Peters Sue, Botero Marcela, Evers Allison, Fong Brianna, Jakab Botond, Petter Emily, Eng Janice J
Elborn College, Room 1000, Western University, 1151 Richmond Street London, Ontario, N6A 3K7, Canada.
Department of Physical Therapy Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
Pilot Feasibility Stud. 2021 Jun 7;7(1):121. doi: 10.1186/s40814-021-00862-8.
The majority of stroke survivors experience motor impairment which benefits from rehabilitation treatment. Telerehabilitation, remote delivery of rehabilitation services, is a possible solution providing access to rehabilitation for stroke survivors living in rural areas or in situations like the COVID-19 pandemic where face-to-face treatment may be risky. However, valid and reliable motor impairment measures have not yet been established over a telerehabilitation platform. The Fugl-Meyer (FM) lower extremity assessment is widely used clinically and in research. Thus, the aim was to develop a modified FM for telerehabilitation (FM-tele) and assess the feasibility and preliminary agreement of FM-tele scores with the FM.
Three phases were employed: phase 1 development, phase 2 feasibility, and phase 3 preliminary agreement. Literature review and consultation with clinicians were employed to develop the FM-tele. Community-dwelling individuals with stroke and FM evaluators were consulted to provide feedback via questionnaires on the feasibility of the FM-tele. To assess the preliminary agreement of the FM-tele, individuals with stroke participated in two sessions, one in-person and one via telerehabilitation. The standard version of the FM was administered during the in-person session. The FM-tele was administered in both sessions.
From phase 1, clinician consultation identified the following key principles: safety of the client, clear lower extremity visualization, and minimization of position changes which guided FM-tele development (n = 7). Feasibility was established in phase 2 where participants with stroke indicated that they felt safe and experienced ease following the standardized instructions, despite some technological concerns (n = 5). FM evaluators agreed that participants were safe and indicated effective standardized instructions. Phase 3 (n = 5) indicated preliminary agreement of the FM-tele compared with the FM.
Participants with stroke and clinical consultation indicated the FM-tele developed for telerehabilitation is feasible. A lower extremity motor assessment tool for telerehabilitation is urgently needed for stroke survivors living in rural areas or when face-to-face visits are impossible. This pilot study provides preliminary support for a future study.
大多数中风幸存者存在运动功能障碍，康复治疗对其有益。远程康复，即远程提供康复服务，是一种可行的解决方案，可为居住在农村地区或处于新冠疫情等情况下的中风幸存者提供康复途径，因为在这些情况下面对面治疗可能存在风险。然而，尚未在远程康复平台上建立有效且可靠的运动功能障碍评估方法。Fugl-Meyer（FM）下肢评估在临床和研究中被广泛应用。因此，本研究旨在开发一种适用于远程康复的改良FM（FM-tele），并评估FM-tele评分与FM评分的可行性和初步一致性。
本研究分为三个阶段：第一阶段为开发阶段，第二阶段为可行性阶段，第三阶段为初步一致性阶段。通过文献综述和与临床医生协商来开发FM-tele。咨询社区中风患者和FM评估人员，通过问卷调查就FM-tele的可行性提供反馈。为评估FM-tele的初步一致性，中风患者参加两次评估，一次是面对面评估，一次是通过远程康复评估。在面对面评估期间使用FM的标准版本。在两次评估中均使用FM-tele。
在第一阶段，临床医生的咨询确定了以下关键原则：患者安全、下肢清晰可视化以及尽量减少体位变化，这些原则指导了FM-tele的开发（n = 7）。在第二阶段确定了可行性，中风患者表示，尽管存在一些技术问题，但按照标准化指导他们感到安全且操作轻松（n = 5）。FM评估人员一致认为患者是安全的，并表示标准化指导有效。第三阶段（n = 5）表明FM-tele与FM相比具有初步一致性。
中风患者和临床咨询表明，为远程康复开发的FM-tele是可行的。对于居住在农村地区或无法进行面对面就诊的中风幸存者来说，迫切需要一种用于远程康复的下肢运动评估工具。这项试点研究为未来的研究提供了初步支持。
