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J Rehabil Med 2019; 51: 665–674 ORIGINAL REPORT FACTORS ASSOCIATED WITH WILLINGNESS TO USE eREHABILITATION AFTER STROKE: A CROSS-SECTIONAL STUDY AMONG PATIENTS, INFORMAL CAREGIVERS AND HEALTHCARE PROFESSIONALS Berber BROUNS, MSC 1,3,4,5 , Jorit J. L. MEESTERS, PhD 1,3,5 , Manon M. WENTINK, MSC 1,3,5 , Arend J. DE KLOET, PhD 3,5 , Henk J. ARWERT, MD 1,3 , Liesbeth W. BOYCE, MSC 1, 4, Thea P. M. VLIET VLIELAND 1,3,4 and Leti VAN BODEGOM-VOS, PhD 2 From the 1 Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, 2 Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Centre, 3 Basalt, The Hague, 4 Basalt, Leiden, and 5 Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands Objective: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with wil- lingness to use eRehabilitation. Design: Cross-sectional survey. Subjects: Stroke patients, informal caregivers, health­care professionals. Methods: The survey included personal characte- ristics, willingness to use eRehabilitation (yes/no) and barriers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. Results: Overall, 125 patients, 43 informal caregi- vers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34–5.33), informal caregivers (OR 8.98; 95% CI 1.70–47.33) and healthcare professionals (OR 6.25; 95% CI 1.17–10.48). Insufficient knowledge decreased wil- lingness to use eRehabilitation among patients (OR 0.36, 95% CI 0.17–0.74). Limitations of the study include low response rates and possible response bias. Conclusion: Differences were found between pa- tients/informal caregivers and healthcare professio- nals. However, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabilitation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation. Key words: stroke; barriers and facilitators; implementation; rehabilitation; eRehabilitation, survey. Accepted Jul 8, 2019; Epub ahead of print Aug 15, 2019 J Rehabil Med 2019; 51: 665–674 Correspondence address: Berber Brouns, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands. E-mail: [email protected] S troke is a major cause of disability worldwide (1), including long-term physical and cognitive LAY ABSTRACT The use of digital eRehabilitation after stroke (e.g. in serious games, e-consultation and education) is increa- sing. However, the use of eRehabilitation in daily prac- tice is limited. As a first step in increasing the use of eRehabilitation in stroke care, this study examined which factors influence the willingness of stroke patients, in- formal caregivers and healthcare professionals to use eRehabilitation. Beliefs about the benefits of eRehabi- litation were found to have the largest positive impact on willingness to use eRehabilitation. These benefits included reduced travel time, increased adherence to therapy or motivation, and better health outcomes. The willingness to use eRehabilitation is limited by a lack of knowledge about how to use eRehabilitation. impairments (2). Recovery of these functions requires specialized multidisciplinary stroke rehabilitation (3). Due to the increasing incidence of stroke and the major increase in the cost of healthcare (4), there is a need for more efficient rehabilitation strategies. The rapid growth of accessible and affordable information and communication technology (ICT) offers a potential solution, and may improve the effectiveness of reha- bilitation (5, 6). The use of ICT in rehabilitation (i.e. eRehabilitation) is a method for delivering rehabilitation in addition to conventional modes of delivery in the sub-acute and chronic phases of rehabilitation. eRehabilitation is delivered using a variety of possible ICT devices, such as computers, tablets and smartphones, and includes exercise programmes, serious gaming (conducting rehabilitation through playing games), education and e-consultations (7). Randomized clinical trials (RCTs) showed that eRehabilitation can decrease stroke- related impairments (6, 8, 9), reduce physical effort required from healthcare professionals, make rehabili- tation accessible to larger number of stroke patients (5), make it possible to continue therapy-related cognitive and physical activities after discharge (10), decrease chronic disability, and facilitate home-therapy (11, 12). A positive attitude toward the use of eRehabilita- tion was found among all end-users, including stroke patients, informal caregivers (13–15) and healthcare This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2586