Patients Most Likely To Benefit From Home-Based Telerehabilitation After Stroke

Introduction: Higher doses of rehabilitation therapy are associated with better outcomes after stroke Many patients do not receive high-dose therapy, however, e g , due to limited availability and access, especially in the COVID era Telehealth approaches can overcome many barriers, and evidence suggests that some forms of telerehabilitation are efficacious after stroke However, uncertainty exists as to which patients are most likely to benefit from telerehabilitation This issue was examined in the current study Methods: Data are from patients randomized to telerehabilitation (TR) in an 11-site, assessor-blind trial (JAMA Neurol 76:1079) that provided 6 weeks of intensive arm motor therapy to hemiparetic patients with stroke 4-36 weeks prior The primary endpoint was change in arm motor Fugl-Meyer (FM) from pre-treatment to 1-month post-treatment Predictors of TR-related FM gain were identified using forward stepwise multivariable linear regression analysis, advancing the most significant predictor from each of 8 categories (demographics, stroke characteristics, medical history, amount of outside therapy, motivation, sensorimotor impairment, cognitive/affective status, and functional status) if it survived bivariate screening with p90 days post-stroke onset (n=44), sex (r= 33, p= 028), # hours of outside therapy post-randomization (r= 36, p= 019), spasticity (r=- 37, p= 014), and NIHSS visual field score (r=- 28, p= 068) were bivariate predictors of TR-related FM gain In multivariable analysis, all except therapy hours survived as significant (P90 days post-stroke, behavioral gains from home-based TR were greatest in patients who were female and who had less spasticity and visual field defects These results might be useful for patient selection and for design of future TR-based therapeutic approaches