Telerehabilitation in Community Stroke Services: Mixed Methods Evaluation of Current Practice and Lessons for...

The delivery of specialist stroke rehabilitation is undergoing a significant transformation, with telerehabilitation increasingly integrated into clinical practice and supported by guidelines and policy. There is a need for the pragmatic evaluation of telerehabilitation in service, which includes insights from clinical teams and people with stroke. This evaluation sought to address that need in the context of community stroke services in the East of England.

Our evaluation addressed two over-arching aims: (1) to investigate and map contemporary models and experiences of telerehabilitation delivery in community stroke services, examining how it is currently used and perceived by both health care providers and service-users; and (2) to identify practical lessons and enabling factors that support the sustained integration of telerehabilitation into routine community stroke services.

This study is a two-phase exploratory sequential mixed methods evaluation. Phase one involved discussion groups with stakeholders already using telerehabilitation to explore experiences, attitudes, influences, and behaviors associated with its use. Findings from phase one directly informed phase two by the development of a conceptual framework and in shaping the content of an online survey for clinicians and people with lived experience of stroke. Quantitative and qualitative data were subsequently integrated through triangulation during analysis, interpretation, and reporting stages. Data from the discussion groups were analyzed using a recognized framework for reflexive thematic analysis within a contextualist approach. Descriptive statistics were used to summarize quantitative survey responses.

A total of 20 people attended the discussion groups (n=4 groups total). Further, 96 people responded to the survey. Three themes underpinning successful use of telerehabilitation in this context were derived from triangulation across our data sources: (1) consideration of risks and benefits, with fewer than half of staff viewing telerehabilitation as equivalent in safety (22/49, 45%) or effectiveness (18/49, 37%), but most reporting that they could build rapport remotely (34/49, 69%); (2) the importance of individualized care approaches, where most clinicians reported confidence in identifying which service-users would benefit from telerehabilitation (42/49, 85%), although only 20% (10/49) offered it routinely; and (3) the need for staff support, with up to 34% of staff reporting no training in how to assess suitability for telerehabilitation. Key insights included the potential for telerehabilitation to increase efficiency and address service pressures, the importance of addressing digital exclusion, the value of individualized approaches, and the need for timely and tailored staff training.

Our pragmatic, in-service evaluation demonstrates that telerehabilitation works best not as a replacement for in-person care, but as part of a responsive, blended approach grounded in individual need. These findings highlight that, with appropriate clinician training and flexibility in delivery, telerehabilitation can meet the needs of individuals through personalized approaches while supporting service responsiveness in pressurized clinical environments.