Maximizing Telerehabilitation for Patients With Visual Loss After Stroke: Interview and Focus Group Study With Stroke Survivors, Carers, and Occupational Therapists

Abstract

Background: Visual field defects are a common consequence of stroke, and entraining compensatory eye-movement strategies has been identified as the most promising rehabilitation option. There has been a move towards compensatory telerehabilitation options such as the Durham Reading and Exploration (DREX) training app which significantly improves visual exploration, reading, and self-reported quality of life. Objective: This study details an iterative process of liaising with stroke survivors, carers, and healthcare professionals to identify barriers and facilitators to using such tools, alongside elements of good practice in telerehebalitation, with a focus on how the DREX package can be maximised. Methods: Survey data from 75 stroke survivors informed 12 semi-structured engagement activities (seven focus groups and five interviews) with 32 stroke survivors, 10 carers, and 24 occupational therapists. Results: Thematic analysis identified key themes within the data. Themes identified problems associated with post-stroke healthcare from both patient and occupational therapists’ perspective that need to be addressed to improve uptake of this rehabilitation tool and telerehabilitation options generally. This included identifying what additional materials or assistance were required to boost the impact of training packages generally. The acute rehabilitation setting was an identified barrier, with perceptions of technology considered to be a barrier by some but a facilitator by others. In addition to which four key features of telerehabilitation were identified: additional materials, the importance of goal-setting, repetition, and feedback. Conclusions: The data was utilised to try and overcome some barriers to the DREX training and are further discussed in terms of considerations for e-therapies more generally moving forward.