.34 (1.01)], and possession of the necessary resources [mean(sd)= 1.94(1.60)] to perform TR. After the home-based TR treatment patients showed significant improvements of their motor function (F-M UE: p<0.001; NHPT: p<0.001), ADLs (MBI: p<0.001), and QoL (EQ-5D: p<0.001).

Conclusions: The proposed home-based TR treatment proved to be feasible, effective and accepted by patients, allowing to perform different rehabilitative methodologies and providing an integrated approach. This study showed a beneficial effect of the motor function in post-stroke patients, which was accompanied by enhanced levels of independence in activities of daily living and a general increase of perceived quality of life.

Implications: This Integrated TR-System might represent a valid platform to provide innovative rehabilitation personalised care, thus supply neurorehabilitation services in the community after stroke.

Funding acknowledgements: This project is part of IRCCS Neurology and Rehabilitation network, part of Ministerial funding for current research in 2016- CC2015-2361009

Keywords:
Telerehabilitation
e-health
stroke

Topics:
Innovative technology: robotics
Disability & rehabilitation
Neurology: stroke

Did this work require ethics approval? Yes

Institution: San Camillo IRCCS Hospital

Committee: Ethical Committee of the Province of Venice and IRCCS San Camillo

Ethics number: 2017.16