Preliminary Effect of Person-Centered Stroke Telerehabilitation That Combines Rasch Analysis Keyform Mapping With...

To test the preliminary effect of an innovative, in-home person-centered stroke telerehabilitation program combining Rasch keyform mapping with metacognitive strategy training.

Single-group pre-/posttest quasi-experimental design.

University research laboratory and in-home telerehabilitation.

Thirty (N=30) stroke survivors with a mean age ± SD of 59.7±16 years, 3.92 years poststroke (SD, 5.76), and with arm/hand hemiparesis.

The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) keyform, derived from Rasch analysis, maps personalized motor skill levels to the likelihood of successfully performing home/community activities of varying difficulty. Scored keyforms were made available to participants. Participants/therapists co-created an in-home telerehabilitation program (nine 1-h sessions over 6 wks) to address participants' self-identified home activity goals through individualized cognitive strategy training using a metacognitive strategy training approach.

Activity performance using the Patient-Specific Functional Scale (PSFS); self-efficacy using the Stroke Self-Efficacy Questionnaire; skill generalization using the Performance Quality Rating Scale (PQRS); and paretic arm motor ability using the telerehabilitation-specific FMA-UE (tFMA-UE). Pre-to-post mean score differences were compared using the Wilcoxon signed-rank test (P<.05), and Cohen's d indicated effect size.

Ninety percent of participants completed the intervention. The mean pre-to-post score differences ± SD were as follows: PSFS: pre: 2.30±1.67, post: 5.76±1.99, P<.001, d=1.73; Stroke Self-Efficacy Questionnaire: pre: 87.93±18.24, post: 99.96±12.92, P<.001, d=1.12; PQRS Completeness: pre: 9.19±1.00, post: 9.33±1.75, P=.13; PQRS Quality: pre: 4.04±2.09, post: 5.72±2.24, P<.001, d=1.25; telerehabilitation-specific FMA-UE: pre: 22.11±9.12, post: 23.74±9.43, P=.01, d=0.55.

Pre-to-post comparisons were significant, and effect sizes for all measures were medium/large. Combining keyform mapping with strategy training during stroke telerehabilitation may facilitate the co-creation of personalized intervention plans. The combined intervention may improve paretic upper extremity motor skills and increase activity performance, self-efficacy, and skill generalization.