Brodie Sakakibara

BACKGROUNDApproximately 30% of stroke survivors report unmet lower extremity (LE) recovery needs after returning to community living. Telerehabilitation can be used to mitigate issues surrounding accessibility and provide ongoing support, however, evidence in this area is limited. The overall purpose of this thesis is to develop a better understanding of telerehabilitation for LE recovery post-stroke. OBJECTIVESChapter 2: To describe telerehabilitation interventions for LE recovery following stroke; and to quantitatively assess their effects on LE recovery.Chapter 3: To determine the feasibility of TRAIL among individuals with stroke, including estimating the effects of TRAIL on clinical outcomes.METHODSChapter 2: All interventional studies investigating telerehabilitation for LE recovery post-stroke were included from MEDLINE, EMBASE, PSYCInfo, and Cochrane. Quality was assessed for all included studies. RCTs were meta-analyzed using RevMan 5.4. GRADE was performed for each outcome.Chapter 3: 32 individuals were recruited in this single group pre-post study. Feasibility outcomes were treated as binary outcomes based on pre-defined indicators. Clinical outcomes (TUG, FMA-Tele, 30s S2S, ABC, SIS, FR, TS and GAS) were analyzed using Wilcoxon signed-rank test for statistically significant differences (p0.05).RESULTSChapter 2: 21 studies were included for the qualitative analysis and 12 RCTs were included for the meta-analysis. A moderate body of evidence indicated that telerehabilitation was as effective as usual care for improving balance (MD = 1.67 [95% CI = 0.52, 2.82], I² = 0%, p = 0.004) and motor impairment (SMD = 3.73 [95% CI = 2.12, 5.33, I² = 27%, p 0.00001).Chapter 3: The following effect sizes were observed: TUG (0.57, p = 0.02); FMA-Tele (0.76, p = 0.001); 30s S2S (0.89, p = 0.001); ABC (0.60, p = 0.015); GAS (0.95, p = 0.001); SIS-ADL (0.52, p = 0.038); SIS-Mobility (0.59, p = 0.017). Seven out of eleven (63.6%) threshold criteria of feasibility were considered a success.CONCLUSIONThe information from the review allows for practical recommendations for future research, such as identifying knowledge gaps. The TRAIL feasibility study offered insight into understanding the key factors that contribute to a successful telerehabilitation intervention for LE recovery.

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Background Chronic diseases are prevalent in Canada’s aging population, creating importance for older adults (age ≥65 years) to practice positive health behaviours (e.g., physical activity, healthy diet) for chronic disease management. However, novel coronavirus (COVID-19) prevention strategies of quarantining, social isolation, and physical distancing may compromise one's ability to manage health and thus, increase risk of adverse health events.Purpose To develop an understanding of chronic disease management in community-living older adults (age ≥65 years) during the COVID-19 pandemic. This included quantitatively evaluating a student-led Community Outreach teleheAlth program for Covid education and Health promotion (COACH) (Chapter 2), and qualitatively exploring the management strategies of older adults during COVID-19 and COACH participation (Chapter 3). Methods Chapter 2: In a single-group, pre-post study (n = 75), multiple paired sample t-tests were used to examine COACH’s effects on: (1) health directed behaviour (primary outcome); (2) perceived depression, anxiety, and stress; (3) social support; (4) health-related quality of life; (5) health promotion self-efficacy; and (6) self-management indicators.Chapter 3: A subset of COACH participants (n = 24) participated in semi-structured interviews. Interpretive description was the guiding methodological framework, and thematic analysis was performed to categorize the data.Results Chapter 2: Participants’ mean age was 72.4 years (59% female), with 80% reporting two or more chronic conditions. There were significant improvements in health directed behaviour (p .001, d = 0.45). After applying Bonferroni correction on secondary outcomes, results showed significant improvement in self-efficacy (p .001, d = 0.44) and significant decrease in mental health-related quality of life (p .001, d = -1.69).Chapter 3: Participants’ mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions. Participants described purposes for optimizing their health, maintaining a sense of control, and using social support to optimize their management efforts. COACH further supported participants during COVID-19 through coach interactions and knowledge and skill development.Conclusion Chronic disease management in older adults can be described with identifying purposes to optimize health, followed by using internal and external motivators (like COACH) to support their self-management efforts during COVID-19.

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