JMIR Publications

ABSTRACT

Background:

Accumulating evidence and medical guidelines recommend high-dose neurorehabilitation for recovery after stroke. The reality, however, is that most patients receive a fraction of this dose, with therapist availability and costs of delivery being major implementational barriers.

Objective:

To explore a potential solution, we conducted a retrospective analysis of a real-world enhanced clinical service that used gamified self-training technologies at home under remote therapist supervision.

Methods:

Data from 17 patients who completed a 12-18 week full-body, high-dose neurorehabilitation program entirely at home were analyzed. Program delivery relied on patients mostly training independently (asynchronously) with the MindMotion GO gamified-therapy solution. Accompanying telerehabilitation training sessions with a therapist occurred weekly while therapists used a web application to continuously monitor and manage the program remotely. Effectiveness of the program was assessed through measured active training time (ATT), a measure more closely reflecting delivered dosage as opposed to scheduled dose. Patient recovery was evaluated with standardized impairment and functional clinical measures, and patient self-reported outcome measures. Finally, a cost model was computed to evaluate the resource efficiency of the program.

Results:

Patients maintained high training adherence throughout and reached an average total ATT of 39.7 ±21.4 hours, with the majority delivered asynchronously (82.2 ±10.8%). Patients improved in both upper-limb (Fugl-Meyer Upper Extremity, +6.4 ±5.1; P<.001) and gait and balance measures (Functional Gait Assessment, +3.1 ±2.6; P<.001; Berg Balance Scale, +6.1 ±4.4; P=.025). Overall, the program was viewed very favorably amongst patients, with 73.7% respondents being satisfied or very satisfied, while 63.2% of respondents reporting subjective improvements in physical abilities. Per-patient therapist costs approximated $338 USD, representing a resource-efficient alternative to delivering the same dose via one-on-one in-person training sessions ($1903 USD).

Conclusions:

This work demonstrates effective high-dose neurorehabilitation delivery via gamified therapy technologies at home and shows that training time can be successfully decoupled from therapist-presence without compromising adherence, outcomes, or patient satisfaction. Given growing concerns over therapist availability and increasing health care costs, this resource-efficient approach can help achieve medical guidelines and complement existing clinic-based approaches.