TeleRehab Improves Physical Function in Veterans with Stroke
BACKGROUND:
Physical function reaches its peak at around 6 months post-stroke, and begins to decline as soon as 1 year after the stroke, which suggests that the increasing use of rehabilitation following hospital discharge is likely to result in better functional recovery. The main barriers cited by patients to participating in rehabilitation after discharge are getting to the rehabilitation clinic and inconvenience; thus, stroke survivors might benefit from home-based tele-rehabilitation. This prospective, multi-site, single-blinded trial sought to determine the effects of a multi-faceted Stroke Tele-Rehabilitation (STeleR) intervention on physical function, and secondarily on disability, in community-dwelling Veterans who had experienced a stroke within the past two years. Investigators identified 48 Veterans with stroke from three VAMCs, who were randomized to the STeleR intervention (n=25) or usual care (n=23). The STeleR intervention consisted of three home visits, five telephone calls, and an in-home messaging device provided over three months to instruct patients in functionally-based exercises and adaptive strategies. It further assessed for common post-stroke complications of depression, self-care/mobility, and falls. Usual care participants received routine rehabilitation care, as prescribed by their physicians. The primary outcome focused on physical function (i.e., basic activities of daily living) that was most directly affected by the lower extremity exercise and adaptive strategies used in this study.
FINDINGS:
- The STeleR intervention significantly improved lower body physical functioning in Veterans with stroke. Most gains in physical functioning and other improvements occurred during the initial 3 months of the study, but were maintained during the subsequent 3 months during which no STeleR services were provided.
- The STeleR intervention also improved Veterans' ability to perform life tasks such as "take part in regular fitness program" and management of social tasks that involve minimal mobility or physical activity, such as "take care of own health."
- The authors suggest the STeleR intervention could be a useful supplement to traditional post-stroke rehabilitation given the limited resources available for in-home rehabilitation for stroke survivors.
LIMITATIONS:
- Study participants had to be deemed competent to provide informed consent, and stroke survivors who could not successfully follow a 3-step command were excluded. Thus, investigators do not know what added challenges might be present in applying the intervention to stroke survivors with receptive aphasia or other cognitive deficits.
AUTHOR/FUNDING INFORMATION:
Dr. Chumbler is part of HSR&D's Center of Excellence on Implementing Evidence-Based Practice, Indianapolis, IN. He also is part of VA/HSR&D's Stroke Quality Enhancement Research Initiative.
Chumbler N, Quigley P, Li X, Morey M, Rose D, Sanford J, Griffiths P, and Hoenig H. Effects of Tele-Rehabilitation on Physical Function and Disability for Stroke Patients: A Randomized, Controlled Trial. Stroke May 24, 2012;43(8):2168-74.
