title: Web-based physiotherapy for people undergoing stroke rehabilitation
Creators: name: Alhusayni, Abdullah Ibrahim
Publisher: name: University of Glasgow
Year: 2021

description: In the UK, disability is a common consequence of stroke. The improvement of post-stroke arm function is one of the top 10 priority research areas for stroke survivors, carers and healthcare professionals. However, current clinical practice in most of the stroke units within the UK does not meet the recommended dose for rehabilitating stroke patients in the acute stage when functional recovery is at its peak. A higher dose of rehabilitation can result in enhanced functional recovery. Therefore, developing interventions to augment current clinical practice in order to increase the dose of rehabilitation without supervision is becoming a necessity, given the anticipated rise in stroke incidence coupled with the reduction in the number of available physiotherapists worldwide. Telerehabilitation has the potential to provide the stroke population with access to rehabilitation without direct supervision, but stroke-related complications, such as aphasia, may hinder their ability to access these services. This thesis aims to do the following: 1) To evaluate whether an existing web-based physiotherapy platform (www.webbasedphysio.com, now www.giraffehealth.com) can be adapted through a user-centred design to be an acceptable medium to deliver exercise programmes for people after a stroke and 2) To evaluate the acceptability and feasibility, and to explore the possible effectiveness, of an individualised 4-week programme of augmented upper-limb rehabilitation, delivered via the modified webbased physiotherapy platform, for the stroke population in acute stroke rehabilitation. The first study adopted a user-centred design, which involved modifying an existing webbased physiotherapy platform by gathering views of seven participants, five stroke survivors and two carers, with the aim of customising the platform to be accessible and appropriate for the stroke population. Three consecutive focus groups were conducted for the same participants and data were analysed based on themes. Four themes were identified, which allowed an understanding of participants’ needs and preferences in using technology as a medium to deliver rehabilitation and highlighted the required platform modifications using iterative consultation. The data captured different experiences toward disability after stroke from public, clinical staff and stroke survivors. The rehabilitation that stroke survivors received prioritised leg mobility exercises, and family members and carers lacked the needed support. The variation of the kind of rehabilitation provided and the influence of geographical areas were reported as the main barriers to access rehabilitation therefore, stroke survivors reported paying for private physiotherapy and practicing non-prescribed exercises including online resources. The key recommendations included modifications to the web-based physiotherapy platform to improve accessibility (format, information, advice) and modelling/image (stroke survivor actors filming exercise video recordings) in order to meet their rehabilitation needs. The study concluded with accessible and positively evaluated platform. The second study was a randomised controlled pilot study to evaluate the feasibility (in terms of recruitment strategy, usage and adherence to the intervention and participants’ attrition and safety), acceptability and potential efficacy of delivering a 4-week individualised webbased upper-limb exercise programme using the modified web-based platform compared to usual care in terms of arm function, trunk function and muscle spasticity for stroke survivors in the acute hospital setting. In addition, questionnaires were used to evaluate the feedback of physiotherapists who prescribed and monitored the web-based augmented intervention and to capture views of carers of stroke survivors in the intervention group. Twenty-six stroke survivors were recruited to the study from three acute stroke units and were randomly allocated and equally divided (n=13) into two groups: an intervention group and a control group. Seven participants used the platform and accessed their exercise programmes. Of those, five were adherent to the intervention during the study; these five adherent participants represented half of the patients in the intervention group. Five participants withdrew from the study before the final assessments, of whom three were participants in the intervention group and two were participants in the control group. Although five adverse events were reported during the study, none of these was considered to be related to the intervention. More participants in the intervention group demonstrated clinically important improvements in the Action Research Arm Test (arm function) than in the control group. In addition, among the participants in the intervention group, those who were adherent showed trends towards improvements in the Trunk Impairment Scale (trunk function). In total, seven stroke survivors, five carers and five physiotherapists reported that the delivery of a nonsupervised, augmented intervention through the modified web-based physiotherapy platform was acceptable. Among the participants who used the platform, web-based physiotherapy was considered more beneficial to stroke survivors who have carers helping them to access their online exercise programmes. To summarise, this thesis indicates that web-based physiotherapy is feasible, safe and acceptable for stroke survivors, carers and physiotherapists; furthermore, it is capable of providing unsupervised augmented interventions. More studies that are adequately powered are needed to examine effectiveness of this intervention and provide further insight to the current findings.