Telerehabilitation Following Stroke: Development of Training Content and Evaluation of an App-Based Training Program

Background: Enhancing rehabilitation methods for patients with stroke is essential, particularly during the transition from inpatient to outpatient care. Digital applications are being developed to provide telerehabilitation programs. The existing virtual blended care platform Blended Clinic (Blended Clinic AI GmbH) offers app-based training for patients after a stroke and comprises 3 main components, including training, coaching, and monitoring. Objective: This study assesses the usability and user experience of the novel Swiss Tele-Assisted Rehabilitation and Training (START) program within the Blended Clinic platform in patients after stroke and therapists. Methods: The START program was developed within 3 workshops and an online survey. It contains 10 6-week exercise programs tailored to the levels of the modified Rankin Scale (mRS), 5 infographics, and 5 podcasts. Eight patients after stroke and 10 therapists took part in a single-center usability study. All participants were introduced to the Blended Clinic app and subsequently used it independently. The Blended Clinic platform, including the START program, was evaluated by both user groups based on the System Usability Scale (SUS) and the Mobile App Rating Scale (MARS-G). Additionally, feedback was collected, observations were documented, and program adherence metrics were calculated. Results: The mean SUS scores were 87.2 (SD 10.8) for 8 patients and 83.3 (SD 11.3) for 10 therapists. The MARS-G scores were 3.9 (SD 0.5) for patients and 4.1 (SD 0.4) for therapists for categories A-D. User experience was rated 4.1 (SD 0.5) for patients, while device usability was 3.8 (SD 0.8) for patients and 4.2 (SD 0.5) for therapists. Adherence to the training schedule varied among patients (16.7%-80% of the planned sessions) and was rather low for many of the patients. Conclusions: The START program, delivered via the Blended Clinic platform, was considered user-friendly and received good usability ratings from patients with stroke and therapists. Recommendations to enhance compliance are provided.