JMIR Publications

ABSTRACT

Background:

The delivery of specialist stroke rehabilitation is undergoing significant transformation, with telerehabilitation and remote working increasingly integrated into clinical practice and supported by guidelines and policy. While the COVID-19 pandemic catalysed the rapid adoption of these delivery methods, there is growing recognition of the requirement for pragmatic evaluation within existing service frameworks to inform sustained use. Evaluation that includes insights from clinical teams and individuals with lived experience of stroke is needed to deepen understanding and inform future service development. This evaluation sought to address that need, in the context of community stroke services in the East of England.

Objective:

Our evaluation addressed two over-arching aims: (1) To map contemporary models and experiences of telerehabilitation delivery in community stroke services, examining how it is currently used and perceived by both healthcare providers and service-users; and, (2) To identify practical lessons and enabling factors that support the sustained integration of telerehabilitation into routine community stroke services.

Methods:

This exploratory sequential mixed-methods evaluation comprised two phases. Phase one involved discussion groups with stakeholders already using telerehabilitation to explore experiences, attitudes, influences, and behaviours associated with its use. These findings were synthesised with published literature and guidelines to produce a conceptual framework, which was then used to inform the design and content of a broader online survey in Phase two. Data from the discussion groups were analysed using a recognised framework for reflexive thematic analysis within a contextualist approach. Descriptive statistics were used to summarise quantitative survey responses.

Results:

A total of 20 people attended the discussion groups (n=4 groups total). 96 people responded to the survey. Three themes underpinning successful use of telerehabilitation in this context were derived from triangulation across our data sources: 1) consideration of risks and benefits, 2) the importance of individualised care approaches and, 3) the need for staff support. Deep insights were gained within themes and are reported here- e.g. the potential for telerehabilitation to increase efficiency and address service pressures, the importance of addressing digital exclusion and the need for timely and tailored staff training.

Conclusions:

Our pragmatic, in-service evaluation demonstrates that telerehabilitation works best not as a replacement for in-person care, but as part of a responsive, blended approach grounded in individual need. These findings highlight that, with appropriate clinician training and flexibility in delivery remote rehabilitation can meet the needs of diverse individuals through personalised approaches whilst supporting service responsiveness in pressurised clinical environments. Clinical Trial: N/A