JMIR Publications

ABSTRACT

Background:

During the COVID-19 pandemic, rehabilitation providers and consumers adopted telehealth practices at unprecedented rates. Multiple pre-pandemic studies demonstrate feasibility and comparable efficacy between in-clinic and remote treatment for certain impairments caused by stroke, such as upper extremity weakness and impaired motor function. However, less guidance has been available regarding gait assessment and treatment. Despite this limitation, safe and effective gait treatment is fundamental toward optimizing health and well-being post-stroke and should be considered a treatment priority, including during the COVID-19 pandemic.

Objective:

This study explores the feasibility of utilizing telehealth to deliver gait treatment using a wearable gait device, the iStrideTM device, to stroke survivors during the 2020 pandemic. The gait device is used to treat hemiparetic gait impairments caused by stroke. The device alters the user’s gait mechanics and creates a subtle destabilization of the non-paretic limb; therefore, supervision is required during its usage. Before the pandemic, treatment with the gait device had been provided in person to appropriate candidates using a combination of physical therapists and trained personnel. However, upon the emergence of the COVID-19 pandemic, in-person treatment was halted in adherence to pandemic guidelines. This study investigates the feasibility of two remote delivery treatment models with the gait device for stroke survivors.

Methods:

Participants were recruited during the first half of 2020 after the onset of the pandemic and included five individuals with chronic stroke (average age 72 years and 84 months post-stroke). Four participants were previous gait device users who transitioned to the telehealth delivery model to continue their gait treatment remotely. The fifth participant performed all study-related activities, recruitment through follow-up, remotely. The protocol included virtual training for the at-home care partner followed by three months of remote treatment with the gait device. Participants were instructed to wear gait sensors during all treatment activities. To assess feasibility, we monitored safety of the remote treatment, compliance with protocol activities, acceptability of the telehealth treatment delivery, and preliminary efficacy of the gait treatment. Functional improvement was measured using the 10-Meter Walk Test, the Timed Up and Go Test, and the Six-Minute Walk Test, and quality of life was assessed using the Stroke-Specific Quality of Life Scale.

Results:

No serious adverse events occurred, and participants rated high acceptance of the telehealth delivery. Protocol compliance averaged 95% of treatment sessions, 100% of assessments, and 85% sensor usage during treatment. Average improvement on each functional outcome exceeded the minimal clinically important difference or minimal detectable change value after three months of treatment.

Conclusions:

Remote treatment delivery with the gait device appeared feasible with care partner support. Gait treatment using telehealth may be useful to offset negative immobility impacts for those requiring or preferring remote care during the pandemic or otherwise. Clinical Trial: ClinicalTrials.gov NCT04434313