Researchers led by Regenstrief Institute investigator Neale
Chumbler, Ph.D., a research scientist with the Center
of Excellence on Implementing
Evidence-Based Practice at the Richard Roudebush VA Medical Center in Indianapolis, have
developed STeleR, a home telerehabilitation program that they report improves
lower body physical functioning after a stroke. Participating in STeleR also
increased the likelihood of maintaining a regular fitness routine, enhanced
money management skills, and improved the capability to prepare meals and take
care of personal needs such as bathing.
“Effects of Telerehabilitation on Physical Function and
Disability for Stroke Patients” appears online ahead of print publication
in the August issue of the journal Stroke.
“We know that post-stroke rehab is critically
important,” said Dr. Chumbler, a medical sociologist who chairs the
Department of Sociology and directs the Institute for Research on Social Issues
in the School of Liberal Arts at Indiana
University-Purdue University Indianapolis. “But for many veterans and
others who experience a stroke, participating in supervised rehab can be
difficult because they live far from a rehab facility. Even if distance isn’t
an impediment, getting someone to provide transportation may not be easy.
Providing rehab in the home is costly, and the availability of qualified
physical or occupational therapists may be limited, particularly in rural
areas.
“We found that stroke survivors will participate in and
can benefit from a telehealth system that enables therapists to deliver and
monitor rehab in the patient’s home from a remote location.”
The 52 veterans in the multi-site study received care from
VA medical centers in Atlanta, Durham,
N.C., and Tampa, Fla.;
were predominantly male; were ethnically diverse; and had an average age of 67.
Each had experienced an ischemic or hemorrhagic stroke within the previous two
years and lived in the community rather than in an institution. The study
participants were randomized to usual care or the STeleR (short for stroke
telerehab) intervention.
Three hourlong visits were made to the homes of those in the
intervention arm of the study, during which a study team member used a
camcorder to record physical and functional performance as well as discussed
the home environment with the stroke survivor. An in-home messaging device that
looks like a clock radio and plugs into a telephone line was installed and
monitored weekly by a teletherapist who responded after reviewing information
entered by the study patients. Over the three-month period, telephone calls
between the teletherapist and the patient took place biweekly. Both STeleR and
usual care group participants received routine VA care as directed by their
health care providers.
Most of the gains in physical functioning and other
improvements occurred during the initial three months of the study but were
maintained during the subsequent three months during which no STeleR services
were provided.
“STeleR has potential to be a useful supplement to
traditional post-stroke rehabilitation, given the limited resources available
for in-home rehabilitation for stroke survivors,” Dr. Chumbler said.
“STeleR or a similar telehealth program could be an important way to
overcome access barriers and may be particularly useful for reaching vulnerable
patient groups, such as individuals from a lower socioeconomic status and those
who live in a rural area.”
