Increasing practice intensity after stroke: Description of a caregiver-led exercise program using a telehealth approach

Background and Rationale: Caregiver-mediated exercises (Vloothuis et al. 2014) and tele-rehabilitation (Kairy et al, 2013) solutions are novel ways to assist with exercise delivery and increase practice intensity. We describe the content of an 8-week caregiver-mediated exercise program combined with tele-rehabilitation after stroke.

Methods: Key elements were: coaching role of carer, ‘practice and homework’, easy-to-use technologies, and videoconferencing. An iPad with customised exercise application was provided, including 31 standardized exercises to improve sitting, standing and transfer skills, as well as strength and balance. Patients and caregivers were asked to practice for 8 weeks, 5 times/ week, for 30 minutes. The program commenced in hospital and, after discharge, continued in the community for up to 8 weeks. Telehealth support using a secure videoconferencing app allowed contact with physiotherapists outside weekly face-to-face sessions. Participants wore a Fitbit ZipTM to encourage increasing physical activity. Amount of practice was self-reported, and the intervention was evaluated with the System Usability Scale (SUS) (Bangor, Kortum and Miller, 2008) and a satisfaction questionnaire.

Results: Over the 8-week period, patients (N = 31) reported practicing on average 3749.5 min (SD 2168), and had approximately 1000 min of total extra therapy time (~2 hrs/week) when compared to a control group (N = 32) receiving usual care only. The average total number of video calls was 2.9 (SD 1.4), receiving on average a total of 45 min (SD 27.2) video call therapy. The average number of face-to-face therapy sessions was 7.3 (SD 1.0). Technical support was provided for on average 19.3 min (SD 9.6). High scores on the SUS, mean 73.8 (SD 24.7), indicated that participants were generally confident with the technology. Over 90% of the patients and caregivers stated they would continue with the programme and would recommend it to others.

Conclusion: This caregiver-led exercise program combined with telehealth support shows promise to increase practice intensity. With little direct therapist contact required to deliver the intervention, this could be a cost-effective way to improve outcomes after stroke in the community.