This study aimed to 1) Describe and explore potential sex- and gender-based characteristics that may be associated with the clinical responses of six participants to a 4-week telerehabilitation program [TeleRehabilitation with Aims to Improve Lower extremity recovery post-stroke; TRAIL], and 2) Explore adherence, adverse events, and program satisfaction.
Using a multiple case study design and homogeneous sampling (age and stroke severity), we contrasted and compared responses of three male and three female participants. Participants completed 4 assessments: pre-post-intervention, 3- and 6-month follow-up. The selection of outcome assessments reported in our study was informed by the International Classification of Functioning, Disability and Health Framework, of which included the Stroke Impact Scale-3 (SIS-3), 30s-sit-to-stand test (30s-STS), and Activity-Specific Balance Confidence Scale. A study specific participant satisfaction survey was administered upon completion of TRAIL (post-intervention assessment) and included factors important for satisfaction with virtual stroke care (e.g., staff communication and facilitation, usefulness of the services). Sex- and gender-based characteristics were reported, and individual trajectories were described.
Female participants had more favourable trajectories in emotion, memory & thinking, mobility, participation domains of the SIS-3, and activity-specific balance confidence. Female participants also had sustained improvements in 30s-STS. Stroke type and marital status are among the personal characteristics of female participants that may explain the responses observed. All participants completed all 8 telerehabilitation sessions and at least 1 weekly self-managed exercise session each week. All participants were satisfied or highly satisfied with the TRAIL program, based on their ratings of each of the 5 constructs assessed. There were no adverse events reported by any participants.
We found that male cases included personal characteristics often associated with poorer functional recovery, contradicting sex- and gender-based disparities generalized to females with stroke.
While some observations aligned with what we know about potential mechanisms for sex/gender differences in recovery after stroke, the cases also demonstrated that group differences reported in the literature do not always apply at an individual level, and that an array of sex- and gender-related personal and environmental factors will contribute to variation in treatment response. We thereby identified potentially pertinent personal variables for clinicians and researchers to consider in future telerehabilitation trials.
telerehabilitation
sex and gender
