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
11 affiliations
- 1Research and Innovation, Reha Rheinfelden, Rheinfelden, Switzerland
- 2Physiotherapy Department, Reha Rheinfelden, Rheinfelden, Switzerland
- 3School of Engineering and Computer Science, Bern University of Applied Sciences, Biel, Switzerland
- 4Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- 5Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- 6Institute for Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
- 7Ozyra GmbH, Nuremberg, Germany
- 8Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- 9Department of Medicine, University Hospital Münster, Münster, Germany
- 100Stroke Center and Department of Neurology, University Hospital Basel, Basel, Switzerland
- 111Department of Clinical Research, University of Basel, Basel, Switzerland
Abstract
IntroductionIntensive rehabilitation is crucial for functional recovery after stroke, particularly during the subacute phase. However, therapy intensity often substantially declines after discharge from inpatient rehabilitation. This study evaluated the feasibility, safety, and performance of the Swiss tele-assisted rehabilitation and training program (START) facilitating transition from inpatient to outpatient stroke rehabilitation.MethodsThis single-center observational feasibility study enrolled 40 patients. START was introduced during the last two weeks of inpatient rehabilitation and continued for 12 weeks after discharge. START included daily exercise, coaching, monitoring and blood pressure measurements. Feasibility was assessed using predefined process-, training-, and mHealth-related criteria including recruitment, safety, acceptance, adherence, dropout, system stability, usability, quality, satisfaction, and perceived change. Secondary outcomes included disability, functional status, quality of life, life-space mobility, physical performance and activity level.ResultsOf the 94 informed patients, 40 were enrolled (recruitment rate 42.6%); 29 patients (59.7 ± 13.7 years, 11/29 females) completed the study. Dropout rate was 27.5%, exceeding the predefined threshold (≤20%). No serious protocol-related adverse events occurred. Training adherence was 65.1 ± 31.4% during inpatient and 66.7 ± 29.9% during outpatient rehabilitation. Adherence to blood pressure measurements was 79.0 ± 27.6% and 83.6 ± 20.3%, respectively. System stability was high (0.7 failures/week). Usability was rated high (System Usability Scale: 88.3 ± 10.7/100; German mHealth Application Usability Questionnaire: 5.3 ± 1.1/7), and application quality was rated 4.1 ± 0.5/5 on the App Quality Assessment Tool for Health-Related Apps. Patient satisfaction was high (median 8/10), and patients reported positive changes. Functional outcomes changed, including examiner-rated modified Rankin Scale (median 2 to 1), Timed Up and Go (13.7 ± 14.3 to 10.3 ± 8.9), Short Physical Performance Battery (median 10 to 11), Trunk Impairment Scale (median 17 to 20), life-space mobility (55.9 ± 33.4 to 80.1 ± 27.3), and moderate-to-vigorous physical activity (58.1 ± 41.5 to 83.0 ± 46.4 min/day).Discussion and conclusionSTART was well accepted, technically stable, and appeared feasible with an acceptable safety profile for supporting transition from inpatient to outpatient stroke rehabilitation. However, dropout and training adherence require optimization. These findings warrant further evaluation of START compared with conventional care in a randomized controlled trial.
Related
- Integrating Wearable Sensor Technology into Outpatient Rehabilitation Care: A Proof-of-Concept Study
- Performance of large language models in postoperative hip fracture rehabilitation counseling for older adults: a comparative evaluation of safety, accuracy, reliability, readability, and empathy
- Patient factors influencing participation in aerobic exercise during inpatient and outpatient rehabilitation post stroke: a prospective cohort study
- A feasibility study to empower patients with individualised physical rehabilitation through wearable technology: The potential of the ‘RehabBuddy’ system
- Feasibility and safety of early bedside personalized rehabilitation in acute decompensated heart failure: a pilot randomized trial
BibTeX
@article{gaumann2026startthe,
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}},
author = {Szabina Gäumann and Carina Ziller and Carina Ziller and Nele Paulissen and Nele Paulissen and Frank Behrendt and Frank Behrendt and Zorica Suica and Zorica Suica and Mara Augstburger and Sarina Mai Matsushita and Philipp Lars Schneider and Björn Crüts and Luana Gammerschlag and Katrin Parmar and Katrin Parmar and Hans Ulrich Gerth and Hans Ulrich Gerth and Leo H. Bonati and Leo H. Bonati and Leo H. Bonati and Corina Schuster-Amft and Corina Schuster-Amft and Corina Schuster-Amft},
journal = {Frontiers in Digital Health},
year = {2026},
month = nov,
doi = {10.3389/fdgth.2026.1936375},
url = {https://doi.org/10.3389/fdgth.2026.1936375},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Szabina Gäumann
AU - Carina Ziller
AU - Carina Ziller
AU - Nele Paulissen
AU - Nele Paulissen
AU - Frank Behrendt
AU - Frank Behrendt
AU - Zorica Suica
AU - Zorica Suica
AU - Mara Augstburger
AU - Sarina Mai Matsushita
AU - Philipp Lars Schneider
AU - Björn Crüts
AU - Luana Gammerschlag
AU - Katrin Parmar
AU - Katrin Parmar
AU - Hans Ulrich Gerth
AU - Hans Ulrich Gerth
AU - Leo H. Bonati
AU - Leo H. Bonati
AU - Leo H. Bonati
AU - Corina Schuster-Amft
AU - Corina Schuster-Amft
AU - Corina Schuster-Amft
PY - 2026
DA - 2026/11/04
JO - Frontiers in Digital Health
DO - 10.3389/fdgth.2026.1936375
UR - https://doi.org/10.3389/fdgth.2026.1936375
AB - IntroductionIntensive rehabilitation is crucial for functional recovery after stroke, particularly during the subacute phase. However, therapy intensity often substantially declines after discharge from inpatient rehabilitation. This study evaluated the feasibility, safety, and performance of the Swiss tele-assisted rehabilitation and training program (START) facilitating transition from inpatient to outpatient stroke rehabilitation.MethodsThis single-center observational feasibility study enrolled 40 patients. START was introduced during the last two weeks of inpatient rehabilitation and continued for 12 weeks after discharge. START included daily exercise, coaching, monitoring and blood pressure measurements. Feasibility was assessed using predefined process-, training-, and mHealth-related criteria including recruitment, safety, acceptance, adherence, dropout, system stability, usability, quality, satisfaction, and perceived change. Secondary outcomes included disability, functional status, quality of life, life-space mobility, physical performance and activity level.ResultsOf the 94 informed patients, 40 were enrolled (recruitment rate 42.6%); 29 patients (59.7 ± 13.7 years, 11/29 females) completed the study. Dropout rate was 27.5%, exceeding the predefined threshold (≤20%). No serious protocol-related adverse events occurred. Training adherence was 65.1 ± 31.4% during inpatient and 66.7 ± 29.9% during outpatient rehabilitation. Adherence to blood pressure measurements was 79.0 ± 27.6% and 83.6 ± 20.3%, respectively. System stability was high (0.7 failures/week). Usability was rated high (System Usability Scale: 88.3 ± 10.7/100; German mHealth Application Usability Questionnaire: 5.3 ± 1.1/7), and application quality was rated 4.1 ± 0.5/5 on the App Quality Assessment Tool for Health-Related Apps. Patient satisfaction was high (median 8/10), and patients reported positive changes. Functional outcomes changed, including examiner-rated modified Rankin Scale (median 2 to 1), Timed Up and Go (13.7 ± 14.3 to 10.3 ± 8.9), Short Physical Performance Battery (median 10 to 11), Trunk Impairment Scale (median 17 to 20), life-space mobility (55.9 ± 33.4 to 80.1 ± 27.3), and moderate-to-vigorous physical activity (58.1 ± 41.5 to 83.0 ± 46.4 min/day).Discussion and conclusionSTART was well accepted, technically stable, and appeared feasible with an acceptable safety profile for supporting transition from inpatient to outpatient stroke rehabilitation. However, dropout and training adherence require optimization. These findings warrant further evaluation of START compared with conventional care in a randomized controlled trial.
SN - 2673-253X
ER -