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Telehealth ‘can open up access to stroke rehab’

Use of digital means can address inequity in post-stroke rehabilitation provision, study finds

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Telerehab has a vital role to play in addressing limitations around access to rehab for stroke survivors, a new study has found. 

The use of digital and remote rehab has seen rapid expansion into healthcare since the onset of the COVID-19 pandemic, and has been adopted widely in chronic care management. 

However, there is limited evidence that the rise in the use of telehealth has addressed disparities in the care of patients recovering from stroke, says a new review from UTHealth Houston.

“As we begin to advance the use of telehealth in stroke and in chronic diseases in general, we must consider the potential advantages and barriers to use in populations at highest risk for disparities,” said Dr Anjail Sharrief, director of stroke prevention at the UTHealth Houston Institute of Stroke and Cerebrovascular Disease and director of the Stroke Transitions Education and Prevention (STEP) clinical program. 

“While telehealth can expand access to care and treatment in many ways, it also has potential to increase disparities in populations with lower levels of digital literacy, limited access to internet, and in whom physical and cognitive limitations pose barriers to telehealth utilisation.”

Previous research has shown the benefits of remote rehab, and particularly that using gamification, in supporting stroke survivors. 

This study again highlights the benefits use of telerehab offers for a range of impairments after stroke – including problems with gait, vision and cognition – as well as in addressing issues of economic instability, geographic location and limited social support.

For example, for patients dealing with stroke-related disabilities, the researchers found that telehealth addresses barriers related to mobility challenges and special equipment needed to access clinic spaces by removing the need for transportation altogether. 

It also decreases the number of in-person visits required of patients, allowing for better multidisciplinary care and the ability to remotely monitor blood pressure and cardiac arrhythmias.

“One important thing to consider is that while we focus on stroke-related disability, the same principles apply to patients with other neurological diseases,” Dr Sharrief said.

The research team made a number of recommendations in widening access to telehealth, including providing mobile hotspot devices to patients with limited wifi access, developing digital tools to accommodate patients with impaired literacy or cognitive skills, and developing the use of digital navigators. 

“Several of the listed recommendation have shown promise for improving telehealth access and utilisation in other chronic disease populations,” Dr Sharrief said. 

“My group and co-authors on the manuscript are testing these in the stroke population.”

Additionally, to accommodate patients with hemiparesis or incoordination resulting from stroke, the researchers recommend developing telehealth tools and engaging informal caregivers and family members to participate in telehealth interventions. 

For stroke survivors with cognitive issues, they suggest avoiding the use of some tools, such as platforms and monitoring equipment, that require multiple steps for setup or need regular troubleshooting.

For patients with limited English proficiency, the authors encourage the development of telehealth platforms, telemonitoring tools, and other digital health tools to accommodate patient and caregiver language preferences.

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