Several weeks ago, I presented a three-part series on telehealth, exploring what it is, potential issues, the current legal landscape and suggestions for facilities, insurers and practitioners related to the increasing utilization of telehealth services. One of the increasing ways providers are utilizing telehealth capabilities is in connection with rehabilitation after a patient suffers a stroke. In a new, randomized clinical trial of 124 adults following stroke, researchers found that telerehabilitation showed comparable efficacy to traditional in-clinic rehabilitation for improving motor status and for improving patient knowledge about stroke.  In fact, many patients receive inadequate rehabilitation therapy after stroke, often as a result of limited access to therapists and difficulty with transportation, and of a limited scope of knowledge about their stroke and prognosis. Telehealth, including telerehabilitation, has great potential to address these issues.
One of the main draws of utilizing telemedicine is that it increases appropriate and timely access to medical services, especially in rural areas, and promotes improved health outcomes and less costly treatments. In Idaho specifically, thirty-five of Idaho’s forty-four counties are rural or frontier, often facing limited access to health-care services and challenges in recruiting and retaining local physicians. Hospital systems recognize the need to provide medical services in these more rural communities: For example, Intermountain Healthcare operates a twenty four-hour telehealth center that provides forty telehealth services to seven western states, and St. Luke’s Healthcare System recently opened a twenty four-hour Virtual Care Center, which provides telehealth services throughout Idaho and Eastern Oregon. Through its Virtual Care Center, St. Luke’s successfully piloted a unique Remote Patient Management program for home monitoring of patients living with chronic conditions.
In this recent study, participants underwent a 6-week course of intensive home-based telerehabilitation programs targeting arm movements after stroke. The goal of the study was to determine whether treatment targeting arm movement delivered via a home-based telerehabilitation system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic setting, and to examine whether this system has comparable efficacy for providing stroke education. All participants received 36 sessions (70 minutes each) of arm motor therapy plus stroke education, with therapy intensity, duration, and frequency matched across the home-based telerehabilitation and in-clinic groups. Participants in the telerehabilitation group actually participated in a greater number of the sessions than the clinic based group, and showed as substantial of gains in their arm motor function as those participants in the in-clinic rehabilitation group.
Ultimately, the researchers concluded that telehealth, particularly telerehabilitation, is an effective way to provide rehabilitation therapy and improve patient outcomes after stroke and is also useful in connection with improving patient access to rehabilitation therapy. Telerehabilitation programs can produce benefits that are comparable with those derived from dose-matched, traditional, in-clinic rehabilitation therapy, which is encouraging for ongoing telehealth expansion efforts.
 Study | Steven C. Cramer, MD1; Lucy Dodakian, MA, OTR/L1; Vu Le, MS1; et al., Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial (June 24, 2019), JAMA Neurol. 2019;76(9):1079-1087. doi:10.1001/jamaneurol.2019.1604.
Stroke remains one of the leading causes of death in the US, and in Idaho alone in 2013, 598 total deaths were attributed to stroke. See Stats of the State of Idaho, published by the CDC, available at https://www.cdc.gov/nchs/pressroom/states/ID_2015.pdf.
 Marc Harrison, Telehealth is Improving Health Care in Rural Areas, Harvard Business Review, May 15, 2019, https://hbr.org/2019/05/telehealth-is-improving-health-care-in-rural-areas.
 Mandy Roth, Got Rural? Go Virtual. St. Luke's Did, Health Leaders (Sept. 11, 2018), https://www.healthleadersmedia.com/innovation/got-rural-go-virtual-st-lukes-did.
 Eric Wicklund, New Telemedicine Center to Extend Connected Health Across Idaho, mHealthIntelligence (Aug. 28, 2018), https://mhealthintelligence.com/news/new-telemedicine-center-to-extend-connected-health-across-idaho.