Understanding how stroke telerehabilitation works and for whom to inform recommendations for practice: The TELSTAR study protocol

Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high quality, equitable community-based stroke rehabilitation and under what conditions. Using a realist approach, we will synthesise information from: 1) a comprehensive evidence review; 2) qualitative interviews with clinicians (n≤30), and patient-family carer dyads (n≤60), from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service users and policy makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of realist methodology and co-production to inform evidence-based recommendations which consider the needs and priorities of clinicians and people affected by stroke.