Telerehabilitation in Community Stroke Services: A mixed-methods evaluation of current practice and lessons for sustained use

Chandler, Elizabeth, Dorer, Charlie, Pomeroy, Valerie and Hancock, Nicola (2026) Telerehabilitation in Community Stroke Services: A mixed-methods evaluation of current practice and lessons for sustained use. Journal of Medical Internet Research. ISSN 1439-4456 (In Press)

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Abstract

Background: The delivery of specialist stroke rehabilitation is undergoing significant transformation, with telerehabilitation increasingly integrated into clinical practice and supported by guidelines and policy. There is growing recognition of the need for pragmatic evaluation of telerehabilitation within existing service frameworks, that includes insights from clinical teams and people with stroke to deepen understanding and inform sustained use. This evaluation sought to address that need, in the context of community stroke services in the East of England. Objectives: Our evaluation addressed two over-arching aims: (1) To investigate and map contemporary models and experiences of telerehabilitation delivery in community stroke services, examining how it is currently used and perceived by both healthcare providers and service-users; and, (2) To identify practical lessons and enabling factors that support the sustained integration of telerehabilitation into routine community stroke services. Methods: A two-phase exploratory sequential mixed-methods evaluation. Phase One involved discussion groups with stakeholders already using telerehabilitation to explore experiences, attitudes, influences, and behaviours associated with its use. Findings from Phase One directly informed Phase Two by the development of a conceptual framework and in shaping the content of an online survey for clinicians and people with lived experience of stroke. Quantitative and qualitative data were subsequently integrated through triangulation during analysis, interpretation, and reporting stages. Data from the discussion groups were analysed using a recognised framework for reflexive thematic analysis within a contextualist approach. Descriptive statistics were used to summarise quantitative survey responses. Results: A total of 20 people attended the discussion groups (n=4 groups total). 96 people responded to the survey. Three themes underpinning successful use of telerehabilitation in this context were derived from triangulation across our data sources: 1) consideration of risks and benefits, with fewer than half of staff viewing telerehabilitation as equivalent in safety (45%) or effectiveness (59%) but most reporting that they could build rapport remotely (69%). 2) the importance of individualised care approaches where most clinicians reported confidence in identifying which service-users would benefit from telerehabilitation (85%), although only 20% offered it routinely and, 3) the need for staff support with up to 34% of staff reporting no training in how to assess suitability for telerehabilitation. Key insights included the potential for telerehabilitation to increase efficiency and address service pressures, the importance of addressing digital exclusion, the value of individualised approaches and the need for timely and tailored staff training. Conclusions: Our pragmatic, in-service evaluation demonstrates that telerehabilitation works best not as a replacement for in-person care, but as part of a responsive, blended approach grounded in individual need. These findings highlight that, with appropriate clinician training and flexibility in delivery telerehabilitation can meet the needs of individuals through personalised approaches whilst supporting service responsiveness in pressurised clinical environments.

Item Type:	Article
Additional Information:	Data Availability: Qualitative data (discussion group transcripts) are not publicly available due to the risk of participant identification and the confidential nature of the discussions. De-identified extracts are presented within the manuscript. Quantitative survey data underlying the reported findings are provided in aggregated form in Multimedia Appendices 2-4. The raw data supporting the conclusions of this manuscript can be made available from the corresponding author upon reasonable request.
Uncontrolled Keywords:	stroke,telerehabilitation,stroke rehabilitation,service innovation,community services
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Rehabilitation Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health) Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Depositing User:	LivePure Connector
Date Deposited:	12 May 2026 16:04
Last Modified:	14 May 2026 15:17
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102973
DOI:	10.2196/87741

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