Acceptance of Tele-Rehabilitation by Stroke Patients: Perceived Barriers and Facilitators.

OBJECTIVE: To explore the perceived barriers and facilitators of tele-rehabilitation (TR) by stroke patients, caregivers and rehabilitation therapists in an Asian setting. DESIGN: Qualitative study involving semi-structured in-depth interviews and focus group discussions. SETTING: General community. PARTICIPANTS: Participants (N=37) including stroke patients, their caregivers, and tele-therapists selected by purposive sampling. INTERVENTIONS: Singapore Tele-technology Aided Rehabilitation in Stroke trial. MAIN OUTCOME MEASURES: Perceived barriers and facilitators for TR uptake, as reported by patients, their caregivers, and tele-therapists. RESULTS: Thematic analysis was used to inductively identify the following themes: facilitators identified by patients were affordability and accessibility; by tele-therapists, was filling a service gap and common to both was unexpected benefits such as detection of uncontrolled hypertension. Barriers identified by patients were equipment setup-related difficulties and limited scope of exercises; barriers identified by tele-therapists were patient assessments, interface problems and limited scope of exercises; and common to both were connectivity barriers. Patient characteristics like age, stroke severity, caregiver support, and cultural influence modified patient perceptions and choice of rehabilitation. CONCLUSIONS: Patient attributes and context are significant determinants in adoption and compliance of stroke patients to technology driven interventions like TR. Policy recommendations from our work are inclusion of introductory videos in TR programs, provision of technical support to older patients, longer FaceTime sessions as re-enforcement for severely disabled stroke patients, and training of tele-therapists in assessment methods suitable for virtual platforms.