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Updated: Jun 17, 2026
Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation
Published on: March 8, 2018
Health Care Providers' Perspectives on a Hybrid Outpatient Stroke Telerehabilitation Program: Qualitative
Marina B Wasilewski1,2,3, Shaghayegh Mirbaha1, Karl Wong1
1St. John's Rehab, Sunnybrook Research Institute, 285 Cummer Ave, North York, ON, M2M 2G1, Canada, 1 416-226-6780 ext 57957.
Background:
Although patient outcomes are improved by stroke rehabilitation, the suggested amount of therapy is rarely maintained. The COVID-19 pandemic aggravated this situation further due to disruptions in health care. One solution was the rapid and extensive transition to virtual care. A hybrid outpatient stroke telerehabilitation program (HOSTP) was introduced by St John's Rehab-a tertiary rehabilitation hospital in Toronto, Ontario. The HOSTP integrated in-person and virtual care in an effort to alleviate long-standing obstacles that challenge stroke rehabilitation.
Objective:
This study explored health care providers' (HCPs) experiences with the HOSTP and their perspectives on its implementation, quality, and impact to determine the modifications needed to optimize its delivery and sustainability.
Methods:
A qualitative implementation study was conducted, with semistructured interviews conducted among HCPs involved in the HOSTP. The interview guide was informed by the CFIR (Consolidated Framework for Implementation Research). In total, 14 HCPs were recruited and interviewed from St John's Rehab outpatient program. Interview transcripts were analyzed using a 2-stage analytic approach involving inductive thematic analysis, followed by deductive categorization using CFIR.
Results:
Four main themes were identified across CFIR domains: (1) adaptability and flexibility of the hybrid care model (intervention characteristics), (2) alignment with patient needs and resources (outer setting), (3) the impact of organizational resources and infrastructure (inner setting), and (4) variability in provider confidence and perceptions of virtual care (characteristics of individuals). Key determinants were identified as adaptability, patient-related factors, resource availability, and provider beliefs about virtual care.
Conclusions:
Our findings suggest that, from HCPs' viewpoints, optimizing virtual care processes and resources may support access and care quality within hybrid outpatient stroke rehabilitation. HCPs viewed maintaining virtual care as important for supporting ongoing access and patient-centered care. Lastly, optimizing the benefits and mitigating the drawbacks of hybrid care can ensure future integration of virtual care into standard outpatient stroke rehabilitation.
