TEleRehabilitation Nepal (TERN) to improve quality of life of people with spinal cord injury and acquired brain injury. A proof-of-concept study.

Dhakal, R.; Baniya, M.; Solomon, R. M.; Rana, C.; Ghimire, P.; Hariharan, R.; Makeower, S. G.; Meng, W.; Halpin, S.; Xie, S.; O'Conner, R. J.; Allsop, M.; Sivan, M.

Background: Spinal Cord Injury (SCI) and Acquired Brain Injury (ABI) lead to unemployment, poverty, increased mortality and decreased quality of life in low-and middle-income countries (LMICs). Telemedicine is increasingly facilitating access to healthcare, in LMICs. This prospective cohort intervention study aims to investigate feasibility and acceptability of telerehabilitation to provide long-term follow-up of individuals with SCI and ABI, in Nepal, post-discharge from hospital. Methods: TERN was delivered by Spinal Injury Rehabilitation Centre, Nepal, in collaboration with University of Leeds, UK. A home visit connected participants to the Multidisciplinary Team (MDT), through a specialised video conference system. The MDT performed a comprehensive assessment before recommending personalised interventions. Outcome measures assessed functional independence in performing activities of daily living, health-related quality of life and emotional disturbances using Modified Barthel Index, EuroQoL-5D, and Depression, Anxiety, Stress Scale, respectively. A subset of participants was interviewed, exploring acceptability of telerehabilitation. Findings: Between January and December 2020, 97 participants with SCI (n = 82) and ABI (n = 15) were enrolled. After receiving telerehabilitation, significant improvement to self-reported functional independence (p<.001) and quality of life were found, (p<.001). Self-reported severity of depression, anxiety and stress significantly decreased (p<.001). Qualitative interviews (n = 18) revealed participants accepted telerehabilitation, they valued regular contact with professionals without costly, difficult travel. Interpretation: This is the first study to test telerehabilitation in Nepal. This approach can be safely delivered for long-term follow-up for individuals with SCI or ABI, overcoming geographical barriers to healthcare access. A larger-scale controlled study is required to further explore clinical and cost-effectiveness.