Home-based telesurveillance and rehabilitation after stroke: a real-life study

Background: After discharge from in-hospital rehabilitation, post-stroke patients should have the opportunity to continue the rehabilitation through structured programs to maintain the benefits acquired during intensive rehabilitation treatment. Objective: The primary objective was to evaluate the feasibility of implementing an home-based telesurveillance and rehabilitation (HBTR) program to optimize the patient's recovery by reducing dependency degree. Method: Post-stroke patients were consecutively screened. Data were expressed as mean +/- standard deviation (SD). 26 patients enrolled: 15 were sub-acute (time since stroke: 112 +/- 39 days) and 11 were chronic (time since stroke: 470 +/- 145 days). For 3 months patients were followed at home by a nurse-tutor, who provided structured phone support and vital signs telemonitoring, and by a physiotherapist (PT) who monitored rehabilitation sessions by videoconferencing. Results: 23 patients completed the program; 16.7 +/- 5.2 phone contacts/patient were initiated by the nurse and 0.9 +/- 1.8 by the patients. Eight episodes of atrial fibrillation that required a change in therapy were recorded in two patients. Physiotherapists performed 1.2 +/- 0.4 home visits, 1.6 +/- 0.9 phone calls and 4.5 +/- 2.8 video-conferencesessions per patient. At least three sessions/week of home exercises were performed by 31% of patients, two sessions by 54%. At the end of the program, global functional capacity improved significantly (P< 0.001), in particular, static (P< 0.001) and dynamic (P= 0.0004) postural balance, upper limb dexterity of the paretic side (P= 0.01), and physical performance (P= 0.002). Symptoms of depression and caregiver strain also improved. Conclusion: The home-based program was feasible and effective in both sub-acute and chronic post-stroke patients, improving their recovery, and maintaining the benefits reached during inpatient rehabilitation