STROKE REHAB IN INDIA
What? Two previous large clinical trials (ATTEND, RECOVER) did not find task-shifting completely to a family caregiver and nurse to be superior to conventional therapy. Appropriate therapy intensity and duration were not delivered due to lack of continued professional supervision after discharge. Tele-stroke rehabilitation was widely adopted during and after the COVID-19 pandemic for motor, sensory, cognitive, pulmonary and functional rehabilitation, to avoid person-to-person contact and spread of the pandemic (DBC et al 2021, Surya N et al 2021). This mode of rehabilitation has developed into an effective service delivery system, in rehabilitating gait and mobility impairments and upper limb deficits post-stroke and has also proven to be suitable among geriatric population (Ciortea et al 2020, English C et al 2022). Cramer S et al (2019) reported non-inferior improvements in arm deficits among stroke patients with synchronous telerehab through an adequately powered trial. So we combine the advantages of home-based rehabilitation and intense-supervised rehabilitation into a structured tele-stroke rehabilitation program customized for patients with upper limb & mobility deficits after stroke. Why? The current apps providing tele-stroke rehab in India are limited and do not have the features required to make them effective in improve stroke related deficits. For example the Careforstroke app (Suresh et al, 2015) proved to be a feasible and acceptable mode of rehabilitation delivery in South India, although this app does not deliver a customized rehabilitation program to each patient. Similarly the Strokehelp app (Menon B et al) which is a commercial and widely used app, does not deliver tailor-made rehabilitation plans and does not have the feature of rehabilitation-progression with changing needs and changing physical status of patients over time. A small sample study in Southern India established the need and effectiveness of use of a set of adherence strategies to improve patient adherence to home-based rehab (Mahmood A et al, BMJ Open 2021). A handful of small feasibility studies on the use of telehealth in India show potential (Mahmood A 2021, Garg D 2020), however there have been no adequately powered randomized controlled trials (RCTs) to test effectiveness or an implementation study. The ATTEND-2 app is designed to be socio-culturally specific, allows for continued monitoring via provision of exercise logs with a reward system and allows the supervising Physiotherapist to modify treatment regimes remotely as per patient need and changing sensorimotor status after discharge. Potential impact? 1) Longer periods of supervised rehabilitation post discharge 2) Improved patient follow-ups 3) Socio-culturally relevant exercise regimens that include locally specific ADL training 4) Inclusion of clinical decision making tool-kit for clinicians and package of adherence strategies for patients to help improve use of the app and adherence to rehab regime respectively 5) Building capacity among stroke rehab professionals Where we are? We have developed a complete design of the app with centralised web-console through which the health professional can access the exercise library and recruited patient details. This is a preliminary design awaiting funding for development and use in Phases 1 & 2 of the trial. Where we need to be The development of the app will the first step towards this trial. Through this trial that fulfills digital Health Recommendations put forth by the Indian government, World Heart Federation and World Health Organization Let's Get Proof Project Link https://www.letsgetproof.com/project/app-based-tele-stroke-rehabilitation-in-india-16-2
- Raised
- $0
- Goal
- $126,200