A home-based telerehabilitation randomized trial for stroke care: Effects on falls self-efficacy and satisfaction with care

We determined the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on falls-related self-efficacy and satisfaction with care in stroke patients. We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers. Individuals who experienced a stroke in the past 24 months were randomized to the STeleR intervention or usual care. In addition, participants in the intervention arm were administered an exit interview three months after their final outcome measure was administered that included more in-depth questions related to their satisfaction. This interview was performed via the telephone by the Coordinating Center. The STeleR intervention consisted of 3 home visits, 5 telephone calls, and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies. The outcome measures included Falls Efficacy Scale to measure fall-related self-efficacy and Reker et al.'s Stroke-Specific Patient Satisfaction with Care (SSPSC) scale, a measure separated into two subscales (satisfaction with home care and satisfaction with hospital care) was employed to measure the participants' satisfaction. At six months, compared with the usual care group, the STeleR group showed statistically significant improvements in one of the two SSPSC scales (satisfaction with hospital care, p = .029) and approached significance in the second SSPSC scale (satisfaction with home care, p = .077)). There were no improvements in fall-related self-efficacy. Core concepts identified were: (a) expansion of home-based instruction of exercises; and b) technology. The STeleR intervention improved satisfaction with care, especially as it relates to care following their experience from the hospital. With the limited resources available for in-home rehabilitation for stroke survivors, STeleR (and especially its exercise components) can be a useful complement to traditional poststroke rehabilitation.