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Effect of a comprehensive eRehabilitation intervention alongside conventional stroke rehabilitation on disability and health-related quality of life: A pre–post comparison

Berber Brouns, Leti van Bodegom-Vos, Arend J. de Kloet , Sietske J. Tamminga, Gerard Volker, Monique A.M. Berger , Marta Fiocco, Paulien H. Goossens, Thea P. M. Vliet Vlieland, Jorit J. L. Meesters
Basalt Rehabilitation Centre, The Hague and Leiden, Department of Innovation, Quality + Research, Leiden, Haag, The Netherlands. E-mail: b.brouns@lumc.nl, b.brouns@basaltrevalidatie.nl
DOI: 10.2340/16501977-2785

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Abstract

Objective: To compare the effect on disability and quality of life, of conventional rehabilitation (control group) with individualized, tailored eRehabilitation intervention alongside conventional rehabilitation (Fast@home; intervention group), for people with stroke.
Methods: Pre–post design. The intervention comprised cognitive (Braingymmer®) and physical (Telerevalidatie®/Physitrack®) exercises, activity-tracking (Activ8®) and psycho-education. Assessments were made at admission (T0) and after 3 (T3) and 6 months (T6). The primary outcome concerned disability (Stroke Impact Scale; SIS). Secondary outcomes were: health-related quality of life, fatigue, self-management, participation and physical activity. Changes in scores between T0–T3, T3–T6, and T0–T6 were compared by analysis of variance and linear mixed models.
Results: The study included 153 and 165 people with stroke in the control and intervention groups, respectively. In the intervention group, 82 (50%) people received the intervention, of whom 54 (66%) used it. Between T3 and T6, the change in scores for the SIS subscales Communication (control group/intervention group –1.7/–0.3) and Physical strength (–5.7/3.3) were significantly greater in the total intervention group (all mean differences< minimally clinically important differences). No significant differences were found for other SIS subscales or secondary outcomes, or between T0–T3 and T0–T6. Conclusion: eRehabilitation alongside conventional stroke rehabilitation had a small effect on communication and physical strength on the longer term.

Lay Abstract

Digital eRehabilitation, including cognitive/physical exercises, activity-tracking and psycho-education, is available for rehabilitation after stroke. In daily practice, these are used in parallel, and evidence regarding the effect of combining applications is scarce. The aim of this study was to investigate the effect of eRehabilitation in clinical practice. Outcomes for 153 people with stroke admitted to conventional rehabilitation only (control group) were compared with the outcomes for 165 people with stroke admitted when eRehabilitation was available (intervention group). A total of 82 people in the intervention group (50%) received the intervention, of whom 54 (66%) used it. In the first 3 months of rehabilitation, no differences were found between the groups. Between 3 and 6 months, the intervention group as a whole showed greater improvements regarding communication and physical strength. However, differences were below minimal clinical importance. In conclusion, adding eRehabilitation to conventional rehabilitation after stroke appears to be beneficial for some health-related outcomes on the long term.

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