JMIR Publications

ABSTRACT

Background:

For stroke and other neurologic conditions associated with aphasia, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient’s ability to receive the support needed to optimize functional gain. While digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient’s level of engagement with technology-based therapy is currently unknown.

Objective:

This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics including age, gender, diagnosis, time from disease onset and geographic location (urban vs. rural).

Methods:

Data for patients with stroke or traumatic brain injury (TBI) that initiated use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, was retrospectively analyzed. Only data from therapeutic sessions completed at home were included. Three activity metrics were evaluated: 1) the number of active weeks of therapy; 2) the average number of active therapy days per week; and 3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An ‘active’ day/week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates.

Results:

Data for 2,850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older were more active during their first 20 weeks of program access, with patients age 51–70 completing 5.01 more sessions than patients <= 50 years (P=.04). Similarly, patients living in a rural area, who face greater barriers to technological and clinical access, were more actively engaged than their urban counterparts, with rural patients having 0.06 (P=.051) more active therapeutic days per week and completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates.

Conclusions:

An evaluation of real-world data demonstrated that stroke and TBI patients use digital therapy frequently for cognitive and language rehabilitation at home, with usage not being limited by typical barriers to technological adoption, such as age and living in a rural location. These findings will help clinicians identify patients that would be ideal candidates for remotely-delivered rehabilitation, as well as guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.