Telemedicine-guided education on secondary stroke and fall prevention following inpatient rehabilitation for Texas patients with stroke and their caregivers: a feasibility pilot study

Abstract

Introduction: The aftermath of stroke leaves many consequences including cognitive deficits and falls due to imbalance. Stroke survivors and families struggle to navigate the complex healthcare system with little assistance posthospital discharge, often leading to early hospital readmission and worse stroke outcomes. Telemedicine Guided Education on Secondary Stroke and Fall Prevention Following Inpatient Rehabilitation feasibility study examines whether stroke survivors and their caregivers find value in telerehabilitation (TR) home visits that provide individualised care and education by a multidisciplinary team after discharge from inpatient rehabilitation.

Methods and analysis: A prospective, single arm, pilot study is designed to evaluate the feasibility of weekly TR home visits initiated postdischarge from inpatient rehabilitation. Newly diagnosed patients with stroke are recruited from a Houston-based comprehensive stroke centre inpatient rehabilitation unit, loaned an iPad with data plan and trained to use information technology security-approved videoconferencing application. After hospital discharge, six weekly TR home visits are led by rotating specialists (pharmacist, physical/occupational therapist, speech therapist, rehabilitation physician, social worker, geriatrician specialised in fracture prevention) followed by satisfaction survey on week 7. Specialists visually assess patients in real time, educate them on secondary stroke and fall prevention and suggest ways to improve function including direct medical interventions when indicated. Primary outcomes are proportion of eligible patients consenting to the study, participation rate in all six TR home visits and satisfaction score. The study started 31 December 2015 with plan to enrol up to 50 patients over 24 months. Feasibility study results will inform us as to whether a randomised controlled trial is warranted to determine efficacy of TR home visit intervention in improving stroke outcomes.

Ethics and dissemination: Ethics approval obtained by the Institutional Review Board (IRB), Committee for the Protection of Human Subjects, IRB number: HSC-MS-14-0994. Study results will be submitted for publication in a peer-reviewed journal.

Keywords: neurology; rehabilitation medicine; stroke; telemedicine.

Figure 1

Study identification, inclusion and exclusion criteria.

Figure 2

TR home intervention after discharge from inpatient rehabilitation. BP, blood pressure; DVT, deep venous thrombosis; ED, emergency department; MD, medical doctor; PCP, primary care physician; PE, pulmonary embolism; TR, telerehabilitation; UTI, urinary tract infection.

Figure 3

Telerehabilitation data collection. Response rate: number of eligible patients divided by number consented. ER, emergency room; FRAX, Fracture Risk Assessment Tool; MoCA, Montreal Cognitive Assessment; PCP, primary care physician; PHQ-9, Patient Health Questionnaire; RCT, randomised controlled trial; TR, telerehabilitation.