Impact of Telerehabilitation on Functional Outcomes in Rural Neurological Patients: A Hospital-Based Observational Study.

DR. Sanhai Singh; Singh; Sharma; Ahmad; Kanaujia

doi:10.51168/r94b5e29

Autori

DR. Sanhai Singh Assistant Professor, Department of Physical Medicine and Rehabilitation, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India.
Singh Assistant Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India
Sharma Assistant Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India
Ahmad Assistant Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India
Kanaujia Associate Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India

DOI:

https://doi.org/10.51168/r94b5e29

Cuvinte cheie:

Telerehabilitation, neurological rehabilitation, Functional Independence Measure, Barthel Index, rural health, observational study

Rezumat

Background

Neurological disorders cause long-term disability, while access to rehabilitation remains limited in rural areas. This study evaluated telerehabilitation outcomes among rural neurological patients.

Methods

A hospital-based observational study was conducted in the Department of Physical Medicine and Rehabilitation, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, over one year. A total of 110 adult patients with neurological disorders receiving telerehabilitation were included. Functional improvement was assessed using the Functional Independence Measure (FIM), Barthel Index (BI), and Modified Rankin Scale (mRS) at baseline and after 12 weeks. Data were analyzed using IBM SPSS Statistics version 26.0.

Results

Among 110 patients, the mean age was 58.6 ± 13.7 years, and males constituted 61.8% of the study population. Stroke was the most common neurological diagnosis (54.5%), followed by Parkinson's disease (18.2%), spinal cord injury (12.7%), traumatic brain injury (9.1%), and multiple sclerosis (5.5%). Significant improvements were observed after 12 weeks of telerehabilitation. Mean Functional Independence Measure increased from 79.8 ± 13.4 to 96.5 ± 12.2 (p<0.001), while Barthel Index improved from 58.6 ± 15.8 to 78.9 ± 14.1 (p<0.001). Modified Rankin Scale scores demonstrated significant functional recovery. Treatment adherence exceeded 90%, and 88.2% of participants reported high satisfaction with telerehabilitation services.

Conclusion

Telerehabilitation was associated with improved functional outcomes, treatment adherence, and patient satisfaction among rural neurological patients.

Recommendation

Structured telerehabilitation may be considered to improve access to rehabilitation services in rural settings. Further multicenter studies with larger samples and longer follow-up are recommended.

Biografii autori

DR. Sanhai Singh, Assistant Professor, Department of Physical Medicine and Rehabilitation, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India.

is an Assistant Professor in the Department of Physical Medicine and Rehabilitation at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. His clinical and academic interests include neurological rehabilitation and telerehabilitation.
Singh, Assistant Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India

is an Assistant Professor in the Department of Physical Medicine and Rehabilitation at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. His clinical and academic interests include rehabilitation medicine and neurological rehabilitation.
Sharma, Assistant Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India

is an Assistant Professor in the Department of Physical Medicine and Rehabilitation at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. His clinical and academic interests include neurological rehabilitation and functional recovery.
Ahmad, Assistant Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India

is an Assistant Professor in the Department of Physical Medicine and Rehabilitation at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. His clinical and academic interests include physical medicine, rehabilitation, and neurological disorders.
Kanaujia, Associate Professor, Department Of Physical Medicine And Rehabilitation, Uttar Pradesh University Of Medical Sciences, Saifai, Etawah, India

is an Associate Professor in the Department of Physical Medicine and Rehabilitation at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. His academic and clinical interests include rehabilitation medicine and neurological rehabilitation.

Referințe

1. Feigin VL, Vos T, Nichols E, Owolabi MO, Carroll WM, Dichgans M, et al. The global burden of neurological disorders: translating evidence into policy. Lancet Neurol. 2020;19(3):255-65. https://doi.org/10.1016/S1474-4422(19)30411-9

2. GBD 2021 Nervous System Disorders Collaborators. Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol. 2024;23(4):344-81.

3. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery. Stroke. 2016;47(6):e98-e169. https://doi.org/10.1161/STR.0000000000000098

4. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693-702. https://doi.org/10.1016/S0140-6736(11)60325-5

5. Cifu DX, Stewart DG. Factors affecting functional outcome after stroke: a critical review of rehabilitation interventions. Arch Phys Med Rehabil. 1999;80(5 Suppl 1):S35-S39. https://doi.org/10.1016/S0003-9993(99)90101-6

6. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low- and middle-income countries. Int J Environ Res Public Health. 2018;15(10):2165. https://doi.org/10.3390/ijerph15102165

7. Gupta N, Castillo-Laborde C, Landry MD. Health-related rehabilitation services: assessing the global supply of and need for human resources. BMC Health Serv Res. 2011;11:276. https://doi.org/10.1186/1472-6963-11-276

8. World Health Organization. WHO guideline: recommendations on digital interventions for health system strengthening. Geneva: World Health Organization; 2019.

9. Keesara S, Jonas A, Schulman K. COVID-19 and health care's digital revolution. N Engl J Med. 2020;382(23):e82. https://doi.org/10.1056/NEJMp2005835

10. Cramer SC, Dodakian L, Le V, See J, Augsburger R, McKenzie A, et al. Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after stroke: a randomized clinical trial. JAMA Neurol. 2019;76(9):1079-87. https://doi.org/10.1001/jamaneurol.2019.1604

11. Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020;1:CD010255. https://doi.org/10.1002/14651858.CD010255.pub3

12. Chen J, Jin W, Zhang XX, Xu W, Liu XN, Ren CC. Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015;24(12):2660-68. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.014

13. Ellis TD, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE. Which measures of physical function and motor impairment best predict quality of life in Parkinson disease? Parkinsonism Relat Disord. 2011;17(9):693-97. https://doi.org/10.1016/j.parkreldis.2011.07.004

14. Gandolfi M, Geroin C, Dimitrova E, Boldrini P, Waldner A, Bonadiman S, et al. Virtual reality telerehabilitation for postural instability in Parkinson disease: a multicenter randomized controlled trial. Biomed Res Int. 2017;2017:7962826. https://doi.org/10.1155/2017/7962826

15. Dorsey ER, Okun MS, Bloem BR. Care, convenience, comfort, confidentiality, and contagion: the 5 C's that will shape the future of telemedicine. J Parkinsons Dis. 2020;10(S1):S35-S41. https://doi.org/10.3233/JPD-202109

16. Brennan DM, Mawson S, Brownsell S. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation, and self-management. Stud Health Technol Inform. 2009;145:231-48.

17. Rogante M, Grigioni M, Cordella D, Giacomozzi C. Ten years of telerehabilitation: a literature overview of technologies and clinical applications. NeuroRehabilitation. 2010;27(4):287-304. https://doi.org/10.3233/NRE-2010-0612

18. Ministry of Health and Family Welfare, Government of India. Telemedicine Practice Guidelines. New Delhi: MoHFW; 2020.

19. National Health Authority. Ayushman Bharat Digital Mission: Strategy Overview. New Delhi: Government of India; 2022.

20. World Health Organization. Rehabilitation 2030: A Call for Action. Geneva: World Health Organization; 2017.

21. Cella A, Squeri V, Toscano A, Gandolfi M, Morone G. What is the role of telerehabilitation in patients with neurological disorders? A systematic review and meta-analysis. Healthcare (Basel). 2021;9(9):1131.

22. Prvu Bettger J, Thoumi A, Marquevich V, De Groote W, Rizzo Battistella L, Imamura M, et al. COVID-19: maintaining essential rehabilitation services across the care continuum. BMJ Glob Health. 2020;5(5):e002670. https://doi.org/10.1136/bmjgh-2020-002670

23. Sivan M, Gallagher J, Holt R, Weightman A, Levesley M, Bhakta B. Developing a model for telerehabilitation in neurological practice. J Telemed Telecare. 2014;20(6):307-16.

24. Lloréns R, Noé E, Colomer C, Alcañiz M. Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke. J Neuroeng Rehabil. 2015;12:35.

25. Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, et al. Outpatient physical, occupational, and speech therapy synchronous telemedicine: a survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. Am J Phys Med Rehabil. 2020;99(11):977-81. https://doi.org/10.1097/PHM.0000000000001571

26. Howard IM, Kaufman MS. Telehealth applications for outpatient rehabilitation of people with stroke. Top Stroke Rehabil. 2018;25(5):381-89.

27. Bakas T, Clark PC, Kelly-Hayes M, King RB, Lutz BJ, Miller EL. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke. 2014;45(9):2836-52. https://doi.org/10.1161/STR.0000000000000033

28. Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable task force. Int J Stroke. 2017;12(5):444-50. https://doi.org/10.1177/1747493017711816

29. World Health Organization. Global report on health equity for persons with disabilities. Geneva: World Health Organization; 2022.