Authors' objectives:

"Objective was to evaluate the available data on the use of telehealth to deliver health services to acute stroke patients. This report describes: 1) a systematic review of the peer-reviewed literature on the impact of telestroke initiatives on health outcomes, process of care (e.g., access to health services), health resources, and user satisfaction 2) an environmental scan of organizations that provide acute telestroke services of relevance to Canadian policy makers." (executive summary)

Authors' results and conclusions: The systematic review included 22 original studies from the 863 citations identified. The included studies had diverse designs, interventions, and outcomes, precluding a meta-analysis. Eight studies were judged to be of high quality using standardized quality assessment tools. Most study reports included outcomes related to process of care issues and reported improved access to thrombolysis, acceptable "door-to-needle times" (time elapsed from the patient's arrival in hospital and the start of thrombolysis), and a decreased need to transfer patients across institutions. Three and six month postevent functional outcomes using telestroke services were comparable with those of face-to-face stroke care. Mortality rates were also similar. Patients and health care providers reported high levels of satisfaction, although few studies assessed this outcome in detail. Several telerehabilitation studies were identified during the search on telehealth services for post-acute stroke management. Although it is difficult to draw conclusions from this small sample of studies, the trend suggests that in poststroke patients, telehealth led to improvements in caregivers- mental health and high levels of patient satisfaction. There was minimal evidence regarding the impact on resource utilization. The environmental scan identified 15 telestroke programs worldwide, with more than half of them in North America. Programs had different approaches to staffing the centres, determining catchment areas, and measuring the number of interventions.

Authors' recommendations: Stroke is a neurological condition that affects many Canadians, resulting in socioeconomic costs. The use of thrombolysis that is delivered within a narrow window of time after the presentation of symptoms has been shown to significantly reduce the burden of illness. The use of telestroke seems to improve access to the administration of thrombolysis, could reduce the number of poor outcomes three and six months post-stroke, and may improve the quality of care in acute stroke management. Two studies assessed patient satisfaction. Both documented high levels of acceptability. It is unclear, however, whether this modality is cost-effective and safe relative to faceto- face care. The evidence obtained for the use of telestroke in the rehabilitation of post-stroke survivors was not exhaustively reviewed, so no conclusions could be drawn. The few articles that were identified, however, suggest a trend towards improved caregivers' well-being. More research is warranted to determine the impact of telehealth on post-stroke care. While several organizations have been identified to be at the forefront of telestroke, the lack of standardized reporting of resources and outcomes precludes comparisons among programs and the determination of best practices. The use of telestroke services seems to reduce inappropriate variations in practice. The recent creation of two programs in Canada opens the door for collaborative efforts that could lead to standardized evaluation frameworks, economies of scale for knowledge transfer, and a better understanding of the safety and resource implications of the services that they offer. Telestroke, like telehealth in general, transcends distance and geographic boundaries. Canada has made strides in many areas of telehealth. The availability of picture archiving and communication systems (PACS) in almost 20% of all Canadian hospitals and free-standing imaging facilities (Canadian Institute for Health Information, 2005 figures) provides the foundation for telestroke care to play a greater role in Canada. The emerging telestroke programs, and their financial and political Telehealth for Acute Stroke Management (Telestroke): Systematic review of analytic studies and environmental scan of relevant initiatives backers, have an opportunity to join efforts that could place Canada at the forefront of telestroke care, while ensuring that Canadians have access to the services that they expect, regardless of where they live.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://cadth.ca/index.php/en/hta/reports-publications/search/publication /783

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)