Abstract
Background and Aims: Globally, 87% of stroke patients are left with disability in low and middle-income countries. Continual rehabilitation is significant to maximize functional recovery. However, heterogeneity exists due to lack of guidelines, low prioritization of rehabilitation services, inadequate numbers of skilled rehabilitation specialists, limited health literacy, financial constraints and transportation limitations which leads to suboptimal rehabilitation. In this study we have presented tele-rehabilitation model of care for post stroke patients. Methods: IMPETUS stroke is an ongoing multicentric, prospective, multiphase, mixed-method, quasi- experimental implementation study intended to examine changes in a select set of stroke care-related indicators over time within 23 medical colleges in India. As a part of study, low cost model of tele-rehablitation services initiated using WhatsApp video communication. Periodic meetings with the collaborators and Rehabilitation teams had been done to outline the different strategies. Audio-visual training materials such as rehabilitation video and teaching manual are used as a study tool. Short specific videos had been crafted and finalized with the rehabilitation experts and collaborators specifically directed towards the post stroke recovery rehabilitation. Feasibility assessment will be done based upon the caregiver responses on the Client Satisfaction Questionnaire . Barthel Index, Stroke Rehabilitation Assessment of Movemement (STREAM) assessment and Modified Rankin Scale (mRS) will be used to assess the motor and functional outcomes. Results: A total of 731 patients provided the telerehabilitation services through live WhatsApp video conferencing after discharge. Initial assessments were done using Barthel Index, Stroke Rehabilitation Assessment of Movement assessment and Modified Rankin Scale at the time of discharge. Tailor-made exercise programs were prepared for each patient based upon the impairments. Primary caregivers were trained through on-patient demonstration and rehabilitation videos. One on one interactive and guided sessions were conducted on the 7th, 15th, 30th day of discharge in one month and then every once in a month for the next 2 months. The patient outcome data will be presented. Conclusions: The aforementioned tele-rehabilitation model of care will help to optimize motor and functional outcomes of the patient. Understanding the limitations and success of these interventions will be helpful.
Published Version
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