Feasibility of an at-home telerehabilitation programme for upper limb impairment post-stroke

Background: Access to stroke rehabilitation in low-resource South African areas is limited. Telerehabilitation (TR) offers a promising solution, particularly for upper limb recovery post-stroke. Aim: To assess the feasibility of a task-oriented TR home programme for mild to moderate upper limb impairment post-stroke in a South African context. Setting: Bishop Lavis, South Africa, a low-income area. Methods: A single-site parallel randomised feasibility study was conducted. Feasibility outcomes included: process, resource, management and scientific outcomes. Outcome measures included satisfaction survey, log sheets, Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Chedoke Arm and Hand Activity Inventory (CAHAI), Visual Analogue Scale (VAS) and BORG Rating of Perceived Exertion (RPE) scale. Participants completed an 8-week home programme (H-Graded Repetitive Arm Supplementary Program [GRASP]). The experimental group received weekly TR, while the control group received face-to-face care. Results: A total of 12 participants were recruited, with 10 completing the programme. The experimental group reported 96.9% perceived benefit, 60.0% exercise and task adherence and had 41 telephonic sessions in total. The control group reported 76.9% perceived benefit, no exercise adherence, 20.0% task adherence and attended 13 face-to-face sessions in total (67.5% non-attendance). Post-intervention, FMA-UE improved significantly (control: p = 0.0003; experimental: p = 0.0013) with a mean difference of 6.0 (95% confidence interval [CI]: -6.2 to 18.2). The CAHAI showed borderline significance (control: p = 0.0556; experimental: p = 0.0601) with a mean difference of -1.0 (95% CI: -3.2 to 1.2). Conclusion: The feasibility study achieved success in retention rates, safety and perceived benefit for the experimental group, with treatment equivalence in the CAHAI scores. Recruitment rate and exercise and task adherence were below criteria. Perceived benefit in the control group fell short. Treatment equivalence for FMA-UE scores exceeded the set margin. Contribution: Persons with upper limb impairments post-stroke in low-resource contexts may benefit from a repetitive task-oriented TR home programme.