Implementation of Home-based Telerehabilitation of Patients with Stroke: A Realist Review Protocol (Preprint)

UNSTRUCTURED Stroke is a common cause of mortality and morbidity in the United States. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely, effective, and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a healthcare team's use of a communication mode (e.g., telephone, email, integrated video and audio, videoconferencing, text messaging) to remotely provide rehabilitation services. Evidence indicates that home-based telerehabilitation is as effective as facility-based rehabilitation for individuals with stroke. However, it is infrequently used due to implementation barriers. This realist review will explore the interaction between the implementation context and outcomes of home-based telerehabilitation of patients with stroke, mediated by the studied implementation strategies and their underlying mechanisms. The aim is to develop a theoretical framework to guide the implementation of home-based telerehabilitation of people with stroke. Methods and analysis: This realist review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. The following databases will be queried till October 2022: PubMed via MEDLINE, the PEDro database, and CINAHL, and supplemented with citation tracking and grey literature search. The quality of articles will be appraised based on their relevance and rigor, using TAPUPAS and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist synthesis publication standards set by Wong and colleagues (2013). Ethics and dissemination: Ethics approval is not required for this study as it is secondary research, synthesizing evidence from primary studies. The review team will disseminate the findings through peer-reviewed publications and conference presentations.