Tele-rehab found to be effective for stroke patients

OTTAWA – A five-year study of six tele-rehabilitation projects involving more than 300 Canadians in 10 cities found that technology can be as effective in delivering post-stroke therapy to people living in rural and remote parts of Canada as traditional care, according to a review published in the Journal of Telemedicine and E-Health.

“The key to optimal recovery after stroke lies in the intensity and frequency of rehabilitation therapy,” says Dr. Patrice Lindsay (pictured), Heart & Stroke Foundation’s director of system change and the stroke program.

“Only 19% of all people admitted to acute care with stroke are discharged to inpatient rehabilitation. Research indicates that over 40% need some rehabilitation and over 60% need some assistance with daily activities after they leave hospital,” she says. “Tele-rehabilitation will help those not able to access inpatient or community rehab in their region.”

In 2013, researchers in Nova Scotia, P.E.I., Quebec, Ontario, Manitoba and British Columbia received $1.3 million from Heart & Stroke to test innovative ways to provide physical, occupational and speech therapy and lifestyle coaching to people who are recovering at home after a stroke. Funding was administered through the Heart & Stroke Foundation Canadian Partnership for Stroke Recovery.

“Tele-rehabilitation interventions have great potential to increase efficiency and access to post-stroke therapy,” says senior author Dr. Robert Teasell of Western University. “Our research highlights that many studies have reported tele-rehabilitation to be comparable or more beneficial over in-person rehab programs.”

Among technologies included in the studies were virtual reality, computer gaming, tablet-based software, video-conferencing, the use of wearable activity-monitors, and coaching over the phone. Patients used the technologies at their homes or at a local healthcare facility.

Researchers found:

• Efficacy of tele-rehabilitation is similar to and sometimes better than traditional face-to-face therapy.
• Engagement of caregivers is important.
• Clinicians prefer face-to-face therapy but they will use tele-rehab when other options aren’t available.
• Technology must be easy to use for clinicians and patients.

“Heart & Stroke is committed to addressing the gaps, advocating for increased access to therapy, and helping to find new and innovative ways to deliver rehabilitation,” says Heart & Stroke CEO Yves Savoie.

Tele-rehabilitation is gaining traction across North America. A recent U.S. clinical trial published in JAMA Neurology (Cramer et al.) found that tele-rehab produced substantial gains in arm function after stroke, regardless of whether it was provided by home-based tele-rehabilitation or traditional in-clinic rehabilitation.

Dr. Teasell said Canadian research “offers rare insights – and a Canadian lens – into the application of tele-rehabilitation. We believe this will be of great value to clinicians and healthcare institutions alike.”

He added that this important research provides valuable evidence to inform the Heart & Stroke Canadian Stroke Best Practice guidelines for delivering rehabilitation therapy after stroke.

More than 405,000 Canadians are living with long-term disability from stroke – a number is that is expected to double in the next 20 years because of the aging population and lifestyle factors. At the same time, access to therapy varies greatly from one part of Canada to another and between urban and rural areas.

The use of tele-rehabilitation for stroke therapy will be a focus at the Canadian Stroke Congress in Ottawa, October 3-5, as researchers and policymakers from across the country gather to look at new approaches to the prevention and treatment of stroke, Dr. Lindsay says.

Stroke facts:

• A stroke happens when blood stops flowing to a part of the brain or bleeding occurs in the brain, leading to damage to brain cells.
• 62,000 strokes occur in Canada each year – that is one stroke every nine minutes.
• Each year, more than 13,000 Canadians die from stroke.
• 80% of people survive stroke.
• Brain cells die at a rate of 1.9 million per minute after stroke.
• After stroke 60% are left with some disability; 40% require more intense rehabilitation and support.
• More than 400,000 Canadians live with long-term disability from stroke and this will almost double in the next 20 years.
• Stroke can happen at any age. Stroke among people under 65 is increasing and stroke risk factors are increasing for young adults.