Introduction:
Higher doses of rehabilitation therapy are associated with better outcomes after stroke. Many patients do not receive high-dose therapy, however, e.g., due to limited availability and access, especially in the COVID era. Telehealth approaches can overcome many barriers, and evidence suggests that some forms of telerehabilitation are efficacious after stroke. However, uncertainty exists as to which patients are most likely to benefit from telerehabilitation. This issue was examined in the current study.
Methods:
Data are from patients randomized to telerehabilitation (TR) in an 11-site, assessor-blind trial (JAMA Neurol 76:1079) that provided 6 weeks of intensive arm motor therapy to hemiparetic patients with stroke 4-36 weeks prior. The primary endpoint was change in arm motor Fugl-Meyer (FM) from pre-treatment to 1-month post-treatment. Predictors of TR-related FM gain were identified using forward stepwise multivariable linear regression analysis, advancing the most significant predictor from each of 8 categories (demographics, stroke characteristics, medical history, amount of outside therapy, motivation, sensorimotor impairment, cognitive/affective status, and functional status) if it survived bivariate screening with p<0.1.
Results:
In patients >90 days post-stroke onset (n=44), sex (r=.33, p=.028), # hours of outside therapy post-randomization (r=.36, p=.019), spasticity (r=-.37, p=.014), and NIHSS visual field score (r=-.28, p=.068) were bivariate predictors of TR-related FM gain. In multivariable analysis, all except therapy hours survived as significant (P<0.05) predictors: TR-related FM gains were higher in females and lower in patients with spasticity or visual field defects. When the 15 patients randomized to TR ≤90 days post-stroke were added in secondary analysis, multivariable analysis found that sex, # hours of therapy post-randomization, and NIHSS neglect score were significant predictors.
Conclusions:
In patients with stable motor status >90 days post-stroke, behavioral gains from home-based TR were greatest in patients who were female and who had less spasticity and visual field defects. These results might be useful for patient selection and for design of future TR-based therapeutic approaches.
A Case Report on Treating Post-stroke Visual Impairment with Gami-banhabakchulchunma-tang and Acupuncture
