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Stroke is the third largest cause of death and a major factor in permanent disability. Disparities in access to healthcare services exist due to geographical barriers and limited resources. Rural locations often lack the resources for adequate acute stroke care. Telestroke is intended to enable the transfer of knowledge of acute stroke management t...
Context in source publication
Context 1
... length of interventions varied from 4 -6 weeks with an one-hour session five days per week. 3,13 -15 Outcome categories measured A broad range of outcome measures was used in the telerehabilitation studies (Table 2). A short description of the instruments is given in Table 3. Different scales for measuring quality of life, health status and depression were used. ...
Citations
... Governments should construct adequate telecommunications networks and provide technical and financial assistance for remote acute stroke therapy. Essentially, improving stroke therapy in distant areas necessitates empowering healthcare staff at the forefront, using telemedicine, and implementing systemic policy changes (12). ...
Stroke care in low- and middle-income countries (LMICs) is suboptimal due to limited access to services. Tele-stroke services can improve access to care, but implementation barriers exist, such as physician inertia and inadequate infrastructure. Governments in LMICs should prioritise the development of tele-stroke services to enhance stroke care and improve patient outcomes, thereby reducing healthcare costs. Reliable telecommunication networks and training for healthcare providers are necessary for successful implementation. Tele-stroke services have the potential to bridge the gap in stroke care between LMICs and high-income countries (HICs) by providing better access to services.
... As IVT and MT should be performed as soon as possible, the question is raised if acute stroke patients benefit from direct admission to a comprehensive center or a primary admission to the nearest hospital with the capability to administer IVT and a secondary transport to a center with MT expertise [11][12][13]. In recent years, telemedical stroke networks have emerged offering rural hospitals instant consultation by stroke experts, enabling swift administration of IVT on-site and transportation for MT ("drip-and-ship") [14,15]. Outcomes in drip-and-ship cases have been reported to be sometimes equal [13,15,16] and sometimes worse than in direct-to-center patients [17,18], however not all studies contain stroke care within a standardized telemedical network. ...
Background
Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking.
Methods
We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared.
Results
Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients.
Conclusion
We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.
... Telestroke services improve the rates of reperfusion treatment and functional patient outcomes without increasing the rates of treatment-induced hemorrhage, although it has been noted that evidence for impacts on resource use and cost-effectiveness is limited [50,51]. As a result, patients treated through telestroke networks achieve outcomes that are similar to those managed at comprehensive stroke centers [10,12,13]. ...
Background
Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context.
Objective
We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact.
Methods
The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training.
Results
TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site).
Conclusions
TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.
... 9,10 Despite these barriers, the benefits from a patient perspective are wellestablished. [11][12][13] As with any resource-heavy tool, telestroke utilization should be wielded wisely. Likewise, once the investment is made, optimization must remain a top priority. ...
Introduction: Telestroke is an effective strategy to increase appropriate stroke treatments among patients in resource-limited environments. Despite the well-documented benefits of telestroke, there is limited literature regarding its utilization. The purposes of this study are: (1) determine the percentage of potential stroke patients who generate a telestroke consult in rural critical access hospitals (CAHs) and (2) validate an electronic medical record (EMR)-derived report as a stroke screen. Methods: This retrospective chart review analyzed patients presenting between September 1, 2020 and February 1, 2021 to three CAHs. Visits with triage complaints suggesting acute ischemic stroke (AIS)/transient ischemic attack (TIA) were pooled for analysis using an EMR-derived report. Patients with confirmed AIS/TIA at discharge over this period were used to validate the EMR tool. Results: The EMR report pooled 252 possible AIS/TIA visits out of 12,685 emergency department visits for analysis. It had a specificity of 98.78% and sensitivity of 58.06%. Of the 252 visits, 12.7% met telestroke criteria and 38.89% received telestroke evaluation. Among these, a definite diagnosis of AIS/TIA was made in 92.86%. Of the remaining population who met criteria but didn't undergo consultation, 61.11% were diagnosed with AIS/TIA at discharge. Conclusion: This study provides novel characterization of stroke presentations and telestroke in rural CAHs. The EMR-derived report is a reasonable tool to concentrate potential AIS/TIA cases for review and resource allocation but is not sensitive enough to detect stroke as a stand-alone tool. The majority (56%) of eligible patients did not undergo telestroke consultation. Future studies are critical to further understand reasons contributing to this.
... Manajemen komprehensif stroke harus dilakukan secara terpadu dan holistik sejak fase akut (Lip dkk., 2022), dengan prinsip tatalaksana perawatan stroke dengan sumber daya manusia yang handal (Rodgers dkk., 2021). Pada era pandemi COVID-19, tatalaksana stroke (terutama stroke akut) harus menggunakan protected code stroke (Johansson and Wild, 2010;Norrving dkk., 2018). ...
Gangguan hemoreologi berupa peningkatan kadar D-dimer dan penurunan nilai INR pada pasien stroke dengan Corona Virus Disease (COVID-19) merupakan faktor potensial penyebab perubahan sirkulasi serebral, sehingga dibutuhkan strategi baru dalam manajemen stroke fase akut dan pasca stroke. Penelitian ini bertujuan untuk mengetahui faktor risiko, gangguan hemoreologi, dan outcome pada pasien stroke iskemik pasca pandemi COVID-19 dengan metodelogi cross sectional study. Penelitian dilakukan pada tahun 2022 di RSUD dr. Zainoel Abidin Banda Aceh terhadap penderita stroke iskemik yang dibuktikan dengan pemeriksaan CT scan kepala, usia 45−75 tahun, dengan seluruh pasien dilakukan pemeriksaan hemoreologi darah. Dijumpai 90 pasien stroke iskemik, terdiri dari 52 laki-laki dan 38 perempuan, dengan faktor risiko hipertensi 79%, diabetes melitus 39%, penyakit jantung 9%, dan riwayat stroke 16%. Hasil pemeriksaan D-dimer adalah 1124.7+1293.0, dan INR 1.1+0.2, dengan analisis one way ANOVA tidak menunjukkan perbedaan bermakna berdasarkan outcome fungsional stroke (p>0.05). Berdasarkan uji korelasi hanya D-dimer yang menunjukkan hubungan bermakna dengan outcome stroke iskemik (koefisien korelasi -0.220, p=0.037), di mana makin tinggi kadar D-Dimer maka makin jelek outcome stroke iskemik, demikian juga sebaliknya.
... 39 Based on American Heart Association guidelines, telestroke has been proven as a valid tool for acute stroke assessment and it is being successfully utilized in stroke clinic and emergency room settings for many years in the developed countries. 40,41 By the virtue of teleneurology/telestroke services, there is a better chance of patients living in the medically underserved areas to receive the timely and consistent care as it provides the ease of access to neurological care, which in turn is helpful to overcome the physician shortage and improve the continuity of care by reducing unnecessary transfers and testing by non-trained neurologist/ vascular neurologist. 42 Covid-19 crisis has significantly highlighted the importance of telemedicine and there is significant advancement in the usage of telemedicine services during the past two-years. ...
Background and objective:Ischemic stroke still poses a significant health concern throughout the world. However, low and middle-incomecountries (LMIC) in Asia have more devastating outcome. The vascular risk factors are prevalent in most parts of Asia, contributing to increasing incidence. The recommended approved treatment for acute stroke is limited to a few areas in these countries. We aimed to identify stroke risk factors, its incidence and prevalence; treatment opportunities offered in various parts of the region and utilizing the alternate pathways to improve the disease recognition and management outcome.Method:A comprehensive search using PubMed, MEDLINE, Medline Plus, PubMed Central and Pak Medinet, including the various key words was performed.Results:Two-hundred-fifty-five articles of potential interest were found through the initial search. The studies were analyzed in detail in order to obtain relevant information according to the objectives of the review. Most of the literature was regarding the stroke risk factors. Only few articles regarding the current status of stroke services and management options in LMIC were available.Conclusion:Some of the factors identified in previous studies preventing the utilization of recent advancement in the diagnosis and management of stroke in LMIC, including Pakistan, were lack of awareness of stroke symptoms among general population and physicians, poor knowledge of management options, unavailability of trained stroke neurologists, poor infrastructure, cost effectiveness and patients’ trust more on homeopathic physicians, quacks and spiritual healers instead of medical doctors. Stroke is still managed conservatively in most part of these countries. There is strong need of alternate means to overcome these shortcomings in managing this highly morbid condition. As only few studies specifying the prevalence and management outcome in LMIC including Pakistan are available, a strong database is needed to quantify the real burden.
... 'Telestroke' has been defined as 'the process by which electronic, visual and audio communications (including the telephone) are used to provide diagnostic and consultation support to practitioners at distant sites, assist in or directly deliver medical care to patients at distant sites, and enhance the skills and knowledge of distant medical care providers'. 38 By comparison, MSUs are highly equipped ambulances, which usually incorporate a 'CT scanner, point-of-care laboratory and a device for teleconsultation with the hospital neuroradiologist', 39 along with highly trained staff. MSUs therefore represent a high-tech (and often high-cost) solution, one deemed particularly useful where access to hyper-acute services is limited. ...
Background
In response to COVID-19, alongside other service changes, North Central London and East Kent implemented prehospital video triage: this involved stroke and ambulance clinicians communicating over FaceTime (Apple Inc., Cupertino, CA, USA) to assess suspected stroke patients while still on scene.
Objective
To evaluate the implementation, experience and impact of prehospital video triage in North Central London and East Kent.
Design
A rapid mixed-methods service evaluation (July 2020 to September 2021) using the following methods. (1) Evidence reviews: scoping review (15 reviews included) and rapid systematic review (47 papers included) on prehospital video triage for stroke, covering usability (audio-visual and signal quality); acceptability (whether or not clinicians want to use it); impact (on outcomes, safety, experience and cost-effectiveness); and factors influencing implementation. (2) Clinician views of prehospital video triage in North Central London and East Kent, covering usability, acceptability, patient safety and implementation: qualitative analysis of interviews with ambulance and stroke clinicians ( n = 27), observations ( n = 12) and documents ( n = 23); a survey of ambulance clinicians ( n = 233). (3) Impact on safety and quality: analysis of local ambulance conveyance times ( n = 1400; April to September 2020). Analysis of national stroke audit data on ambulance conveyance and stroke unit delivery of clinical interventions in North Central London, East Kent and the rest of England ( n = 137,650; July 2018 to December 2020).
Results
(1) Evidence: limited but growing, and sparse in UK settings. Prehospital video triage can be usable and acceptable, requiring clear network connection and audio-visual signal, clinician training and communication. Key knowledge gaps included impact on patient conveyance, patient outcomes and cost-effectiveness. (2) Clinician views. Usability – relied on stable Wi-Fi and audio-visual signals, and back-up processes for when signals failed. Clinicians described training as important for confidence in using prehospital video triage services, noting potential for ‘refresher’ courses and joint training events. Ambulance clinicians preferred more active training, as used in North Central London. Acceptability – most clinicians felt that prehospital video triage improved on previous processes and wanted it to continue or expand. Ambulance clinicians reported increased confidence in decisions. Stroke clinicians found doing assessments alongside their standard duties a source of pressure. Safety – clinical leaders monitored and managed potential patient safety issues; clinicians felt strongly that services were safe. Implementation – several factors enabled prehospital video triage at a system level (e.g. COVID-19) and more locally (e.g. facilitative governance, receptive clinicians). Clinical leaders reached across and beyond their organisations to engage clinicians, senior managers and the wider system. (3) Impact on safety and quality: we found no evidence of increased times from symptom onset to arrival at services or of stroke clinical interventions reducing in studied areas. We found several significant improvements relative to the rest of England (possibly resulting from other service changes).
Limitations
We could not interview patients and carers. Ambulance data had no historic or regional comparators. Stroke audit data were not at patient level. Several safety issues were not collected routinely. Our survey used a convenience sample.
Conclusions
Prehospital video triage was perceived as usable, acceptable and safe in both areas.
Future research
Qualitative research with patients, carers and other stakeholders and quantitative analysis of patient-level data on care delivery, outcomes and cost-effectiveness, using national controls. Focus on sustainability and roll-out of services.
Study registration
This study is registered as PROSPERO CRD42021254209.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 10, No. 26. See the NIHR Journals Library website for further project information.
... The current systematic review found that patients in the majority of the studies are satisfied with both telerehabilitation and conventional delivery method of treatment for MSD [8][9][10][19][20][21][22]. Satisfaction with telehealth approach also has been reported in systematic reviews on teledermatology [30], telepsychiatry [31], and telemedicine for stroke [32]. ...
... The high level of satisfaction with telerehabilitation among the professionals found in two studies is consistent with earlier reports [30,32]. Three areas of satisfaction assessed, patient performance, patient-provider relationship, and quality of technology are related to the capability of professionals to adapt and accept of the new technology in their practice. ...
Telerehabilitation offers an alternative healthcare delivery remotely in a patient’s environment at a lower cost, better accessibility, and equivalent quality to the standard approach. Several studies had examined the effectiveness of telerehabilitation inpatients with musculoskeletal disorders, and although there is evidence that it is at least equally effective as the standard care, the patient and rehabilitation professional satisfaction with the delivery method is not conclusive. A systematic review was conducted to study the patients’ and rehabilitation professionals’ satisfaction with telerehabilitation for musculoskeletal disorders. A search for relevant studies on 29 April 2021 was carried out in Medline/PubMed, Scopus, and Web of Science (WOS). The search terms included “telerehabilitation,” AND “satisfaction” AND “musculoskeletal disorders,” “telehealth,” “telemedicine,” “patient experience,” and “pain”. Fifteen eligible studies with 12,341 patients were included in this systematic review. A report was included if it (a) assessed the satisfaction of patients or professionals or both as one of the outcomes of a telerehabilitation intervention, (b) included adults 18 years and above with musculoskeletal disorders, and (c) is an intervention study using a quantitative approach. The quality of studies was assessed using the critical appraisal checklist tool developed by Joanna Briggs Institute (JBI). Most of the studies reported that patients were satisfied with both telerehabilitation and face-to-face intervention. However, few studies reported that patients were more satisfied with telerehabilitation compared to face-to-face of intervention. Patients in one study had preferred the incorporation of telerehabilitation and face-to-face sessions. Two of three studies had reported overall satisfaction with telerehabilitation by the professionals. Overall, there is evidence that patients and rehabilitation professional are satisfied with telerehabilitation compared to face-to-face consultation.
... Telehealth has long been used to improve access to care for patients located in rural and regional areas, becoming a mainstay of disease-specific management for certain conditions (eg stroke and congestive heart failure). 1,2 More recently, similar technology has been used to deliver care to vulnerable clients defined as having highly complex or exceptional needs-those with numerous chronic medical conditions and social issues which require the coordinated input of multiple specialties across different services. 3,4 Since the advent of COVID-19 in March 2020, patients in this category may be at greater risk of deterioration, due to disruptions in their usual care, stemming from the need to maintain social distancing and closure of some health facilities. ...
Objective:
To understand the experiences of vulnerable clients who used telehealth during the Coronavirus pandemic.
Design:
The study employed a qualitative enquiry, utilising semi-structured interviews lasting 30-60 minutes with a thematic analysis approach to explore factors influencing client experience with telehealth.
Setting:
A wide range of locations across Tasmania, Australia.
Participants:
Twelve participants who were considered to be vulnerable on a number of domains, including: health and human wellbeing factors, social risk factors, functional limitations, and individual behavioural factors.
Interventions:
The provision of telehealth consultations to vulnerable clients.
Main outcome measures:
Four global themes were discovered: i) Telehealth saves time, money and energy; ii) User friendly technology facilitates care; iii) Rapport and confidentiality helps clients to feel safe; and iv) Fit for purpose telehealth provides a quality service.
Results:
The discovered themes entailed the major finding that most participants were satisfied with the overall quality of the telehealth service they received and the convenience of this service. Concerns were raised regarding the limitations around social interaction, physical examination, and access to fit-for-purpose telehealth devices.
Conclusion:
This research with vulnerable clients, from Tasmania, supports the evidence that the utilisation of telehealth allows more convenient access to care. To optimise the service, however, concerns regarding the desire for social interaction, appropriate physical examination, and access to fit-for-purpose telehealth devices will need to be addressed.
... In recent years, telemedicine has also been used as a method of intervention and support to families of patients with stroke (9). Technologies related to remote health services also offered an alternative solution for extending neurological interventions to patients who do not live near a qualified care provider, thus, addressing inequalities in access to health (10). ...
Introduction: Telerehabilitation (TR) is defined as a model of home service for motor and cognitive rehabilitation, ensuring continuity of care over time. TR can replace the traditional face-to-face approach as an alternative method of delivering conventional rehabilitation and applies to situations where the patient is unable to reach rehabilitation facilities or for low-income countries where outcomes are particularly poor. For this reason, in this study, we sought to demonstrate the feasibility and utility of a well-known TR intervention on post-stroke patients living in one of the poorest indebted regions of Italy, where the delivery of rehabilitation services is inconsistent and not uniform.
Materials and Methods: Nineteen patients (13 male/6 female; mean age: 61.1 ± 8.3 years) with a diagnosis of first-ever ischemic (n = 14) or hemorrhagic stroke (n = 5), who had been admitted to the intensive rehabilitation unit (IRU) of the Institute S. Anna (Crotone, Italy), were consecutively enrolled to participate in this study. After the discharge, they continued the motor treatment remotely by means of a home-rehabilitation system. The entire TR intervention was performed (online and offline) using the Virtual Reality Rehabilitation System (VRRS) (Khymeia, Italy). All patients received intensive TR five times a week for 12 consecutive weeks (60 sessions, each session lasting about 1h).
Results: We found a significant motor recovery after TR protocol as measured by the Barthel Index (BI); Fugl-Meyer motor score (FM) and Motricity Index (MI) of the hemiplegic upper limbs.
Conclusions: This was the first demonstration that a well-defined virtual reality TR tool promotes motor and functional recovery in post-stroke patients living in a low-income Italian region, such as Calabria, characterized by a paucity of specialist rehabilitation services.
