Tele-reha Versus Paper-based Aftercare Programme Following Inpatient Rehabilitation

Overview

The goal of this three-armed, observer-blinded, randomised controlled trial is to (i) to implement a telerehabilitation intervention in routine care after an inpatient rehabilitation stay for people insured with the Social Insurance Institution for the Self-Employed (SVS), (ii) to evaluate the impact of telerehabilitation on the consolidation of goals achieved during the inpatient stay in everyday life, and (iii) to evaluate whether independence in everyday life can be increased by implementing telerehabilitation at home compared to standard care. Our hypothesis is that the tele-reha intervention, including ongoing therapist support, will improve independence in daily living (defined as the primary outcome of this study), as measured by the Functional Assessment Measure (FAM), compared to a control group receiving a standard paper-based program.

All patients admitted to the NRZ receive a Baseline Assessment (T0). Rehabilitation aims are defined based on symptoms, functional limitations and participation restrictions, and routine care is provided accordingly. At discharge, patients undergo another assessment to determine if the rehabilitation aims have been reached (Post-inpatient Evaluation \[T1\]). Between T0 and T1, patients participating in this study will be randomly assigned to either a tele-reha group (Intervention Group) or a control group (Control Group 1) stratified for the likelihood of a positive rehabilitation outcome (determined by the multidisciplinary team), as well as age, and sex. Participation in the tele-reha group and the control group 1 is restricted to patients with SVS insurance. Additionally, a second control group (Control Group 2) will be recruited from patients without SVS insurance who only receive standard care. Control group 2 will be matched with the tele-reha group in terms of age group, sex and the likelihood of a positive rehabilitation outcome as estimated by the multidisciplinary team. The study concludes with a final assessment (Final Evaluation) after 36 days of therapy. SVS patients from control group 1 will be offered the opportunity to participate in an additional tele-care intervention after the study ends. "EvoCare" is the platform for implementing the tele-care intervention, with most of the therapeutic content, such as exercise and training videos, produced by the NRZ. In addition, therapeutic content with a focus on cognition is entered into EvoCare and made available. Interventions will be selected based on the patient's primary concern in therapy, with a maximum of two activity goals and a maximum of two treatment foci set. Patients assigned to one of the control groups will continue with the standard care procedure, consisting of a paper-based home-exercise programme provided by the NRZ after discharge from the rehabilitation centre. This intervention is a programme of exercises for the basic motor skills of mobility, sensitivity, strength, endurance, balance and coordination. The supervising therapists select the content during the inpatient treatment and relate it to the patient's structural and activity-related limitations. The patients are given this paper-based programme at the end of their stay and then perform the exercises independently at home without further support.