Investigating the Telerehabilitation with Aims to Improve Lower Extremity Recovery Post-Stroke (TRAIL) Program: A Feasibility Study

Abstract Objectives The purpose of this study was to examine the feasibility of a progressive virtual exercise and self-management intervention, the TeleRehabilitation with Aims to Improve Lower extremity recovery post-stroke program (TRAIL), in individuals with stroke. Methods A single group pre-post study design was used. Thirty-two participants were recruited who were aged 19 years or older, had a stroke within 18 months of the beginning of the study, had hemiparesis of the lower extremity, and were able to tolerate 50 minutes of activity. Participants completed TRAIL, a synchronous exercise and self-management program delivered via videoconferencing. Participants received 8 telerehabilitation sessions over 4 weeks that were 60 to 90 minutes, with a trained physical therapist in a ≤ 2 to 1 participant-to-therapist ratio. Feasibility indicators in the areas of process (recruitment and retention rates, perceived satisfaction), resources (treatment fidelity and adherence, participant and assessor burden, therapist burden), management (equipment, processing time), and scientific indicators (safety, treatment response, treatment effect) were collected throughout the study using a priori criteria for success. The treatment effect was examined on the Timed “Up & Go” Test (TUG), the virtual Fugl-Meyer Lower Extremity Assessment (FM-Tele), the 30-Second Sit-to-Stand Test (30s S2S), the Functional Reach, the Tandem Stand, the Activities-specific Balance Confidence Scale, the Stroke Impact Scale, and the Goal Attainment Scale (GAS). Results Forty-seven individuals were screened, of which 32 (78% male; median age of 64.5 years) were included for the study from 5 sites across Canada. Nine feasibility indicators met our study-specific threshold criteria for success: retention rate (0 dropouts), perceived satisfaction, treatment fidelity, adherence, therapist burden, equipment, and safety. In terms of treatment response and effect, improvements were observed in TUG (Cohen d = 0.57); FM-Tele (d = 0.76); 30s S2S (d = 0.89); and GAS (d = 0.95). Conclusions The delivery of TRAIL, a lower extremity stroke rehabilitation program using video-conferencing technology, is feasible and appears to have positive influences on mobility, lower extremity impairment, strength, and goal attainment. Impact Community-based telerehabilitation programs, such as TRAIL, could extend the continuum of care during the transition back to community post-discharge, or during global disruptions, such as COVID-19. Delivery of synchronous lower extremity rehabilitation via videoconferencing to community-dwelling stroke survivors is feasible.