Development of a Tele-Rehabilitation Platform for Stroke Survivors: Design, Implementation, and Evaluation

Thesis Abstract

Stroke survivors often face barriers to accessing timely, ongoing rehabilitation due to geographic, transportation, and resource constraints, which can lead to suboptimal recovery and increased risk of disability. This study designs, implements, and evaluates a Tele-Rehabilitation Platform (TRP) to deliver multimodal rehabilitation remotely, integrating physical therapy, occupational therapy, and cognitive training to enhance functional outcomes and adherence. The aim is to develop a scalable platform that supports high-quality, home-based rehabilitation and to evaluate its usability, efficacy, and cost-effectiveness in real-world clinical settings. Specific objectives are (1) to synthesize user requirements from stroke survivors, caregivers, and clinicians; (2) to design an interoperable TRP architecture incorporating real-time video-guided therapy, asynchronous exercise modules, progress monitoring, and secure data management; (3) to implement the platform in two urban–rural healthcare networks and pilot-test with stroke survivors; (4) to evaluate usability and acceptability using the System Usability Scale (SUS) and the Unified Theory of Acceptance and Use of Technology (UTAUT) framework; (5) to assess clinical effectiveness on motor impairment, functional independence, cognitive function, and quality of life; (6) to estimate cost-effectiveness compared with standard clinic-based rehabilitation; and (7) to derive guidelines for implementation and sustainability. A mixed-methods design is employed. The population comprises stroke survivors within six months post-stroke, aged 40–85, and receiving outpatient rehabilitation, along with therapists and caregivers. A sample of 180 stroke survivors will be recruited across three clinical sites and randomized to either the TRP plus standard care (intervention) or standard care alone (control) for 12 weeks, with follow-up at three and six months post-intervention. Qualitative data will be collected from 30 purposively selected participants (patients, caregivers, and therapists) through semi-structured interviews to explore experiences, barriers, and facilitators. Instruments include the TRP usability and engagement metrics, the Fugl-Meyer Assessment for upper and lower extremities, the Barthel Index, the Montreal Cognitive Assessment, the Stroke-Specific Quality of Life Scale, and health economics data capture tools. Data analysis will proceed as follows quantitative data will be analyzed using mixed-model repeated measures ANOVA to examine group-by-time interactions on motor, functional, cognitive, and quality-of-life outcomes, with post hoc contrasts (p<0.05). Mediation analysis will test whether adherence mediates clinical outcomes. Regression analyses will adjust for baseline characteristics. Economic evaluation will adopt a cost-utility analysis from the healthcare payer perspective, calculating incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). Qualitative data will be analyzed through thematic analysis, guided by the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT), ensuring triangulation with quantitative results. Thematic coding will be conducted independently by two researchers, with discrepancies resolved via consensus. The study is anchored in the theoretical framework of Self-Determination Theory to promote autonomous motivation in exercise adherence and the Social Cognitive Theory to model self-efficacy and outcome expectations in remote rehabilitation. Expected findings include higher adherence rates and superior improvements in motor function (as indicated by Fugl-Meyer scores) and activities of daily living (Barthel Index) in the TRP group versus controls, sustained gains at six months, enhanced cognitive performance, and improved health-related quality of life. It is anticipated that TRP will be cost-effective relative to standard care, particularly when factoring reduced travel time and clinic sessions. The research will contribute to knowledge by providing robust evidence on the feasibility, effectiveness, and economic viability of a modular, patient-centered tele-rehabilitation solution for stroke, including insights into optimization of remote supervision, user engagement, and data-driven personalization. The main conclusion is that a well-designed TRP can supplement traditional rehabilitation, improve outcomes, and offer scalable access to high-quality care. Recommendations will address platform governance, data security, interoperability with electronic health records, clinician workflow integration, patient stratification for personalized therapy, and strategies to sustain funding and policy support to facilitate widespread adoption.