Category: Stroke; Technology (e.g. robotics, assistive technology, mHealth)
Objective : To study the experience of tele-rehabilitation in stroke patients, their caregivers and tele-therapists, and the factors associated with tele-technology acceptance.
Design : Qualitative study involving semi-structured in-depth interviews and focus group discussions.
Setting : General community.
Participants (or Animals, Specimens, Cadavers) : 37 participants including stroke patients, their caregivers and tele-therapists selected by purposive sampling.
Interventions : Not applicable.
Main Outcome Measure(s) : Experience of participating in tele-rehabilitation, as reported by stroke patients, their caregivers and tele-therapists.
We conducted thematic analysis to identify the following five themes: technology and aging, motivation and technology adoption, support system including caregivers and family, patient-therapist relationship and role of tele-rehabilitation in patient's recovery. Older patients found tele-technology challenging to adopt, however prior use or technical assistance by caregiver increased acceptance. Intrinsic motivation driven by self-set goals, perceived improvement and satisfaction improved adherence. While older patients set lower goals and had higher satisfaction, severely disabled ones relied on external re-enforcement from therapists. The support system comprising of caregivers was viewed differently by different participants, with patients viewing it as a source of technical assistance and caregivers viewing it as a source of physical or emotional assistance. Two components of patient-therapist relationship emerged, personal touch and softer aspects, with preference for either varying with patient characteristics. Depending on their experience, the participants described tele-rehabilitation as a complimentary or self-sufficient avenue for patients.
Policy recommendations from our work are customization of tele-rehabilitation based on caregiver availability and patient attributes, setting patient-centered goals especially for older patients, provision of external re-enforcement for severely disabled patients to improve adherence and implementing a preparatory phase for elderly patients to familiarize themselves with technology and establish trusting relationship with therapist.
Shilpa Tyagi– PhD Candidate, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Daniel Lim– ., NUS Yong Loo Lin School of Medicine, Singapore
Wilbert Ho– ., NUS Yong Loo Lin School of Medicine, Singapore
Yun Qing Koh– ., NUS Yong Loo Lin School of Medicine, Singapore
Vincent Cai– Research Assistant, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Angela Cheong– Research Assistant, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Helena Legido-Quigley– Associate Professor, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Gerald Choon-Huat Koh– Associate Professor, National University of Singapore, Singapore