Dr. Steve Cramer
Eliminate Barriers to Optimal Outcomes for Your Post-Stroke Patients with Home Telerehabilitation
Updated: Jan 3, 2022
Stroke is one of the leading causes of disability in adults. Take a second to read that sentence again. Given this understanding, it is our duty as healthcare providers to do everything in our power to promote the best outcome for every patient we encounter who has had a stroke. So how do we as healthcare providers make sure each patient achieves the best outcome possible? We start by making sure we dive into the research to understand what promotes the best outcomes and that we then use this information to guide our clinical decision making.
Higher doses of therapy have a positive relationship with improved functional outcomes
So what do the studies show when it comes to rehab post-stroke? First of all, they indicate that higher doses of therapy have a positive relationship with improved functional outcomes (Lohse et al., 2014). Animal studies in particular show that doing 600-700 repetitions per day results in favorable neuroplasticity (Nudo, 1996; Jeffers, 2018).
While it may be possible to achieve these higher doses of therapy with traditional in-clinic therapy in some cases, there are often barriers to being able to deliver this dose of therapy. Often financial constraints limit therapy visits and duration. Sometimes the patient does not have access to a therapy clinic or if they do have access to a clinic, the providers at that clinic may not be trained in how to best treat individuals post-stroke.
Is home telerehabilitation really as effective as in-clinic therapy?
Given the multitude of potential barriers to in-clinic therapy and the variation in the quality of in-clinic therapy, for some people, home telerehabilitation may be a good option when it comes to rehabilitation. But the first question that pops into my head as a clinician is, “Is home telerehabilitation really as effective as in-clinic therapy?”
Home telerehabilitation group averaged 1,031 arm movement repetitions per day
A study by Cramer et al. (2019) aimed to answer this question. These investigators enrolled 124 subjects who were 4 to 36 weeks post-stroke and who were experiencing persistent arm paresis and randomized them into two groups: in-clinic therapy or in-home telerehabilitation. Each group was given 36 sessions that lasted 70 minutes over the course of 6 weeks. Both groups showed substantial and significant gains in arm function. This study also found no significant difference between the two groups in arm improvement. However, what is particularly significant is that the home telerehabilitation group saw a compliance rate of 98.3% with their home therapy whereas the in-clinic group had a compliance rate of 93.4%. Also worth noting is that the home telerehabilitation group averaged 1,031 arm movement repetitions per day, far greater than the 32 repetitions (Lang, 2009) found during a standard rehab therapy session.
Study demonstrates that home telerehabilitation is a viable solution
So what does this mean for your patients? This study demonstrates that home telerehabilitation is a viable solution for addressing the barriers that so often result in subpar outcomes in our patients. With at home therapy often being more accessible and possibly more cost-effective for patients, it may be an outlet that allows your patients to achieve the outcomes they desire. At TRCare, we provide a platform where patients have access to a wide variety of home therapy games and exercises with guided instruction, so that they can get the higher dose of exercise they need to improve their functional capacity.
Now that you are up-to-date on the latest research, explore our digital therapy delivery platform to learn more about how we can help your patients starting today.
Lohse et al. Stroke. 2014; 45:2053-2058.
Cramer et al. JAMA Neurology. 2019; 76:1079-1087.
Jeffers et al. Neurorehab Neural Repair 2018; 32:73-83.
Lang et al. Archives PMR. 2009; 90:1692-1698.