Telerehabilitation of patients with stroke: Initial program theories for successful implementation.

Abstract

Purpose: Telerehabilitation has proven effective for stroke survivors, yet it is slowly implemented. We developed Initial Program Theories (IPTs) that focus on the telerehabilitation of stroke survivors in the United States to uncover the possible causal relationship between implementation strategies and outcomes.

Methods: We created a conceptual framework to steer the development of IPTs. Then, we extracted concepts from theoretical frameworks reported in telemedicine implementation literature combined with feedback meetings with stakeholders with relevant experience.

Results: We developed a framework for implementing telerehabilitation that includes implementation levels, contextual domains, telerehabilitation technology, implementation phases, actors, targets, mechanisms, and outcomes. We created 27 IPTs that specify telerehabilitation interventions, implementation strategies, actors, targets, context, implementation mechanisms, and outcomes. The IPTs were refined and validated through feedback meetings.

Conclusions: This study adds to the relatively scarce literature on IPT development. For each IPT, we elaborated on the implementation mechanism and how it could facilitate or hinder telerehabilitation implementation, an essential insight for researchers and professionals to plan successful implementation strategies. Understanding causal mechanisms helps identify implementation strategies that will work in the U.S. context and improve weak implementation strategies that are potentially significant or commonly used.