Factors influencing the delivery of telerehabilitation for stroke: A systematic review

Abstract

Purpose: Despite the available evidence regarding effectiveness of stroke telerehabilitation, there has been little focus on factors influencing its delivery or translation from the research setting into practice. There are complex challenges to embedding telerehabilitation into stroke services and generating transferable knowledge about scaling up and routinising this service model. This review aimed to explore factors influencing the delivery of stroke telerehabilitation interventions, including platforms, technical requirements, training, support, access, cost, usability and acceptability. Methods: MEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library and Central Registry of Clinical Trials were searched to identify full-text articles of randomized controlled trials (RCTs) and protocols for RCTs published since a Cochrane review on stroke telerehabilitation services. A narrative synthesis was conducted, providing a comprehensive description of the factors influencing stroke telerehabilitation intervention delivery. Results: Thirty-one studies and ten protocols of ongoing studies were included. Interventions were categorized as synchronous telerehabilitation (n = 9), asynchronous telerehabilitation (n = 11) and tele-support (n = 11). Telephone and videoconference were the most frequently used modes of delivery. Usability and acceptability with telerehabilitation was high across all platforms, although access issues and technical challenges may be potential barriers to the use of telerehabilitation in service delivery. Costs of intervention delivery and training requirements were poorly reported. Conclusion(s): This review synthesizes the evidence relating to factors that may influence stroke telerehabilitation intervention delivery at a crucial timepoint given the rapid deployment of telerehabilitation in response to the COVID-19 pandemic. It recommends strategies, such as ensuring adequate training and technical infrastructure, shared learning and consistent reporting of cost and usability and acceptability outcomes, to overcome challenges in embedding and routinising this service model and priorities for research in this area. Impact: Given the rapid widespread adoption of telerehabilitation services, in response to the COVID-19 pandemic, this systematic review was necessary to allow for a deeper understanding of the factors influencing telerehabilitation delivery and its translation into stroke practice to ultimately improve patient experience and service quality. Funding acknowledgements: AS's time was co-funded by Royal College of Surgeons in Ireland (School of Physiotherapy) and the European Union's Horizon 2020 Research and Innovation Programme under grant agreement no. 687228, MAGIC PCP.