Implementation of Home-Based Telerehabilitation of Patients With Stroke in the United States: Protocol for a Realist Review

Abstract

Background Stroke is a common cause of mortality and morbidity. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a health care team's use of a communication mode (eg, videoconferencing) to remotely provide rehabilitation services. Telerehabilitation is as effective as facility-based rehabilitation; however, it is infrequently used due to implementation barriers. Objective The aim of the study is to explore the interaction between the implementation strategies, context, and outcomes of telerehabilitation of patients with stroke. Methods This review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. PubMed via MEDLINE, the PEDro database, and CINAHL will be queried till June 2023 and supplemented with citation tracking and a gray literature search. The relevance and rigor of papers will be appraised using the TAPUPAS (Transparency, Accuracy, Purposivity, Utility, Propriety, Accessibility, and Specificity) and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist Synthesis publication standards set by Wong and colleagues in 2013. Results The literature search and screening will be completed in July 2023. Data extraction and analysis will be completed in August 2023, and findings will be synthesized and reported in October 2023. Conclusions This will be the first realist synthesis, uncovering the causal mechanisms to explain how, why, and to what extent implementation strategies impact telerehabilitation adoption and implementation. International Registered Report Identifier (IRRID) PRR1-10.2196/47009

Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol

“…Another strength of our methodological approach relates to the opportunities it presents for collaborative working and co-production with a diverse group of stakeholders [65]. We envisage that high stakeholder engagement will increase the potential of our findings to be relevant and usable.…”

“…Developing programme theories at a higher level of abstraction is suggested to promote the applicability of findings to similar contexts and families of interventions; in this case, stroke TR services [48,64]. As part of the iterative literature searches, we may draw on findings from studies in related fields to address any gaps in the stroke-specific evidence base and assess the transferability of our finalised programmes' theories to different healthcare contexts (e.g., Hasan et al's study in the US context) [65].…”