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Acceptance of Tele-Rehabilitation by Stroke Patients: Perceived Barriers and Facilitators

  • Author Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Shilpa Tyagi
    Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Affiliations
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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  • Author Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Daniel S.Y. Lim
    Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Affiliations
    Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
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  • Author Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Wilbert H.H. Ho
    Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Affiliations
    Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
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  • Author Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Yun Qing Koh
    Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.
    Affiliations
    Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
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  • Vincent Cai
    Affiliations
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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  • Gerald C.H. Koh
    Correspondence
    Corresponding author Gerald C.H. Koh, PhD, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01 Singapore 117549.
    Affiliations
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore

    Yong Loo Lin School of Medicine, National University of Singapore, National University Health System
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  • Helena Legido-Quigley
    Affiliations
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore

    London School of Hygiene and Tropical Medicine, United Kingdom
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  • Author Footnotes
    ∗ Tyagi, Lim, Ho, and Koh contributed equally to this work.

      Abstract

      Objective

      To explore the perceived barriers and facilitators of tele-rehabilitation (TR) by stroke patients, caregivers and rehabilitation therapists in an Asian setting.

      Design

      Qualitative study involving semi-structured in-depth interviews and focus group discussions.

      Setting

      General community.

      Participants

      Participants (N=37) including stroke patients, their caregivers, and tele-therapists selected by purposive sampling.

      Interventions

      Singapore Tele-technology Aided Rehabilitation in Stroke trial.

      Main Outcome Measures

      Perceived barriers and facilitators for TR uptake, as reported by patients, their caregivers, and tele-therapists.

      Results

      Thematic analysis was used to inductively identify the following themes: facilitators identified by patients were affordability and accessibility; by tele-therapists, was filling a service gap and common to both was unexpected benefits such as detection of uncontrolled hypertension. Barriers identified by patients were equipment setup–related difficulties and limited scope of exercises; barriers identified by tele-therapists were patient assessments, interface problems and limited scope of exercises; and common to both were connectivity barriers. Patient characteristics like age, stroke severity, caregiver support, and cultural influence modified patient perceptions and choice of rehabilitation.

      Conclusions

      Patient attributes and context are significant determinants in adoption and compliance of stroke patients to technology driven interventions like TR. Policy recommendations from our work are inclusion of introductory videos in TR programs, provision of technical support to older patients, longer FaceTime sessions as re-enforcement for severely disabled stroke patients, and training of tele-therapists in assessment methods suitable for virtual platforms.

      Keywords

      List of abbreviations:

      DR (day rehabilitation), RCT (randomized controlled trial), TR (tele-rehabilitation)
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