Comparative Analysis of Tele-rehabilitation vs In-person Therapy Outcomes in Stroke Patients

Thesis Abstract

This study addresses the growing disparity in post-stroke rehabilitation access by comparing tele-rehabilitation and in-person therapy outcomes to determine whether remote modalities can deliver equivalent or superior functional gains, adherence, and patient satisfaction. The problem centers on limited availability of conventional rehabilitation services, geographical barriers, and resource constraints that disproportionately affect stroke survivors. The aim is to evaluate differential outcomes between tele-rehabilitation and traditional in-person therapy, with specific objectives to (1) compare motor and activities of daily living (ADL) outcomes at 6 and 12 weeks, (2) assess cognitive and language recovery trajectories, (3) examine adherence, engagement, and session dose, (4) identify patient-reported quality of life and satisfaction, and (5) explore moderating effects of age, stroke severity, and technological literacy on treatment effectiveness. It is hypothesized that tele-rehabilitation will achieve non-inferior motor and ADL gains relative to in-person therapy, with higher accessibility-related adherence but potential differences in perceived social support. A mixed-methods design is employed, combining a pragmatic randomized controlled trial with an embedded qualitative inquiry. The population comprises adults aged 40–85 years who have experienced a first-ever ischemic stroke within the previous 12 weeks, screened at three urban rehabilitation centers. A total sample of 240 participants will be recruited and randomized (11) to receive either telerehabilitation or standard in-person therapy, each over a 12-week intervention period, with follow-up at 6 months. Intervention protocols draw on guidelines from the American Heart Association and the World Federation for Neurorehabilitation, incorporating task-oriented motor training, constraint-induced movement therapy elements where appropriate, and integrated cognitive-linguistic activities. Tele-rehabilitation sessions will leverage synchronous video conferencing, wearable sensors for movement analysis, and digital home exercise programs, while control participants receive equivalent content through conventional clinic-based sessions. Primary data will include objective motor outcomes using the Fugl-Meyer Assessment for upper and lower extremities, the Barthel Index for ADLs, and the Montreal Cognitive Assessment for cognitive function, measured at baseline, 6 weeks, 12 weeks, and 6 months. Secondary data comprise the Stroke-Specific Quality of Life Scale, the User Engagement Scale, and adherence metrics (session attendance, exercise completion rate, and dose–response indices). Data collection instruments will be validated for the target population, with tele-rehabilitation tools calibrated for reliability. In addition, semi-structured interviews will be conducted with a purposive subsample of 40 participants (20 per arm) and 10 therapists to explore experiences, perceived barriers, and facilitators of remote delivery. Quantitative analyses will use intention-to-treat principles. Descriptive statistics will summarize baseline characteristics. Between-group differences will be examined using repeated-measures ANOVA and mixed-effects linear models to account for intra-individual correlations over time, with fixed effects for group, time, and group-by-time interaction. Non-inferiority margins will be predefined for primary motor and ADL outcomes. Multiple regression analyses will identify moderators (age, stroke severity, digital literacy) and mediators (adherence, engagement) of treatment effects. Thematic analysis following Braun and Clarke will analyze qualitative data, with synthesis achieved through a convergent mixed-methods approach to integrate numerical outcomes with experiential insights. Expected findings include non-inferior motor and ADL improvements in the tele-rehabilitation group compared with in-person therapy, similar cognitive and language gains, higher adherence and broader reach for tele-rehabilitation, and higher reported convenience and satisfaction but varying perceptions of social support. The study contributes to knowledge by providing rigorous comparative effectiveness evidence for tele-rehabilitation in stroke recovery, informing patient-centered care models, reimbursement policies, and scalable service designs. It also advances theoretical understanding of how technology-mediated therapy influences motivation, adherence, and functional recovery in neurorehabilitation, complementing social cognitive and self-determination theories. Conclusions are anticipated to endorse tele-rehabilitation as a viable alternative to conventional therapy for stroke survivors, with recommendations emphasizing structured tele-delivery protocols, target populations most likely to benefit, training for therapists, standardized outcome monitoring, and strategies to optimize social support and digital literacy to maximize equitable access and outcomes.