Factors associated with willingness to use eRehabilitation
Five levels of the implementation model of Grol
(e.g Level of the individual Patient)
667
to use eRehabilitation in addition to the regular
rehabilitation care?”’ (yes, no).
The surveys were tested in a pilot study with
3 stroke patients who were still undergoing
rehabilitation treatment (1 male, 2 females;
Sixteen factors based on the prior study
mean age 59 years; mean time since stroke 10
(e.g. Feasibility)
weeks; all undergoing in-patient rehabilitation
for stroke) and 3 healthcare professionals (2 ma-
96 statements for patient, 99 statements for informal caregivers,
les, 1 female; 2 physiotherapists, 1 occupational
90 statements for healthcare professionals
therapist; mean age 38 years; mean work expe-
(e.g. “eRehabilitation has a positive influence of recovery”)
rience 13.3 years) working in a rehabilitation
centre. The surveys were tested for feasibility,
Fig. 1. Relationship between levels, factors and statements.
legibility, readability and presentation (e.g.
perceived statement difficulty, response errors,
screen layout, etc.). Testing led to small changes
consisted of 3 parts: (i) questions about responder characteris-
in the phrasing and layout. The survey for informal caregivers
tics, (ii) statements about barriers and facilitators influencing
was adjusted based on feedback from the other surveys.
willingness to use eRehabilitation for stroke patients, and (iii)
questions about willingness to use eRehabilitation;
Statistical analysis
(i) Responder characteristics. All 3 surveys included ques-
tions about age and sex. In addition, patients and informal
Participants who completed ≥ 90% of the survey were included
caregivers were asked about the time since the stroke (in
in the analysis, and we did not impute for missing values. Ana-
months), living status (living alone or living with partner/
lysis of survey data was carried out using Statistical Packages
family), employment (paid job, no paid job), self-perceived
for the Social Sciences (IBM SPSS 22.0 for Windows).
impairment (cognitive, physical, communicative), use of
Participant characteristics. Participant characteristics included
electronic devices in daily life (smartphone, tablet, laptop,
socio-demographic data and disease- and work-related cha-
computer) and previous experience with eRehabilitation
racteristics, presented as numbers with percentages or means
(no, yes; if yes: exercises, games, information).
with standard deviation (SD). Age and sex of responders were
For healthcare professionals, the survey started with
compared with those of the stroke population of 2,700 eligible
the question “Are you working with stroke patients?” If
patients in the 2 participating rehabilitation centres, using inde-
not, the survey was ended. If yes, 12 questions followed,
pendent t-test and and Wilcoxon-Mann-Whitney test.
regarding their work setting (primary care, rehabilita-
tion centre, general hospital), years of work experience,
Descriptive analyses. Median scores with interquartile ranges
number of new stroke patients per month and their current
(IQR) were calculated for each of the statement about barriers/
use of eRehabilitation (no, yes; if yes: exercises, games,
facilitators. Based on the median score, the 5 most important
information).
statements were reported for each group (patients, informal
(ii) Barriers/facilitators statements. For the current study, each
caregivers and healthcare professionals), and for physicians,
potential barrier and facilitator identified in the focus group
physiotherapists and psychologists separately. For statements
study was translated into a neutral statement. A total of 69
with a similar median, a more specific ranking (lowest number
statements were formulated, based on the transcripts of
equals largest influence) was made, based on the mean.
the focus group sessions of patients, informal caregivers
Association between barriers/facilitators and willingness to
and healthcare professionals. For patients and informal
use eRehabilitation. The association between a barrier/facili-
caregivers, 26 statements were formulated, based on bar-
tator and willingness to use eRehabilitation was assessed using
riers/facilitators that were not reported by the healthcare
logistic regression analysis. The methods were comparable to
professionals. This concerned the design of the eRehabi-
those used in previous qualitative research about barriers and
litation in terms of colour, use of pictographs and beliefs
facilitators to the implementation of innovations in healthcare
about the skills and knowledge required to use eRehabili-
(25, 26). This analysis was performed separately for patients,
tation. Three statements were formulated for the informal
informal caregivers and healthcare professionals, and consisted
caregivers alone, concerning the information provided to
of 3 steps:
them. Nineteen statements were formulated for the healt-
• All statements about barriers/facilitators were merged into
hcare professionals only. These included organizational
factors, as predefined in the focus group study. The internal
constraints, integration of eRehabilitation in the current
consistency of each factor (i.e. group of statements) was cal-
rehabilitation process, and monitoring patients’ results. The
culated using Cronbach’s alpha. A Cronbach’s alpha of 0.7
barrier/facilitator statements thus included 95 (69 + 26)
was considered acceptable (27) and was determined using a
statements for the patients, 98 (69 + 26 + 3) statements for
factor analysis with an orthogonal rotation approach, using
the informal caregivers and 88 (69 + 19) statements for the
principal component analysis and varimax rotation (28).
healthcare professionals (see Appendix I for all statements).
• Univariate logistic regression analyses were performed to
The influence of the barriers/facilitators mentioned in the
assess whether a factor was significantly associated with wil-
statements on willingness to use eRehabilitation was rated
lingness to use eRehabilitation. Factors were used instead of
on a 4-point Likert scale (1=unimportant, 2=somewhat
statements, to prevent over-fitting of the logistic regression
unimportant, 3=somewhat important, 4=important, or
model by including too many variables. The factors were
1=disagree, 2=partly disagree, 3=partly agree, 4=agree).
included as the independent variables, and willingness to use
(iii) Willingness to use eRehabilitation. Since eRehabilitation
eRehabilitation as the dependent variable. In addition to the
is still not widely used, the surveys included 1 question
factors derived from the focus group study, the characteristics
about willingness to use eRehabilitation: “Would you like
J Rehabil Med 51, 2019