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Introduction
Recurrent stroke is common among stroke survivors. According to a recent report, in China, nearly half (44%) of stroke survivors experience a recurrent stroke and are re-admitted to hospital within 5 years after an initial event.1 Percentages are similar in the USA (43%)2 and the UK (26%).3 Stroke survivors usually encounter a range of stroke complications such as sensory impairment,4 5 cognitive limitations,6 mental suffering7 and muscle weaknesses8 when returning home from an acute stroke unit. The evidence suggests that initiating tertiary stroke prevention strategies immediately after an index stroke can prevent or minimise the debilitating effects of stroke as well as limit the severity of the damage, allowing stroke survivors to maintain their independence and active involvement in life.9
Among the tertiary stroke prevention programmes, there are those where stroke survivors are sent to a nurse-led post-acute stroke clinic right after having been discharged from the acute stroke unit. The clinics are operated independently by stroke nurses who have extensive experience in providing stroke care.10 The stroke nurses in the clinics play a pivotal role in monitoring and supporting the health of stroke survivors after the acute phase of stroke. During a consultation, the stroke nurses follow structured stroke protocols, perform a comprehensive health assessment, reiterate education and self-care techniques and refer the stroke survivor to other healthcare professionals and community services based on the survivors’ condition and needs.10
There is evidence demonstrating that nurse-led post-acute stroke clinics have positive effects on reducing the risk of secondary stroke, improving quality of life and decreasing hospital readmission rates.11 12 These are all significant gains, both from perspective of the patient and for public finances. A local study also confirmed that the implementation of a structured tertiary stroke prevention programme in a nurse-led clinic served by stroke nurses led to an improvement in functional capacity and to fewer hospital readmissions for stroke survivors.12 However, despite its proven outcomes, a recent report showed that more than 15% of stroke survivors were not attending the clinic.13 Stroke survivors, particularly those who are physically disabled due to stroke, commented that the need to travel frequently to the nurse-led clinic after the acute phase of the disease made them unwilling to take part in the programme.14 Healthy stroke survivors, on the other hand, also hesitated to show up for their appointment in the clinic due to the long waiting time in the congested waiting room and the unavoidable travelling time and costs.15–17 Given that the use of technology in the field of healthcare has become increasingly prevalent, telecare consultations may be a viable option to help overcome some of these challenges and reduce the default rate of the nurse-led post-acute stroke clinics.
Telecare consultations have been defined as the use of real-time, audio-video communication tools such as Microsoft Teams to support long-distance virtual face-to-face encounters, in this case between healthcare providers and stroke survivors.18 19 With the application of telecommunication tools, a nurse can assess and monitor visual and verbal symptoms, observe posture and body language, and communicate with the stroke survivors as usual at a remote location. Telecare consultations may not only benefit stroke survivors with mobility restrictions who are having difficulty accessing customary healthcare services, but it may also reduce overcrowding in clinics and protect both healthcare providers and stroke survivors from being exposed to the risk of infection. The Department of Health in the USA also recognised the crucial role that telehealth consultations and promoted its use through a policy to waive the consultation fee if stroke survivors chose to use telecare as a medium to communicate with healthcare professionals during that critical period.20
Additionally, the use of telecare consultation can improve patient engagement and empowerment by showing them the educational resources and self-management tools via the screen, leading to better adherence to self-care routines and lifestyle modifications.19 This, in turn, can positively impact stroke-specific quality of life. Telecare consultations can also offer more frequent and flexible opportunities for psychological support, reducing feelings of isolation and depression.
While the advantages of using telecare consultations are apparent, this new technology has not always been welcomed by healthcare professionals and stroke survivors. Inadequate proficiency in using technology, concerns about the privacy, security, and confidentiality of the system, and the inability to conduct physical assessments, to name a few, are well-documented challenges in adapting telecare consultations in nurse-led clinics.21 22 In a recent systematic review, the effect of using communication tools was compared with traditional onsite consultations on the ability of stroke survivors to perform ADLs. It was found that the intervention programmes were varied and that there was insufficient evidence to support the use of these new technologies.23 Despite the wealth of publications on the use of telephone calls, applications or home monitoring devices by healthcare professionals for post-stroke follow-up care, there have been few studies examining the feasibility of adopting telecare consultations for stroke survivors.23 It remains uncertain whether telecare consultations can serve as a substitute for conventional face-to-face consultations.23
To the best of our knowledge, there is a scarcity of research examining the feasibility of telecare consultations in nurse-led clinics for both healthcare providers and stroke survivors. This study is needed to address this knowledge gap and to evaluate whether telecare consultations can effectively replace traditional face-to-face consultations. By doing so, we aim to provide evidence on the practicality, benefits and potential limitations of telecare consultations, which could inform future healthcare practices and policies for stroke survivors.
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