Factors associated with willingness to use eRehabilitation
dent continuation of therapy activities (10) and easy
contact with healthcare professionals after discharge or
during outpatient therapy (16, 17). Thus, both personal
contacts and a suitable eRehabilitation approach are
important. Therefore, eRehabilitation appears to be
best offered in a blended intervention in which it is
added to conventional rehabilitation (7, 15). The 2017
Stroke Best Practice Recommendations also concluded
that eRehabilitation interventions can only achieve
their full potential if integrated in and added to existing
stroke services delivery plans (30).
In contrast to the patients, the healthcare professionals
considered the factor Feasibility to be the most important
one. This includes support for patients from a helpdesk,
video instructions and FAQ. Support for the healthcare
professionals (which was also part of the factor Feasi-
bility) was not reported to be important. This shows that
healthcare professionals are concerned about sufficient
patient support in the use of eRehabilitation during the
care process. This is not in line with a previous study
among health professionals by Liu et al. (23) about fac-
tors influencing the use of eRehabilitation. They repor-
ted that performance expectancy (“the degree to which
an individual believes that using the system will help
to attain gains”) was the strongest predictor of the use
of new technologies by healthcare professionals. Liu’s
“performance expectancy” section included 6 questions
about patient outcomes, such as accomplishing patient
goals quickly, improving daily life and increasing the
quality of rehabilitation, and thus closely resembles our
factor Motivation to Change at the level of the individual
patient, which was considered important by patients/
caregivers in the current study.
Our logistic regression analyses have shown that
beliefs about potential patient benefits are associated
with willingness to use eRehabilitation for patients,
informal caregivers and healthcare professionals. The
study by Liu et al. (23) already reported that perfor-
mance expectancy (i.e. the benefits of using a system)
is the strongest predictor of the adoption of new tech-
nologies by healthcare professionals. The present study
suggests that this is also true for patients and their
informal caregivers. Another factor associated with
willingness among our patients to use eRehabilitation
was Knowledge: patients have to feel confident about
starting to use eRehabilitation. This is in agreement
with the results of some previous studies. A review by
Pugliese et al. concluded that the most commonly re-
ported patient barrier was that of following instructions
about how to use the device (31). A feasibility study by
Palmcrantz et al. (29) found that the majority of stroke
patients needed support from a physiotherapist to start
using home-based eRehabilitation, and in a focus group
study by Saywell & Taylor (32), the participants emp-
671
hasized that simple, explicit information on how and
why to perform is crucial (31). Educating patients and
involving them as partners in the development process
was an important prerequisite for the successful use of
eRehabilitation in stroke care (16).
Previous research has also shown that the use of
technologies such as eRehabilitation is accurately
predicted by healthcare professionals’ willingness to
use new technologies (24). In the current study, wil-
lingness to use eRehabilitation, rather than the actual
use of eRehabilitation, was used as the dependent
variable. This was done because most of the patients
and healthcare professionals invited to participate in
the current study were not using eRehabilitation in their
daily rehabilitation practice. Since willingness is an ac-
curate predictor of actual use, the factors identified in
the current study may not only influence willingness to
use eRehabilitation, but also its actual use. In addition,
univariate regression analyses showed no associations
between willingness to use eRehabilitation and its prior
use. In all, this suggests that willingness to use eReha-
bilitation is a good predictor of its actual use, but is
not changed by prior experience with eRehabilitation.
This study had some limitations. First, patients
were approached via email, and not all patients had
registered an email address. This may have resulted in
a response bias, since patients with an email address
may have a different perspective on eRehabilitation
compared with those without. Secondly, the limited
response rate may have affected the generalizability
of the results, since those with an interest in eRehabi-
litation may have been more willing to participate and
may have perceived other barriers and facilitators to the
use of eRehabilitation compared with those who did
not respond. However, the response rate of the current
study is comparable with that in other rehabilitation
studies (33, 34), and the age and sex of responders did
not differ from those of the non-responders. In addi-
tion, the age of our responders may seem low, but the
Dutch medical specialist rehabilitation setting does not
included geriatric rehabilitation care, which explains
why the study sample was relatively young. This may
have influenced out finding that age was not a signifi-
cant factor. Thirdly, regression analyses could not be
performed separately for the 3 disciplines of healthcare
professionals, due to the small number of participants.
In addition, occupational and speech therapists were
not included in this study, although they do play an
important role in stroke rehabilitation. Since these th-
erapists participated in the previous focus group study,
their perspectives were included in the survey, but need
to be explored in future studies. The differences found
between disciplines in the 5 highest scoring barriers/
facilitators also warrant further research, in which oc-
J Rehabil Med 51, 2019