N-ROL’s telerehab delivers ‘significant’ progress to survivors
A pioneering telerehabilitation initiative which enabled people recovering from acquired brain injury to continue their therapies during the pandemic has reported significant progress for participants during the programme.
The evaluation of Neuro-Rehabilitation OnLine (N-ROL) and the fact participants “significantly improved on the two planned quantitative outcome measures” provides further academic analysis to support the hugely positive anecdotal evidence about the impact of telerehabilitation, which has grown exponentially in its use during the past year.
N-ROL, a multidisciplinary group-based programme, was established in response to the reduced access to continued rehabilitation for people living with the effects of ABI, including stroke survivors, during the COVID-19 pandemic, at a time when their need for support was increasing.
A three-way collaboration between University College London (UCL), University College London Hospitals NHS Foundation Trust (UCLH) and brain injury recovery charity SameYou, N-ROL offered a range of groups that encompass the main areas of unmet need for patients with ABI including physiotherapy, occupational therapy, speech and language therapy, neuropsychology and neurology.
N-ROL is now being rolled out into East Lancashire Hospitals NHS Trust, working alongside the University of Central Lancashire, and again financed by SameYou’s fundraising.
In the findings of its pilot project at UCL, over a 15 week period, 86 stroke survivors participated in N-ROL after being referred by community or hospital-based rehabilitation teams, receiving therapy remotely through the programme.
Their progress was charted against two outcome measures – the 13-question Stroke Self-Efficacy Questionnaire (SSEQ) and the seven-question Neuro-Rehabilitation OnLine Outcome Measure (N-ROLOM) for patients and two for carers or family – which set targets and aspirations for patients to work towards.
Now, in an evaluation of the project published in the BMJ, patients who took part in N-ROL – which was led by Professor Nick Ward, from UCL Queen Square Institute of Neurology – are found to have “significantly” improved on the two defined outcome measures during the period.
“The post hoc analyses suggest that participants gained the most from (1) psychoeducation around ABI, including hearing other people’s stories; (2) gaining advice on how to better structure their day; and (3) perceived improvements in their motor function (meal preparation, balance and walking),” the report states.
Each patient attended on average 27.1 sessions through N-ROL, a mixture of physical and talking therapies, with an average of 5.4 patients per group.
The evaluation concluded: “N-ROL, like all therapist-delivered rehabilitation, is complex with many interacting components. Each group was delivered by highly skilled and specialist neurotrained therapists.
“We speculate that key elements to its success are (1) the multidisciplinary structure of the team; (2) using groups, which allows participants to gain and identify with each other; and (3) the holistic and systemic nature of our therapeutic approach (treating patients in their own home and targeting their carers for specific interventions).”
Jenny Clarke, CEO of SameYou – the charity founded by her daughter, world-famous actress Emilia Clarke after surviving two brain haemorrhages, to give a voice to fellow brain injury survivors and to deliver better holistic rehabilitation care – says: “SameYou’s mission has always been to develop better recovery treatment for survivors of brain injury and stroke, but when COVID hit, we knew that something needed to be done fast to help survivors impacted.
“We are immensely proud of our work with Nick and his whole team at UCL. Their vision and ambition to help patients, and to do so under the enormous pressures of COVID, is first-class. We look forward to seeing N-ROL grow and reach more patients across the UK and beyond.”
