Virtual coaching system for continuity of care and rehabilitation in patients with stroke. Results of the pilot study in the home scenario

Abstract

With the purpose of supporting self-care at home and health management as secondary prevention, the lack of continuity of care for patients with stroke requires innovative approaches that embed the home-rehabilitation into the clinical-care-chain. vCare, a European multicenter project (EU’s Horizon2020 - https://vcare-project.eu), proposes a new ICT-based concept offering personalized home rehabilitation solutions and care pathways through a Virtual Coach (VC) that integrates machine learning technologies with coaching and clinical pathway services. Coaching at home can help these patients to proceed with a personalized form of rehabilitation and the VC can be a key technology to ensure continuity of care, reinforce self-management, enhance adherence to the care plan and risk prevention and ultimately empower patients. From the technical point of view, vCare integrates a set of technologies in a single platform. The VC provides the patient with a number of services clustered into: 1) coaching services such as physical training based on motion tracking and cognitive training; 2) supporting services such as reminders; 3) clinical pathways services allowing the seamless configuration of the VC [1,2]. The aim of this study was to evaluate the health status (EQ-5D), the reduction of risk factors and the adherence to the prescribed care plan in patients with stroke, who experienced home rehabilitation, either mediated by the virtual coach (experimental group – EG) or conventional (control group – CG). Patients with stroke were enrolled among those who were hospitalized at the Casa di Cura del Policlinico (Milan, Italy). For a period of 30-60 days in their own home, patients experienced rehabilitation treatments and activities based on the neurologist, physiotherapist and neuropsychologist’s clinical indications, provided at the discharge after the hospital care. All participants signed an informed consent. All research procedures were approved by the Local Ethics Committee. The patients in the CG performed motor and cognitive exercises suggested by therapists during the first visit. For the EG, personalized treatments and activities were suggested by the VC through a tablet, following the therapists’ predefined schedule. The rehabilitation plan consisted mainly in motor and cognitive serious games executed in a virtual reality environment realized in the patient’s home through a 3D depth camera and a monitor for the motor games, and the tablet for the cognitive ones. Additional risk factor–related activities (e.g.: e-learning session) were also foreseen and suggested. Every day the VC proposed videos with different contents; the patient could evaluate them, allowing the VC to refine the choice of videos and increase the patient’s satisfaction. Moreover, based on the monitoring of patient’s physical activity by means of an activity tracker wristband, the VC counseled additional exercise or leisure activities. The EQ-5D descriptive system and the EQ-5D visual analogue scale (EQ- VAS) were used as measure of health status for both patients belonging to the EG and CG. All the enrolled participants (N=20; 71.9±10.2 years old; 13 males; 16 ischemic) completed the experimental protocol and no adverse events were encountered during the treatment period. Subjects showed mild impairment as documented by median NIHSS of 2.5 (IQR 2.0–4.8), and median FIM score of 115 (IQR 101.3–121.8). Preliminary results on the experimental group showed, for each week of treatment, an average of: 3.07±1.76 accesses to the VC’s platform, 3.60±2.07 e-learning videos viewed, 12.69±10.75 active interactions of patients with the VC (i.e., feedback, reminders, questionnaires). In addition, results showed that patients worn the activity tracker 28.6 ± 7.7% of days of monitoring. Data-analysis and interpretations on potential benefits (quality of life, reduction of risk factors, adherence to the care plan) related to both groups (i.e., experimental and control) will be presented during SIAMOC 2022. Considering: the preliminary results related to the activities performed by the experimental group, the state of the art regarding the adherence to conventional cares and the data already obtained in a clinical home-like scenario during the previous testing phase [3], we expect to demonstrate that the vCare solution is promising in educating and empowering patients to adhere and to pursue personalized physical and cognitive rehabilitation programmes, with the final aim of regaining independence and a better quality of life through a consistent healthier lifestyle.