Phone a Physio: Telerehabilitation for Stroke Survivors

There have been a lot of challenges throughout the COVID-19 pandemic over the last 18 months: social isolation, burden on healthcare systems, loss of jobs and time lost with your family. However, a positive is that the use of technology for your health is becoming easier and more widely used than ever before.

I bet a few you didn’t even know what a video call was in November 2019 – but now every man and his dog knows how to get online for a “FaceTime” or a “Zoom”. This has opened the floodgates for telerehabilitation in physiotherapy – but is this method of service delivery effective for stroke survivors?

What is Telerehabilitation?

Telerehabilitation is defined as the “delivery of rehabilitation services via information and communication technologies”. (1) Think over the phone, Zoom, FaceTime, Teams, Skype or WhatsApp just to name a few. Many people have adopted video calling technology recently to stay connected, and physiotherapy is no different. Although a relatively new/alternate therapy choice only a year ago – the Australian Physiotherapy Association (APA) and Australian universities have been actively upskilling the profession to provide physio services “online” into people’s homes.

Is telerehabilitation physiotherapy effective for stroke survivors?

In a word – yes! There is a growing body of evidence that shows that telerehabilitation can have at least the same effectiveness as in person physiotherapy for some stroke survivors. (2,3,4) Telerehabilitation has been shown to be:

• Feasible and safe
• Cost effective
• A driver for positive behaviour change
• Secure for your privacy (using increased privacy settings or specialised telerehabilitation software)

The Stroke Foundation is currently reviewing the evidence base to update the telerehabilitation Clinical Practice Guidelines on Inform Me. (5)

Why does telerehabilitation physiotherapy work?

• You can translate skills directly into your own home
• You can foster a positive attitude towards exercise at home, which can be a powerful motivator for creating good habits. This can lead to many long term health benefits
• It’s cost effective: no travel time transport and minimal technology needed
• You get to do your physiotherapy in a place you feel comfortable and safe

What resources are out there to help me with telerehabilitation?

The Stroke Foundation has created an excellent collection of resources through the Inform Me platform related specifically to telerehabilitation. These include: exercises to increase your physical activity, ‘how to’ guides for safe exercise set-up, self-management/motivation tools and information packages about the logistics of telerehabilitation. These resources are designed for health professionals, so discuss whatever you find with your healthcare team. Follow the link below to review these resources:

https://informme.org.au/News/2020/03/26/COVID-19-Telehealth-resources

If you want something designed for consumers, follow the link below to the “Safe Exercises at Home” website; made by physiotherapists from around the world with resources for completing exercise at home:

https://www.safeexerciseathome.org.au/

My top tips for telerehabilitation

• Try and start with a face-to-face appointment first: Most telerehabilitation programs start with a face-to-face physio appointment so that your therapist can most easily set-up your program. But if this is not possible – it is not a deal breaker!
• Planning is key: make sure you are set up in a plain background environment, good sound quality and a big enough screen on your device so you can see what your therapist is trying to demonstrate.
• Do a practice call: There’s nothing worse than wasting your time and money so have a practice call with a friend or family member using the video platform before your first tele-appointment if possible to troubleshoot issues.
• Have someone with you for the first appointment: maybe a family member, friend or carer who can supervise your exercises/assessments, help with environment set-up or provide technology support if needed.
• Your environment is your friend: use things in your home to set-up safe, but challenging enough exercises. Corners of rooms, kitchen benches, chairs, ironing boards, taped together books, pillows, etc. can all be used to create effective exercises whilst maintaining safety.
• Be persistent: in my experience it is very common to have some logistical issues during the first few telerehabilitation appointments – your internet cuts out, sound doesn’t work, you can’t quite get the environment set up correctly but PERSIST! We rehabilitation physio’s are pretty crafty and can come up with creative solutions to keep you moving, improving and working towards your goals at home.

Denis Giguere

Physiotherapy Clinical Educator

Neurological, Ageing and Balance Clinic – University of Queensland

Australian Physiotherapy Association Member

1. American Telemedicine Association, A Blueprint for Telerehabilitation Guidelines, http://www.americantelemed.org/docs/default-source/standards/a-blueprint-for-telerehabilitation-guidelines.pdf?sfvrsn=4, 2010.
2. Chen J., Jin W., Zhang X.X., et al. Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis, 24 (2015), pp. 2660-2668: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.014
3. Sarfo F.S., Ulasavets, U., Opare-Sem O.K and Ovbiagele B. Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. J Stroke Cerebrovasc Dis, 27(2018), pp. 2306 – 2318: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.013
4. Ramage E., et al. Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke—A Scoping Review. Physical Therapy (2021), pzab073:https://doi.org/10.1093/ptj/pzab073
5. Stroke Foundation, Clinical Guidelines for Stroke Management, N.S. Foundation, Editor. 2017.