Background Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) - including cognitive/physical exercise applications, activity-tracking, psycho-education -... Show moreBackground Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) - including cognitive/physical exercise applications, activity-tracking, psycho-education - after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. Methods Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it's mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n = 165 patients) were extracted from the eRehabilitation applications. Results Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0-7.75] versus 7.0 [6.0-7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0-8.0] versus 5.5 [4.0-7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. Conclusion Main improvements of the implementation of eRehabilitation are related to professionals' perceptions of the intervention, integration of eRehabilitation and contextual factors.Implication for rehabilitation To increase the use of eRehabilitation by patients, patients should be supported by their healthcare professional in their first time use and during the rehabilitation process. To increase the use of eRehabilitation by healthcare professionals, healthcare professionals should be (1) supported by a clinical champion and (2) provided with sufficient time for learning to work and getting familiar with the eRehabilitation program. Integration of eRehabilitation in conventional stroke rehabilitation (optimal blended care) is an important challenge and a prerequisite for the implementation of eRehabilitation in the clinical setting. Show less
Stroke is a relatively common condition with a large impact on patients’ lives. Rehabilitation treatment aims to support patients in coping with the physical, mental, cognitive and social... Show moreStroke is a relatively common condition with a large impact on patients’ lives. Rehabilitation treatment aims to support patients in coping with the physical, mental, cognitive and social consequences of stroke. Recently, there is an increasing interest in the application of digital technologies (eRehabilitation) in healthcare in general, including in stroke rehabilitation. ERehabilitation may include physical and cognitive exercise programs, patient information and education, e-consultations, physical activity tracking and serious gaming, preferably all together in one digital environment.Although there is evidence on the effectiveness and feasibility of eRehabilitation, the uptake of eRehabilitation in specialized stroke rehabilitation facilities has been slow, warranting the need for implementation research. The aim of this thesis was to provide insight in the complex interplay between the effectiveness, the implementation strategy and the context of eRehabilitation after stroke, as delivered in a specialized rehabilitation facility, in order to improve future use of eRehabilitation in specialized stroke rehabilitation facilities. Show less
This thesis focused on the evaluation of an eHealth intervention for cognitive stroke rehabilitation and the perspectives of different stakeholders on the uptake of eRehabilitation in general. The... Show moreThis thesis focused on the evaluation of an eHealth intervention for cognitive stroke rehabilitation and the perspectives of different stakeholders on the uptake of eRehabilitation in general. The studies included in this thesis showed that there was no overall effect of an online brain training programme on cognitive functioning of patients with stroke. Only performances on cognitive function tests that were similar to the games included in the intervention improved, no near transfer effect was found. Moreover, usage of the training was suboptimal and not all of the patients were able to complete it. It would appear important to support stroke patients with CBCR training, since training is not well used by all patients. However, regarding patients’ ICT readiness, wishes and requirements it was also found that a relatively large amount of patients in rehabilitation wish to incorporate ICT in their rehabilitation treatment. In addition, developing tailored implementation strategies to implement eHealth in the bachelor curriculum of health professionals, based on the identified barriers and facilitators in this thesis is highly relevant to make sure that future health professionals are able to work with eHealth. Show less
Brouns, B.; Meesters, J.J.L.; Wentink, M.M.; Kloet, A.J. de; Arwert, H.J.; Vlieland, T.P.M.V.; ... ; Bodegom-Vos, L. van 2018
