Telehealth interventions for stroke management and rehabilitation in low-and middle-income countries: A scoping review

Introduction: The burden of stroke is higher in low- and middle-income countries (LMICs) than in high-income countries due to the lack of stroke care centers, stroke specialist, and rehabilitation access. One way to increase access to stroke care in LMICs is through the use of telehealth. Material & method: We performed a scoping review to summarize the evidence on telehealth in LMICs. We searched Medline, SCOPUS, and Web of Science through February 18th, 2022. Reviewers screened for studies reporting on health outcomes following telehealth interventions (imaging, thrombolysis, and rehabilitation) in LMICs. We included all study designs. Results: Out of 259 studies, 10 studies met the eligibility criteria. Nine reported on functional or disability measures, 6 reported on cerebral infarction or intracerebral hemorrhage, 5 reported on door-to-needle time to thrombolysis, and 6 reported on mortality rate. Out of 9 studies, 8 reported that the use of telehealth for stroke management and rehabilitation in LMICs has led to a decrease in the degree of post-stroke disability. However, the comparison group may have received no rehabilitation treatment at all in LMICs. All 5 studies that measured administration of thrombolytic therapy in respective telehealth interventions were within the recommended 3hour time window. Studies with a comparison arm found that there was no significant difference in mortality and cerebral infarction/intracerebral hemorrhage rates between telehealth and control. Conclusion: Evidence from this review suggests that telehealth may improve post-stroke disability and facilitate the timely administration of thrombolytics therapy within the 3-hour window by allowing remote access to distant tertiary stroke care center in situations where it would otherwise be delayed in LMICs due to logistical barriers such as an extended travel time. Further research using randomized and quasi-experimental studies are needed in LMICs to determine the overall effectiveness of telehealth intervention for stroke management and rehabilitation.