Feasibility Study Evaluates Swiss Telerehabilitation Program for Post-Stroke Transition Care

A single-center observational feasibility study evaluating the Swiss tele-assisted rehabilitation and training program, known as START, found that the digital health intervention demonstrated high technical stability, strong usability, and an acceptable safety profile for patients transitioning from inpatient to outpatient stroke rehabilitation. The findings, published in Frontiers in Digital Health within the Health Technology Implementation section, examined whether telerehabilitation could address a recognized challenge in post-stroke recovery. According to the research, intensive rehabilitation is crucial for functional recovery after a stroke, particularly during the subacute phase. However, therapy intensity often substantially declines after discharge from inpatient rehabilitation, prompting investigators to evaluate whether a structured blended care protocol could facilitate the transition from inpatient to outpatient care.

The investigated START program was introduced during the final two weeks of inpatient rehabilitation and continued for twelve weeks following discharge home. As a blended care mobile health intervention, START incorporated four core components: daily exercise, coaching, monitoring, and regular blood pressure measurements. Through this structured schedule spanning the end of hospital care and the initial months in the outpatient setting, the study evaluated the feasibility, safety, and performance of delivering tele-assisted support to stroke patients during the subacute transition phase.

To assess whether the intervention could be implemented effectively, the researchers evaluated predefined process-, training-, and mobile health-related feasibility criteria. These benchmarks included recruitment, safety, acceptance, adherence, dropout, system stability, usability, application quality, user satisfaction, and participant-perceived change. In addition to these primary feasibility domains, the trial tracked secondary functional and clinical outcomes across the intervention window, specifically examiner-rated disability, functional status, quality of life, life-space mobility, physical performance, and daily physical activity level.

Conducted by investigators across Swiss and German institutions including Reha Rheinfelden, the study enrolled 40 patients out of 94 informed candidates, reflecting a recruitment rate of 42.6 percent. Ultimately, 29 patients completed the study, with a mean age of 59.7 ± 13.7 years and with 11 of the 29 completers being female. The trial recorded an overall dropout rate of 27.5 percent, which exceeded the predefined feasibility threshold of 20 percent or lower. The researchers noted that participant retention represents an important parameter that will require optimization in future iterations of the intervention.

Safety and digital performance evaluations demonstrated favorable results throughout the observation period. Investigators reported that no serious protocol-related adverse events occurred among the enrolled participants. On the technical side, system stability was high, with the platform experiencing an average of 0.7 failures per week. Application quality was rated at 4.1 ± 0.5 out of 5 using the App Quality Assessment Tool for Health-Related Apps. Usability was similarly rated high by participants, scoring 88.3 ± 10.7 out of 100 on the System Usability Scale and 5.3 ± 1.1 out of 7 on the German mHealth Application Usability Questionnaire. Furthermore, overall patient satisfaction was high, recording a median rating of 8 out of 10 alongside positive perceived changes.

Participant adherence varied across intervention components and treatment settings. Adherence to prescribed physical training averaged 65.1 ± 31.4 percent during the inpatient preparatory period and 66.7 ± 29.9 percent during the outpatient phase. In contrast, compliance with physiological tracking was higher, with adherence to scheduled blood pressure measurements recorded at 79.0 ± 27.6 percent during inpatient care and 83.6 ± 20.3 percent during outpatient rehabilitation. The authors noted that while blood pressure monitoring showed high compliance across both environments, training adherence remained modest and will require dedicated strategies to enhance engagement.

The study also documented changes across secondary functional, mobility, and physical activity outcomes from baseline to post-intervention follow-up. Overall disability assessed via the examiner-rated modified Rankin Scale decreased from a baseline median score of 2 to a median score of 1. Physical performance and functional mobility tests showed corresponding numerical changes. Times recorded on the Timed Up and Go test decreased from 13.7 ± 14.3 to 10.3 ± 8.9. Performance scores on the Short Physical Performance Battery shifted from a median of 10 to 11, and Trunk Impairment Scale scores increased from a median of 17 to 20. In daily mobility and routine activity, life-space mobility expanded from 55.9 ± 33.4 to 80.1 ± 27.3, and recorded moderate-to-vigorous physical activity rose from 58.1 ± 41.5 to 83.0 ± 46.4 minutes per day.

The authors concluded that the START program was well accepted, technically stable, and appeared feasible with an acceptable safety profile for supporting the transition from inpatient to outpatient stroke rehabilitation. However, both participant dropout and training adherence require optimization before wider clinical implementation. Because this single-center observational feasibility study was conducted without a randomized comparator group, the researchers concluded that these promising findings warrant further evaluation of the START intervention compared with conventional care in a randomized controlled trial.

Subject of Research: Feasibility and safety evaluation of a post-stroke telerehabilitation transition program

Article Title: START—the Swiss tele-assisted rehabilitation and training program to support transition from inpatient to outpatient care in the subacute phase after a stroke: results of the feasibility, safety and performance evaluation

Article References: Gäumann, S., Ziller, C., Paulissen, N., Behrendt, F., Suica, Z., Augstburger, M., Matsushita, S. M., Schneider, P. L., Crüts, B., Gammerschlag, L., Parmar, K., Gerth, H. U., Bonati, L. H., & Schuster-Amft, C. (2026). START—the Swiss tele-assisted rehabilitation and training program to support transition from inpatient to outpatient care in the subacute phase after a stroke: results of the feasibility, safety and performance evaluation. Frontiers in Digital Health, 8, Article 1936375. https://doi.org/10.3389/fdgth.2026.1936375

Image Credits: AI Generated

DOI: 10.3389/fdgth.2026.1936375

Keywords: stroke rehabilitation, telerehabilitation, mHealth, feasibility study, subacute stroke, digital health, patient adherence, transitional care, START, Swiss, tele-assisted, rehabilitation