Development and Evaluation of a Tele-Rehabilitation Protocol for Post-Stroke Motor Recovery

Thesis Abstract

Post-stroke motor impairment presents persistent barriers to functional independence and quality of life, with conventional in-person rehabilitation services constrained by access, cost, and logistical barriers. This study addresses the gap by developing and evaluating a Tele-Rehabilitation Protocol designed to deliver structured, evidence-based motor recovery interventions to stroke survivors in community settings. The aim is to determine (1) the feasibility and usability of a tele-rehabilitation platform, (2) its effects on upper- and lower-extremity motor function, activities of daily living, and participation, and (3) the acceptability and perceived barriers/facilitators from patient and clinician perspectives. Specific objectives include (a) to design a theoretically grounded tele-rehabilitation protocol incorporating principles of motor learning and neuroplasticity, (b) to evaluate feasibility metrics (adherence, retention, technical issues) in a single-arm pilot with 60 stroke survivors, (c) to compare pre- and post-intervention motor outcomes using standardized measures, (d) to identify mediators and moderators of treatment response (e.g., baseline impairment, age, comorbidity), and (e) to explore user experiences through qualitative interviews. A mixed-methods design will be employed. The quantitative component will adopt a pre-post single-group design with 60 adults (?6 months post-stroke) recruited from three community-based rehabilitation centers. Primary outcome measures will include the Fugl-Meyer Assessment (FMA) for motor impairment, the Wolf Motor Function Test (WMFT) for functional ability, and the Stroke Impact Scale (SIS) for participation and quality of life. Secondary outcomes will include adherence rates, session completion, and patient-reported perceived exertion. Data collection will occur at baseline, immediately post-intervention (12 weeks), and follow-up at 24 weeks. The qualitative component will involve semi-structured interviews with a purposive subsample of 20 participants and 6 therapists to capture acceptability, usability, and contextual factors influencing engagement. Theoretical framing will draw on the Motor Learning Theory and the Biopsychosocial Model, with Social Cognitive Theory informing self-efficacy and adherence dynamics. A conceptual model will be articulated to explain pathways from tele-delivery variables to motor and participation outcomes. Data analysis will integrate quantitative and qualitative strands. Quantitative analyses will utilize repeated-measures ANOVA to assess changes across time points, with post-hoc pairwise comparisons and effect size estimation (Cohen’s d). Regression analyses will explore predictors of response, including baseline impairment, time since stroke, and dose of intervention. Mediation analyses will test whether self-efficacy mediates the relationship between adherence and motor gains. Qualitative data will be analyzed thematically using a framework approach, with triangulation to corroborate quantitative findings. Validity and reliability will be established through pilot testing of the platform, triangulation of data sources, member checking, and assessor blinding where feasible. The anticipated findings include significant improvements in FMA and WMFT scores post-intervention, with gains maintained at 24-week follow-up, alongside enhanced SIS outcomes indicating better participation and perceived life quality. High feasibility indicators are expected, with adherence above 80%, low dropout rates, and minimal technical disruptions. It is anticipated that greater baseline impairment, higher self-efficacy, and higher dose-intensity will predict superior motor gains, while age and comorbidity may moderate outcomes. Qualitative insights are expected to reveal perceived convenience, perceived exertion balance, and trust in remote monitoring as crucial facilitators, alongside identified barriers such as internet access variability and home environmental factors. The study will contribute to knowledge by providing rigorous, contextually grounded evidence on the feasibility and effectiveness of tele-rehabilitation for post-stroke motor recovery, clarifying the mechanisms through which tele-delivered interventions exert impact, and offering a replicable protocol adaptable to diverse health systems. Practical implications include guidance for scalable implementation, requirements for clinician training, data security considerations, and patient-tailored dosing strategies to optimize outcomes. The main conclusion is that a structured tele-rehabilitation protocol can achieve meaningful motor and participation gains in community-dwelling stroke survivors, provided that interventions are theory-informed, user-centered, and supported by reliable technology. Recommendations include integrating tele-rehabilitation into standard stroke care pathways, investing in equitable access to digital infrastructure, and conducting larger multi-center randomized controlled trials to establish comparative effectiveness against conventional rehabilitation.