Abstract
After a stroke, coming back home is difficult for most stroke patients. Occupational Therapy (OT) promotes coping with this situation, but in-home intervention is scarce. Through patient reported outcomes (PROMs), an OT can detect possible needs in the areas of occupational performance (OP), and then provide the appropriate tools to facilitate occupation in areas of self-care, productivity and leisure. We aimed to evaluate a tele-OT intervention through a holistic app to provide OT after discharge from a comprehensive stroke center. Methods: Consecutive stroke patients discharged home were included in a multimodal digital follow-up program (NORA) through a mobile application validated for communication, education, adherence, risk factors control and PROMs/PREMs recollection. Patients with OT needs are offered a telematic visit to solve stroke-related doubts, everyday activities, home modifications promoting patient’s autonomy and self-care. A tele-OT satisfaction questionnaire (teleOT-PREM) was recollected. Results: Over two years, 993 patients were included in NORA follow-up and reported PROMs at 7-30 days. 147 (14.8%) patients presented OT needs and were included in our tele-OT intervention. Sixty-one were men, with a mean age of 68.5y and a median mRS of 2 at hospital discharge. Tele-OT patients reported worse PROMs than the global series: in HADS, 40.8% anxiety and 34.2% depression and in PROMIS-10 89.3% altered mental health and 82.1% altered physical health, as compared with 13.1%, 17.7%, 64.7%, and 54.8% respectively (p<0.001) 108 patients answered the teleOT-PREM. The median usefulness of intervention (in a scale from 0-10) was 8.2 and 65% reported being “very satisfied” with the visit. Conclusion: Stroke has a direct impact on a person’s occupational performance. Follow-up by an expert of the occupation (OT) could help to identify the post-stroke patient’s needs and poor PROMs can be used as a selection tool. Tele-OT intervention may promote a better OP, facilitating the daily life activities and improving the quality of life. Tele-OT intervention was feasible and considered useful for most of our stroke patients with OT requirements.
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