The SMART rehabilitation system for stroke self-management : issues and challenges for evidence-based health technology research.

Background and Purpose. Stroke is one of the major causes of disability in the UK with over 100,000 cases of first stroke and 3,000 cases of further stroke every year. In the USA, it is the third leading cause of death and serious long-term disability. The benefit of telehealth technologies is now recognized and a range of telehealth systems have already been successfully developed to assist people to self-manage the medical aspects of long term conditions. This paper presents the rationale for the use of technology for the remote rehabilitation of stroke survivors and describes the research findings used to inform the design, development and deployment of the SMART device for upper limb self-managed rehabilitation. Case Description. Case studies involving 4 stroke survivors with a mean age of 61.5 (SD27.5), 2 male and 2 female, were used in the final stages of prototype deployment for the SMART system. Chang es in functional activity were analyzed through predeployment and postdeployment measurement. Descriptive statistics were used to calculate where there was an observed improvement, maintenance, or deterioration in the TELER indicators, the Timed Up and Go (TUG) values and the Motor Assessment Scale (MAS).. Outcomes. Functional improvements were observed in 50% of items measured with 40% unchanged and 10% deterioration. Discussion. The Randomized Controlled Trial may not be the most appropriate research method to be used in the early design, development and prototype deployment of telerehabilitation systems because of the complexity of the development process, the interaction processes, the clinical requirement, and the individual needs of the stroke survivor. An evaluation framework is suggested that can provide observations and information essential in the development of health technologies.