START—the Swiss tele-assisted rehabilitation and training program to support transition from inpatient to outpatient care in the subacute phase after a stroke: results of the feasibility, safety and performance evaluation

Introduction Intensive rehabilitation is crucial for functional recovery after stroke, particularly during the subacute phase. However, therapy intensity often substantially declines after discharge from inpatient rehabilitation. This study evaluated the feasibility, safety, and performance of the Swiss tele-assisted rehabilitation and training program (START) facilitating transition from inpatient to outpatient stroke rehabilitation. Methods This single-center observational feasibility study enrolled 40 patients. START was introduced during the last two weeks of inpatient rehabilitation and continued for 12 weeks after discharge. START included daily exercise, coaching, monitoring and blood pressure measurements. Feasibility was assessed using predefined process-, training-, and mHealth-related criteria including recruitment, safety, acceptance, adherence, dropout, system stability, usability, quality, satisfaction, and perceived change. Secondary outcomes included disability, functional status, quality of life, life-space mobility, physical performance and activity level. Results Of the 94 informed patients, 40 were enrolled (recruitment rate 42.6%); 29 patients (59.7 ± 13.7 years, 11/29 females) completed the study. Dropout rate was 27.5%, exceeding the predefined threshold (≤20%). No serious protocol-related adverse events occurred. Training adherence was 65.1 ± 31.4% during inpatient and 66.7 ± 29.9% during outpatient rehabilitation. Adherence to blood pressure measurements was 79.0 ± 27.6% and 83.6 ± 20.3%, respectively. System stability was high (0.7 failures/week). Usability was rated high (System Usability Scale: 88.3 ± 10.7/100; German mHealth Application Usability Questionnaire: 5.3 ± 1.1/7), and application quality was rated 4.1 ± 0.5/5 on the App Quality Assessment Tool for Health-Related Apps. Patient satisfaction was high (median 8/10), and patients reported positive changes. Functional outcomes changed, including examiner-rated modified Rankin Scale (median 2 to 1), Timed Up and Go (13.7 ± 14.3 to 10.3 ± 8.9), Short Physical Performance Battery (median 10 to 11), Trunk Impairment Scale (median 17 to 20), life-space mobility (55.9 ± 33.4 to 80.1 ± 27.3), and moderate-to-vigorous physical activity (58.1 ± 41.5 to 83.0 ± 46.4 min/day). Discussion and conclusion START was well accepted, technically stable, and appeared feasible with an acceptable safety profile for supporting transition from inpatient to outpatient stroke rehabilitation. However, dropout and training adherence require optimization. These findings warrant further evaluation of START compared with conventional care in a randomized controlled trial.