Feasibility of Intensive Multidisciplinary Telerehabilitation Combined with Health Coaching for Underserved Stroke Survivors: A Pilot Study
Bibliographic record
Abstract
Introduction: Telerehabilitation (TR) can be as effective as in-clinic therapy; however, the implementation of barriers and facilitators to TR is unknown, especially in the underserved and rural population. In addition to TR, self-management support (SMS) interventions have been successful in improving outcomes for stroke survivors using telehealth. We explored the following: (1) Is an intensive multidisciplinary TR intervention combined with SMS feasible to deliver virtual postacute stroke care? (2) Does an intensive TR intervention combined with SMS lead to improvements in level of impairment, functional outcomes, and quality of life? (3) Does an intensive TR intervention combined with SMS impact patient goal attainment? (4) What barriers and facilitators to TR are perceived by stroke survivors? Methods: Virtually assisted home rehabilitation after acute stroke-2 offered two sessions of rehabilitation therapy, 3 days a week, for 4 weeks, consisting of two of the following disciplines: occupational therapy, physical therapy, or speech therapy. SMS was offered during the first and last session each week. Quantitative outcomes were completed at baseline assessment (week 1), postintervention assessment (week 6), and final assessment (week 10). Following grounded theory, semi-structured qualitative interviews were completed to identify barriers and facilitators of TR. Results: A total of N = 15 participants were consented into the program. When excluding the 3 participants who withdrew within or before week 1 of intervention, the average weekly number of therapy sessions completed by the remaining 12 participants was 5.6 (standard deviation [SD] 0.79), 5.6 (SD 0.90), 5.2 (SD 2.19), and 4.9 (SD 1.98) for weeks 2–5, respectively. Posterior probability (PP) results indicated very strong (PP >97%) to extreme (PP >99%) support in favor of change over time across most outcomes, including decreased modified Rankin Scale (marginal improvement of −0.731) and Patient Health Questionnaire scores (−3.606) and increased Montreal Cognitive Assessment (+4.178). Nine participants took part in the semi-structured interviews, and two major themes emerged: 1—“Perceived Access/Delivery” and 2—“Perceived Therapy Advantages.” In regard to the goal attainment, low sample sizes limited precision for analyses, thus these were not included in analyses. Conclusion: TR after acute stroke is feasible, though barriers still exist. This study proved to be a safe and attainable option for underserved populations of stroke survivors, demonstrating high attendance, improved outcomes, and no intervention-related adverse events.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".