Munsell Michael, De Oliveira Emily, Saxena Sadhvi, Godlove Jason, Kiran Swathi
The Learning Corp, Newton, MA, United States.
Aphasia Research Laboratory, Speech Language and Hearing Sciences, Boston University, Boston, MA, United States.
J Med Internet Res. 2020 Feb 7;22(2):e16286. doi: 10.2196/16286.
For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient's ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient's level of engagement with technology-based therapy are currently unknown.
This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural).
Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates.
Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates.
An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.
对于中风、创伤性脑损伤（TBI）以及其他与言语语言障碍相关的神经系统疾病，言语和语言治疗是促进康复的标准治疗方法。然而，诸如临床医生时间限制和保险报销等障碍可能会抑制患者获得优化功能恢复所需支持的能力。尽管数字康复有潜力通过让患者在家练习来增加治疗机会，但目前尚不清楚影响患者参与基于技术的治疗水平的临床和人口统计学特征。
本研究旨在评估不同患者特征（包括年龄、性别、诊断、疾病发病时间和地理位置（城市与农村））对数字治疗参与程度的影响。
对开始使用Constant Therapy（一种为言语语言障碍患者远程提供的基于云的康复计划）的中风或TBI患者的数据进行回顾性分析。仅纳入在家中完成的治疗课程数据。评估了以下三个活动指标：（1）治疗的活跃周数，（2）每周活跃治疗天数的平均值，以及（3）在访问该计划的前20周内完成的治疗课程总数。活跃日或活跃周定义为至少有一次完成的治疗课程。分别以每个活动指标作为因变量，所有可用的患者人口统计学数据作为模型协变量进行多元线性回归模型分析。
分析了2850例中风或TBI患者的数据，平均每位患者每周进行1.5天治疗，共完成8.6周的治疗。与已知的技术采用障碍相反，老年患者在访问该计划的前20周内更活跃，51至70岁的患者比50岁及以下的患者多完成5.01节治疗课程（P = 0.04）。同样，居住在农村地区、前往诊所就医面临更大障碍的患者比城市患者更积极参与数字治疗，在控制其他模型协变量后，农村患者在访问该计划的前20周内多完成11.54节治疗课程（P = 0.001）。
对实际数据的评估表明，中风和TBI患者经常在家中使用数字治疗进行认知和语言康复。在临床服务获取有限的地区使用率更高，并且不受年龄等典型技术采用障碍的影响。这些发现将有助于指导数字康复治疗未来的研究方向，包括人口统计学对康复结果的影响以及大型随机对照试验的设计。
