Assessment of Tele-Rehabilitation Outcomes in Post-Stroke Patients at Urban Community Health Centers

Thesis Abstract

Post-stroke rehabilitation remains a critical component in restoring functional independence and quality of life for stroke survivors, yet traditional in-person therapy often encounters logistical barriers such as transportation challenges, limited rehabilitation facilities, and resource constraints in urban healthcare settings. The advent of tele-rehabilitation offers a promising alternative to augment conventional therapy, but empirical evidence regarding its effectiveness, particularly within urban community health centers, remains fragmented. This study aims to assess the outcomes of tele-rehabilitation in post-stroke patients attending urban community health centers, with specific objectives to evaluate functional recovery levels, patient adherence rates, satisfaction, and perceived barriers to tele-rehabilitation implementation. Employing a mixed-methods sequential explanatory research design, the study integrates quantitative and qualitative approaches to provide a comprehensive understanding of tele-rehabilitation outcomes. The quantitative phase adopts a quasi-experimental pretest-posttest design involving a sample of 150 post-stroke patients recruited from three urban community health centers, using stratified random sampling to ensure demographic and clinical diversity. Data collection instruments include the Fugl-Meyer Assessment (FMA) for motor recovery, the Modified Rankin Scale (mRS) for functional independence, and standardized patient satisfaction and adherence questionnaires. The qualitative component involves semi-structured interviews with 20 patients, caregivers, and healthcare providers, analysed thematically to explore contextual factors influencing tele-rehabilitation outcomes. Data analysis employs descriptive statistics (means, frequencies), paired t-tests, repeated-measures ANOVA to compare pre- and post-intervention scores, and multiple regression analyses to identify predictors of positive outcomes. Thematic analysis follows Braun and Clarke’s six-phase framework to interpret qualitative data, facilitating a nuanced understanding of patient and provider experiences. To underpin the study, the control theory of self-management and the Technology Acceptance Model (TAM) are employed as theoretical frameworks, guiding the interpretation of adherence, satisfaction, and behavioral intentions related to tele-rehabilitation use. Expected findings suggest that tele-rehabilitation significantly improves motor and functional recovery among post-stroke patients, with adherence rates exceeding 80% and high satisfaction levels reported. Factors such as technological literacy, perceived ease of use, and social support are anticipated to emerge as significant predictors of positive outcomes. The study also is expected to identify barriers such as technological challenges, limited caregiver support, and concerns regarding the adequacy of remote assessments, offering critical insights into implementation strategies. This research makes a substantive contribution to existing knowledge by providing empirical evidence on the effectiveness and acceptability of tele-rehabilitation within the urban community health context, filling a notable gap in the stroke rehabilitation literature. It elucidates the determinants of successful remote rehabilitation, informing policymakers, clinicians, and digital health developers. The findings will support the development of evidence-based protocols and strategies that optimize tele-rehabilitation's integration into community-based stroke care. The main conclusion underscores that tele-rehabilitation is a feasible, effective, and acceptable modality for post-stroke recovery in urban settings, provided that technological, social, and healthcare system facilitators are adequately addressed. Based on these findings, recommendations include enhancing digital literacy among patients, fostering caregiver involvement, improving technological infrastructure, and establishing standardized remote assessment protocols. Future research should explore longitudinal outcomes, cost-effectiveness analyses, and scalability across diverse healthcare systems to further advance tele-rehabilitation practices and policies.