Abstract
Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based TR program for stroke patients and evaluated which social factors might be related to motor gains and reduced depressive symptoms.Methods: Stroke patients (n = 13) with arm motor deficits underwent supervised home-based TR for 12 weeks with routine assessments of motor function and mood. At the 6-week midpoint, we mapped each patient's personal social network and evaluated relationships between social network metrics and functional improvements from TR. Finally, we compared social networks of TR patients with a historical cohort of 176 stroke patients who did not receive any TR to identify social network differences.Results: Both network size and network density were related to walk time improvement (p = 0.025; p = 0.003). Social network density was related to arm motor gains (p = 0.003). Social network size was related to reduced depressive symptoms (p = 0.015). TR patient networks were larger (p = 0.012) and less dense (p = 0.046) than historical stroke control networks.Conclusions: Social network structure is positively related to improvement in motor status and mood from TR. TR patients had larger and more open social networks than stroke patients who did not receive TR. Understanding how social networks intersect with TR outcomes is crucial to maximize effects of virtual rehabilitation.
Highlights
Stroke is the leading cause of acquired adult disability worldwide [1]
Key inclusion criteria were: age ≥18 years; stroke onset any time prior to study entry; arm motor deficits with an arm motor Fugl Meyer score (FM-A) of 28-66 out of 66, and if >59, must have a Box and Blocks score on the paretic side that is >25% lower than on the non-paretic side; and minimum level of arm functioning remaining with a Box and Blocks score on the paretic arm that is ≥3 blocks in 60 s
TR patients improved in stroke rehabilitation metrics over 12 weeks (Table 3)
Summary
Stroke is the leading cause of acquired adult disability worldwide [1]. Of the 15 million people worldwide who suffer from a stroke each year, 5 million are permanently disabled and require extensive post-stroke care. Efforts to curb COVID-19 spread have left many patients isolated from medical services they may otherwise access. These changes have especially impacted patients with stroke, many of whom are over 65 years of age and at high risk for serious illness due to COVID19. The social isolation that many patients face during the pandemic is itself an individual risk factor for stroke recurrence [11]. These barriers highlight a need for remote, accessible models of poststroke care that account for patients’ social support systems
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