Development and Evaluation of a Tele-rehabilitation Program for Post-Stroke Recovery

Thesis Abstract

Stroke remains a leading cause of long-term disability worldwide, with post-stroke motor and cognitive impairments significantly impacting patients' quality of life. Despite advances in rehabilitation therapies, traditional in-center rehabilitation often encounters barriers such as limited access, high costs, and geographic constraints, which hinder optimal recovery outcomes for many stroke survivors. This study aims to develop and rigorously evaluate a scalable tele-rehabilitation program designed to enhance functional recovery in post-stroke patients, thereby addressing pressing accessibility and resource limitations within conventional rehabilitation paradigms. The primary objectives include (1) designing an evidence-based tele-rehabilitation intervention integrating current best practices and theoretical frameworks such as the Health Belief Model and the Self-Efficacy Theory; (2) assessing the feasibility and usability of the program among stroke survivors; (3) evaluating the effectiveness of the tele-rehabilitation program on motor recovery, cognitive function, and psychological well-being; and (4) identifying factors influencing adherence, satisfaction, and perceived benefits of the intervention. The research adopts a mixed-methods quasi-experimental design involving 120 post-stroke patients recruited from outpatient neurology clinics within a metropolitan healthcare network. Participants will be randomly assigned to either the intervention group receiving the developed tele-rehabilitation program or a control group receiving standard care. Quantitative data will be collected through validated measures such as the Fugl-Meyer Assessment for motor function, Montreal Cognitive Assessment (MoCA) for cognitive performance, and the Stroke Self-Efficacy Scale. Data on adherence, engagement, and satisfaction will be gathered via structured logs and online questionnaires. Qualitative insights will be obtained through semi-structured interviews with a purposively selected subset of 30 participants and healthcare providers to explore perceptions of usability, barriers, and facilitators. Data analysis will involve descriptive statistics, independent t-tests, and repeated-measures ANOVA to compare pre- and post-intervention outcomes. Regression analyses will identify predictors of recovery and adherence, while thematic analysis will interpret qualitative data, ensuring a comprehensive understanding of participant experiences. It is anticipated that the tele-rehabilitation program will result in statistically significant improvements in motor and cognitive functions among intervention participants compared to controls, alongside higher levels of self-efficacy and satisfaction. The findings are expected to demonstrate the program’s feasibility, acceptability, and potential to augment traditional rehabilitation services, especially in resource-constrained settings. This research contributes to the existing knowledge base by providing an empirically validated framework for implementing technology-assisted rehabilitation tailored to post-stroke recovery, grounded in behavioral change theories. The study concludes that structured tele-rehabilitation can serve as an effective adjunct or alternative to in-person therapy, potentially revolutionizing stroke recovery paradigms. Based on these findings, it is recommended that healthcare providers integrate such digital interventions into standard care protocols, especially to reach underserved populations. Future research is advised to explore long-term outcomes, cost-effectiveness, and integration strategies for broader adoption across diverse healthcare systems. The study’s innovative approach offers a scalable model for enhancing post-stroke rehabilitation outcomes through accessible, patient-centered digital health solutions, aligning with contemporary shifts toward telehealth modalities.