Development and Evaluation of a Tele-rehabilitation Platform for Post-Stroke Care

Thesis Abstract

Stroke survivors often face limited access to intensive rehabilitation services due to geographic, transportation, and resource constraints, leading to suboptimal functional recovery and reintegration into daily life. This study addresses the persistent gap by developing and evaluating a tele-rehabilitation platform that delivers multimodal post-stroke rehabilitation within home and community settings, integrating motor, cognitive, and speech therapies with remote clinician supervision. The aim is to design, implement, and rigorously evaluate a scalable tele-rehabilitation solution that enhances adherence, accelerates motor recovery, and improves health-related quality of life for stroke survivors and their caregivers. The specific objectives are (1) to identify user requirements and barriers to home-based rehabilitation through a mixed-methods needs assessment; (2) to develop a modular tele-rehabilitation platform incorporating sensor-based movement monitoring, guideline-driven exercise programs, remote coaching, and outcome tracking aligned with standard post-stroke care pathways; (3) to evaluate the platform’s usability, feasibility, and acceptability with 120 stroke survivors and 60 caregivers over a 12-week pilot; (4) to determine preliminary effectiveness on motor function (Fugl-Meyer Assessment-Upper Extremity), activities of daily living (Barthel Index), and quality of life (Stroke-Specific Quality of Life Scale) using a quasi-experimental design; (5) to examine implementation processes, fidelity, and contextual factors via the Consolidated Framework for Implementation Research (CFIR); and (6) to model cost-effectiveness relative to usual care. A mixed-methods research design will be employed, beginning with a qualitative needs assessment using thematic analysis of semi-structured interviews with 40 stroke survivors, 20 caregivers, and 15 clinicians to inform platform design. The subsequent feasibility and pilot phases will enroll 120 stroke survivors via outpatient and community-based clinics and 60 informal caregivers, with stratified sampling to ensure representation by age, sex, severity, and urban-rural residence. Data collection instruments will include validated motor and functional outcome measures (Fugl-Meyer Assessment - Upper Extremity, Action Research Arm Test, Modified Rankin Scale), activities of daily living (Barthel Index), mobility (Timed Up and Go), and quality-of-life outcomes (Stroke-Specific Quality of Life Scale). Usability will be assessed with the System Usability Scale and the User Engagement Scale; adherence will be tracked via platform analytics (logins, exercise completion, coaching interactions). For the economic evaluation, direct medical and non-medical costs will be collected to perform a cost-utility analysis from a health-system perspective, expressing outcomes as Quality-Adjusted Life Years (QALYs) obtained from the EQ-5D-5L. Quantitative analyses will include repeated-measures ANOVA and linear mixed-effects models to compare pre- and post-intervention outcomes, adjusting for covariates such as baseline impairment and comorbidities. Regression analyses will identify predictors of adherence and functional gains. The qualitative data will be analyzed thematically, with triangulation to inform refinements in platform design and implementation strategies. A convergent mixed-methods approach will integrate quantitative outcomes with qualitative insights to explain differential responses and contextualize findings. The theoretical framework combines the Biopsychosocial Model of Stroke Rehabilitation with the Technology Acceptance Model (TAM2) and the CFIR to guide design, deployment, and evaluation. Expected findings include improved upper-extremity motor function (mean Fugl-Meyer increase >8 points), enhanced independence in daily activities (Barthel index improvement >10 points), and reported gains in perceived quality of life, alongside high usability scores (SUS > 70) and acceptable adherence rates (?75% of prescribed sessions completed). The study is anticipated to demonstrate favorable short-term cost-effectiveness relative to standard care, driven by reduced travel burdens and optimized therapy dosing. The contribution to knowledge lies in empirically valid evidence for a scalable, patient-centered tele-rehabilitation model that integrates motor, cognitive, and communication therapy with remote clinical oversight, advancing implementation science in post-stroke care. The main conclusion is that a well-designed tele-rehabilitation platform can augment conventional rehabilitation by enabling timely, tailored, and accessible therapy, with positive implications for outcomes and health-system efficiency. Recommendations include refining interoperability standards, expanding caregiver engagement modules, conducting a larger randomized controlled trial to confirm efficacy, and exploring integration with community-based rehabilitation networks to sustain long-term adoption.