A Framework for Integrating Tele-rehabilitation in Post-Stroke Physiotherapy Practice

Thesis Abstract

The increasing prevalence of stroke globally has underscored the urgent need to enhance post-stroke physiotherapy practices, especially through innovative approaches such as tele-rehabilitation, which offers the potential to improve accessibility, continuity of care, and patient outcomes in diverse settings. Despite the rapid growth of telehealth technologies, the integration of tele-rehabilitation into routine post-stroke physiotherapy remains fragmented and lacks a comprehensive framework that guides clinicians, policymakers, and stakeholders in its effective implementation. This study aims to develop a robust, evidence-based framework that facilitates the seamless integration of tele-rehabilitation in post-stroke physiotherapy practice, thereby optimizing rehabilitative outcomes and resource utilization. The specific objectives are to critically review existing models of tele-rehabilitation, identify barriers and facilitators influencing adoption among physiotherapists, and empirically assess the key components necessary for a contextualized framework tailored to post-stroke care. Additionally, the study seeks to evaluate the perceptions, readiness, and preferences of physiotherapists and stroke survivors regarding tele-rehabilitation, to inform the development of a practical, adaptable model. A mixed-methods research design was adopted, comprising both qualitative and quantitative approaches. The qualitative phase involved semi-structured interviews with 30 licensed physiotherapists with experience in stroke rehabilitation across urban and rural clinics, analyzed via thematic analysis to identify core themes related to perceptions, challenges, and strategies for implementing tele-rehabilitation. Concurrently, the quantitative component employed structured questionnaires distributed to 150 physiotherapists and 200 stroke survivors to quantify attitudes, perceived benefits and barriers, technological literacy, and readiness levels, analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression to identify predictors of successful tele-rehabilitation integration. The study also applied Rogers’ Diffusion of Innovation theory alongside the Technology Acceptance Model to frame behavioral and technological adoption determinants. The integration of these theoretical perspectives enabled the identification of critical factors influencing acceptance and sustained use of tele-rehabilitation systems. Expected findings include elucidation of key barriers such as technological infrastructure deficits, lack of training, and resistance to change, as well as facilitators such as perceived ease of use, perceived benefits to patient independence, and organizational support. The regression analysis is anticipated to reveal significant predictors of physiotherapists’ willingness to employ tele-rehabilitation, including technological competence (p < 0.01), organizational readiness (p < 0.05), and prior positive experience with telehealth (p < 0.001). The thematic analysis is expected to uncover themes related to trust in technology, patient engagement, and contextual adaptability. The study's contributions to knowledge are twofold first, providing a validated, context-specific framework that synthesizes empirical insights and theoretical constructs to guide the integration of tele-rehabilitation into post-stroke physiotherapy; second, offering an evidence-based model that addresses identified barriers and leverages facilitators for scalable implementation. This framework is intended to serve as a strategic guide for clinicians, health administrators, and policymakers aiming to incorporate tele-rehabilitation into standard rehabilitation protocols. The main conclusion emphasizes that effective integration of tele-rehabilitation requires a multi-level approach informed by contextual realities, technological competence, and stakeholder engagement. Recommendations include the development of targeted training programs, infrastructural investments, policy guidelines, and continuous evaluation mechanisms. Future research should explore longitudinal impacts of tele-rehabilitation on functional outcomes and cost-effectiveness, as well as adaptation of the framework across different healthcare systems. This study significantly advances the body of knowledge by offering a comprehensive, theoretically grounded model tailored to post-stroke physiotherapy, with practical implications for enhancing remote rehabilitation services and optimizing long-term recovery trajectories.