HOME-BASED TELEREHABILITATION FOR COMMUNITY-DWELLING PERSONS WITH STROKE IN A DEVELOPING COUNTRY DURING THE COVID-19 PANDEMIC: A PILOT STUDY

M.A. Gelisanga¹, C.F. Leochico¹, E.M. Austria¹, S. Ignacio¹, J.A. Mojica¹

¹University of the Philippines - Philippine General Hospital, Rehabilitation Medicine, Manila, Philippines

Background: The COVID-19 pandemic has moved various stakeholders (including patients and healthcare providers) to find alternative ways to safely address medical and rehabilitation needs from a distance. One feasible way is telerehabilitation, which is the use of telecommunication technologies to remotely access consultation and therapy services from rehabilitation professionals. Telerehabilitation may be beneficial for various conditions, including stroke, especially during the pandemic when limited access to in-person therapeutic services can render patients post-stroke at risk for further physical inactivity and consequently cardiovascular diseases. However, telerehabilitation uptake is challenged by several factors like issues related to acceptance, evidence, feasibility and safety.

Purpose: To determine the feasibility and safety of a telerehabilitation program for a stroke support group in a developing country, and changes in the participants’ telerehabilitation perceptions, physical activity level, and well-being after a 2-week intervention.

Methods: This pilot quasi-experimental study recruited community-dwelling, ambulatory, non-aphasic adults with stroke. Pre-participation screening (Physical Activity Readiness Questionnaire) and online medical examination were conducted. Each participant underwent tele-interview to obtain demographic and clinical characteristics, and baseline perceptions on telerehabilitation, physical activity level (using SIMPAQ - Simple Physical Activity Questionnaire), and perceived well-being (Happiness Scale). Home-based asynchronous telerehabilitation was conducted through videos originally developed by the study team and posted on a private group page on Facebook™. Synchronous telerehabilitation was offered for socialization or engagement with other participants in a private group chat. Telerehabilitation providers were available to accommodate any technical or exercise-related concern. After two weeks, participants were asked about their telerehabilitation perceptions, physical activity level, and perceived well-being.

Results: Nineteen patients participated (mean age: 54.9). The majority were males, hypertensive, and had Functional Ambulation Category 5. All had chronic stroke (73.7%: infarct). At baseline, the majority were either neutral, agreeable, or strongly agreeable with statements on the Telepractice Questionnaire. After the program, the majority had strongly agreeable telepractice perceptions. Improvements were observed in all categories of the SIMPAQ after the program. The participants were happier (from 7.4 at baseline to 8.8) after the program. Throughout the study, there was only one untoward event (mild, transient). Many participants shared their positive experiences and recommendations.

Conclusions: This pilot study showed the feasibility, safety, and positive biopsychosocial impact of telerehabilitation among community-dwelling persons with chronic stroke in a developing country during the pandemic. The results could contribute to the limited body of evidence on this emerging technology locally or in other resource-limited settings, wherein telerehabilitation was neither accepted nor implemented widely pre-pandemic.

Implications: Our pilot study can contribute to the limited evidence of telerehabilitation from a resource-constrained country, that it is feasible and safe in overcoming persistent barriers to in-person rehabilitation, such as distance, time, costs, resources, and even viral spread. Incorporating educational infographic materials, asynchronous exercise videos, and private group chats for social interaction and technical and clinical support seemed to yield positive results across different biopsychosocial health-related outcomes.

Funding acknowledgements: None.

Keywords:
Telerehabilitation
Healthcare delivery
Stroke rehabilitation

Topics:
COVID-19
Neurology: stroke
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: University of the Philippines - Manila

Committee: University of the Philippines Manila Research Ethics Board

Ethics number: 2020-412-01