Effectiveness of Telerehabilitation on Post-Stroke Mobility Outcomes: An RCT Field Study

Thesis Abstract

This study addresses the persistent mobility limitations experienced by stroke survivors and the inequities in access to conventional rehabilitation services, by evaluating the effectiveness of a telerehabilitation program delivered over a 12-week period. The aim is to determine whether structured telerehabilitation improves post-stroke mobility outcomes compared with standard in-person care and usual care, and to identify factors that influence adherence and outcomes. Specific objectives are (1) to compare mobility gains between telerehabilitation and conventional rehabilitation using objective performance measures; (2) to evaluate changes in functional independence, gait speed, and balance; (3) to assess adherence, user experience, and technical feasibility of the telerehabilitation platform; (4) to examine the mediating role of therapy adherence and self-efficacy on mobility outcomes; and (5) to explore patient and clinician perspectives on barriers and facilitators to telerehabilitation implementation. A parallel-group randomized controlled trial design will be employed. The population includes adults aged 40–80 years with a first-ever ischemic or hemorrhagic stroke within the previous 3–12 months, living in urban and peri-urban communities. A sample of 200 participants will be recruited from five stroke rehabilitation centers and community clinics and randomly allocated to either telerehabilitation (n=100) or standard care (n=100). The telerehabilitation group will receive thrice-weekly, 60-minute sessions for 12 weeks via a integrated platform combining synchronous video sessions, guided exercises, and real-time feedback, complemented by asynchronous activity tracking. The control group will receive conventional outpatient rehabilitation as available. Primary outcomes include the Functional Ambulation Categories and the 10-Meter Walk Test (gait speed), measured at baseline, post-intervention, and 6-month follow-up. Secondary outcomes encompass the Timed Up and Go test, Berg Balance Scale, Functional Independence Measure, Stroke Impact Scale, and adherence metrics derived from the platform. Data collection instruments will include validated clinical assessments, standardized surveys, system usage logs, and semi-structured interviews for a subsample of participants and clinicians. Quantitative data will be analyzed using intention-to-treat principles. Between-group differences will be examined with analysis of covariance (ANCOVA) adjusting for baseline scores, with effect sizes estimated via partial eta-squared. Repeated-measures ANOVA will assess trajectory changes over time. Regression analyses will explore predictors of mobility improvement, with adherence, self-efficacy (General Self-Efficacy Scale), and social support as potential mediators. A mixed-methods approach will triangulate quantitative outcomes with qualitative data from interviews, analyzed thematically using Braun and Clarke’s framework to elucidate experiential factors influencing engagement and perceived value. Theoretical framing will draw on the International Classification of Functioning, Disability and Health (ICF) and Social Cognitive Theory to interpret mobility changes and adherence behaviors. Key expected findings include greater improvements in gait speed, balance, and functional independence in the telerehabilitation group relative to standard care, with moderate-to-large effect sizes. Higher adherence is anticipated to mediate mobility gains, with user-friendly interface and timely therapist feedback correlating with sustained engagement. The study is expected to demonstrate that telerehabilitation is non-inferior to conventional care for mobility outcomes, with added advantages in accessibility and patient satisfaction, particularly for those facing transportation barriers. Potential challenges such as technical difficulties, cognitive impairment, and data privacy concerns will be identified and addressed through sensitivity analyses and qualitative insights. The study contributes to knowledge by providing robust, ecologically valid evidence on the effectiveness and feasibility of telerehabilitation for post-stroke mobility, delineating factors that optimize outcomes and adherence, and informing policy on scalable rehabilitation models. The findings will inform clinicians, program designers, and health systems about optimizing remote rehabilitation pathways to reduce functional disability and enhance independence after stroke. Recommendations include integration of user-centered design for digital platforms, standardized training for therapists, strategies to support adherence (e.g., goal setting and feedback), and policies to ensure equitable access across settings. The study concludes that well-implemented telerehabilitation can enhance post-stroke mobility, with implications for broader adoption in hybrid rehabilitation models.