This abstract is a heads up for an upcoming clinical trial. The focus is on the impact of telerehabilitation for post stroke on both outcomes and cost of care.
My biggest concern when I hear telerehabilitation is a pendulum swing to where rehabilitation professionals are no longer valued. Maybe rehabilitation providers will evolve to have a larger role in monitoring and managing from afar? Maybe rehabilitation providers will evolve to setting up rehabilitation programs via portals that push the information to patients.
It seems we need to begin thinking of when in-person visits are necessary and when the majority of care can occur in a person's home using technology as the mode.
Here's a quick view of the abstract.
Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the Internet, can contribute to ensure that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance.
A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups.
Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services.
Contemp Clin Trials. 2016 Mar;47:49-53. doi: 10.1016/j.cct.2015.12.006. Epub 2015 Dec 4.