Social factors related to home-based telerehabilitation after stroke

Objective: We designed a 12-week telerehabilitation (TR) program for stroke patients and evaluated which social factors might be important to achieve motor gains and improved mood Background: Telemedicine is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care Stroke patients require high doses of activity-based rehabilitation yet often face barriers in cost, compliance, and access Home-based TR may be useful for addressing these issues Social support influences stroke outcomes, and social networks can affect engagement in therapy programs Methods: Adult stroke patients (n=13) with arm motor deficits saw a licensed OT/PT who performed a live exam followed by supervised home-based TR (12 weeks, 6 days/ week, 1 hour/day) At the 6-week midpoint, each patient's social network was mapped, producing measures of network size, density and constraint With these measures, we tested the following hypotheses: first, social network measures are associated with the MOS-SSS, an established measure of social support Second, social network measures are positively related to (1) arm motor gains (change in score on the 66- point arm motor Fugl-Meyer scale (FM)), (2) walk time improvement (10m walk test), and (3) improved mood (change in Geriatric Depression Score (GDS)) Finally, we compared social networks of TR patients with a cohort of 176 stroke patients with social network data who did not receive any TR to identify structural differences in support Results: Over 12 weeks, median FM score significantly improved from a baseline of 46 [42-57] to 59 [52 5-61 5] (p=0 002) Social network size was related to social support (r=0 69, p=0 018) and improved mood (r=0 679, p=0 015) Network density was related to arm motor gains (r=0 75, p=0 003) Both size and density were related to walk time improvement (r=0 61, p=0 025;r=0 80, p=0 003, respectively) TR patient networks were larger (p=0 012) and less dense (p=0 046) than control networks Conclusions: High doses of home-based TR for 12 weeks is feasible and improves motor outcomes In this pilot study with limited sample size, social network size was validated against MOS-SSS Size was related to walk time and improved mood, and network density was related to arm motor and walk time gains in response to intensive TR Finally, TR patients had larger and more open social networks than stroke patients who did not receive TR Understanding how social networks intersect with TR outcomes is crucial as we transition towards virtual models of care