Expanding Post-Stroke Telerehabilitation: A Qualitative Study of User Experience Piloting VA Secure Messaging Use in a Telerehabilitation Format

Abstract

BACKGROUND: Stroke is the fourth leading cause of death and primary cause of long-term disability in the U.S. As many as 40% of stroke survivors are discharged home without any inpatient or outpatient comprehensive stroke rehabilitation leading to the need for continued care for basic activities of daily living (grooming, toileting and feeding). Barriers to post-discharge comprehensive stroke rehabilitation are distance to travel, lack of transportation and inadequate social support. Telerehabilitation has been suggested as a possible solution for the delivery of low cost, convenient, home-based rehabilitative care. OBJECTIVE: To understand the experience of researchers and stroke survivors piloting the use of the My HealtheVet personal health record and secure messaging for stroke telerehabilitation. METHODS: A retrospective qualitative study using semi-structured interviews with a convenience sample of five study participants from the intervention arm of VA funded stroke rehabilitation single-blinded randomized controlled trail was conducted in addition to a focus group of three of the research team members. A descriptive phenomenological approach was used to describe the study participants and selected research team members experience using the VA’s My HealtheVet personal health record and secure messaging in telerehabilitation research. RESULTS: Researchers and study participants reported benefits from using the My HealtheVet personal health record with secure messaging that included the ability to send and or respond to secure messages at a time and place of their choosing, flexibility in scheduling the time of their therapy, ability to use any internet-enable device to access their My HealtheVet account, and the ability to retrieve and reread or watch education provided by the therapist when needed. Barriers to use were outweighed by the increased flexibility in scheduling, feeling empowered and having caregiver support. CONCLUSIONS: This small feasibility pilot suggests My HealtheVet with secure messaging may be an appropriate telecommunication tool for telerehabilitation. The study researchers caution that this was a small pilot and consideration should be given to ensuring adequate resources to support a larger study panel if expanded.