Open Collections

Park, Sarah

University of British Columbia

BACKGROUND Approximately 30% of stroke survivors report unmet lower extremity (LE) recovery needs after returning to community living. Telerehabilitation can be used to mitigate issues surrounding accessibility and provide ongoing support, however, evidence in this area is limited. The overall purpose of this thesis is to develop a better understanding of telerehabilitation for LE recovery post-stroke. OBJECTIVES Chapter 2: To describe telerehabilitation interventions for LE recovery following stroke; and to quantitatively assess their effects on LE recovery. Chapter 3: To determine the feasibility of TRAIL among individuals with stroke, including estimating the effects of TRAIL on clinical outcomes. METHODS Chapter 2: All interventional studies investigating telerehabilitation for LE recovery post-stroke were included from MEDLINE, EMBASE, PSYCInfo, and Cochrane. Quality was assessed for all included studies. RCTs were meta-analyzed using RevMan 5.4. GRADE was performed for each outcome. Chapter 3: 32 individuals were recruited in this single group pre-post study. Feasibility outcomes were treated as binary outcomes based on pre-defined indicators. Clinical outcomes (TUG, FMA-Tele, 30s S2S, ABC, SIS, FR, TS and GAS) were analyzed using Wilcoxon signed-rank test for statistically significant differences (p<0.05). RESULTS Chapter 2: 21 studies were included for the qualitative analysis and 12 RCTs were included for the meta-analysis. A moderate body of evidence indicated that telerehabilitation was as effective as usual care for improving balance (MD = 1.67 [95% CI = 0.52, 2.82], I² = 0%, p = 0.004) and motor impairment (SMD = 3.73 [95% CI = 2.12, 5.33, I² = 27%, p < 0.00001). Chapter 3: The following effect sizes were observed: TUG (0.57, p = 0.02); FMA-Tele (0.76, p = 0.001); 30s S2S (0.89, p = <0.001); ABC (0.60, p = 0.015); GAS (0.95, p = <0.001); SIS-ADL (0.52, p = 0.038); SIS-Mobility (0.59, p = 0.017). Seven out of eleven (63.6%) threshold criteria of feasibility were considered a success. CONCLUSION The information from the review allows for practical recommendations for future research, such as identifying knowledge gaps. The TRAIL feasibility study offered insight into understanding the key factors that contribute to a successful telerehabilitation intervention for LE recovery.

Text

2022-04-19

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/81235

Rehabilitation Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/