In an original research study funded by a $50,000 TIRR Memorial Hermann Rehabilitation Innovation Award presented in fall 2014, Mansi Jhaveri, DO, and her team are investigating the impact of a novel form of telemedicine-guided education on secondary stroke and fall prevention following inpatient rehabilitation. Dr. Jhaveri presented the preliminary results of the prospective, one-arm, pilot feasibility study at the 2017 TIRR Memorial Hermann Rehabilitation Innovation Awards, held last February. Final results will be reported at the end of the year.
“As a society, we invest substantial manpower and resources for stroke patients in the acute care setting, as well as in inpatient rehabilitation,” says Dr. Jhaveri, clinical assistant professor and co-director of neurorehabilitation in the department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth. “Stroke rehabilitation patients have the potential to improve their functional independence if they continue with their rehabilitation strategies post-discharge. However, many patients we see are transported to the Texas Medical Center from rural areas surrounding Houston, which makes it difficult to return for follow-up care, leading to worse stroke outcomes. For these rural patients or those with financial and/or caregiver constraints, telemedicine is a great tool. By checking in with them remotely for telerehabilitation home visits once a week, we can see patients, talk with their caregivers and intercept potential medical problems more quickly.”
Patients discharged from rehabilitation to home discover a new set of challenges. “They’re accustomed to having nurses administer their medications and having therapists to help with bathing and walking while in the inpatient setting,” says Dr. Jhaveri, who holds a dual appointment in the department of Neurology at UTHealth. “When these same patients go home, patients and family are often not equipped with all the information and support they need to prevent recurrent strokes and fall-related injuries. We provide home-safety evaluations through Memorial Hermann Home Care for selected patients, but prior to this study, we didn’t have a mechanism for physicians and therapists to educate patients at home to reduce their risk factors.”
Dr. Jhaveri and her team deliver education and assess patient compliance with self-care instructions using iPads and the Acano application, which provides high-quality video conferencing. After hospital discharge, patients receive a series of six scheduled telerehab home visits by rotating rehabilitation specialists including a pharmacist, physical/occupational therapist, speech therapist, rehabilitation physician, social worker and a geriatrician specialized in fracture prevention, followed by a satisfaction survey on week 7. Calls are made according to an agreed-upon schedule, and important follow-up issues are shared with the rehabilitation physician, who then communicates with the rest of the team. Preliminary results indicate excellent patient compliance with all six telerehabilitation home visits, and patients completing the study have reported high rates of satisfaction.
Dr. Jhaveri’s long-term goal is a prospective, two-arm, randomized, controlled trial that will allow for assessment of the efficacy of the intervention in prevention of falls, recurrent stroke and hospital readmission. “The data we have now is preliminary,” she says. “If our final results show that telerehab home visits are feasible in educating stroke patients and caregivers, we’ll have the data we need for a larger, longer-term, randomized, controlled trial that will allow us to assess the efficacy of the intervention. The telerehab strategy has great potential to increase access for stroke patients who do not receive proper follow-up due to lack of mobility, transportation limitations, financial resources and caregiver restraints. Our ultimate goal is to improve patient quality of life and reduce health care costs, a win-win situation for both patients and health care system.”
Co-investigators and collaborators in Dr. Jhaveri’s study are Gerard Francisco, MD , chief medical officer at TIRR Memorial Hermann and professor and chair of the department of Physical Medicine and Rehabilitation at McGovern Medical School; Mark Sherer, PhD, ABPP, FACRM , senior scientist and director of research at TIRR Memorial Hermann and clinical professor of PM&R at Baylor College of Medicine and McGovern Medical School; James C. Grotta, MD, neurologist, Memorial Hermann Medical Group, director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann-Texas Medical Center, and director of the Mobile Stroke Unit Consortium; Sean Savitz, MD, professor in the department of Neurology, Frank M. Yatsu Chair in Neurology, and director of the Vascular Neurology Program at McGovern Medical School; Nahid Rianon, MBBS, Dr.PH., clinical associate professor, department of Internal Medicine-Geriatrics; Ruby Benjamin-Garner, PhD, MPH, clinical assistant professor, Clinical and Translational Sciences, McGovern Medical School; Farhaan Vahidy, MBBS, MPH, PhD, assistant professor, department of Neurology, McGovern Medical School; Kayta Kobayashi , Pharmacy Division, TIRR Memorial Hermann; Mary Gaber, PhD , Occupational Therapy Division, Memorial Hermann Texas Medical Center; Rafiq Patel , Occupational Therapy Division, TIRR Memorial Hermann; Paige Shoemake, Memorial Hermann Speech Language Pathology; Jade Woellner, Memorial Hermann Speech Language Pathology; Anna Nodecker, Memorial Hermann Speech Language Pathology; Kim Vu, Memorial Hermann Division of Social Services; and Alyssa Trevino, Department of Neurology, McGovern Medical School.