How equitable is digital rehabilitation for people after stroke? A systematic review using an equity approach

Abstract

Introduction: Stroke is the largest global cause of adult neuro-disability. Health inequities increase the risk of stroke and are likely to influence overall recovery. Rehabilitation after stroke seeks to restore function and independence and may utilise digital technologies to augment usual care. This study systematically investigates the reporting of equity factors in digital stroke rehabilitation research. Methods: This systematic review examined equity factors contained in the PROGRESS-Plus framework in a random sample of clinical trials of technologies used as part of stroke rehabilitation published in 2011-2021. Four reviewers double-screened titles and abstracts of 14,724 papers. A random selection was carried out across all potentially eligible papers (n=821) and 135 papers were reviewed for data extraction. Each study was coded with 36point PROGRESS-plus criteria for inclusion, exclusion, and baseline characteristics. ANOVA and multivariable linear regression were used to assess the variation in PROGRESS-Plus reporting by year of publication, location, type of technology used, intervention target, number of comparison groups and sample size. Results: 87 studies were included with a mean PROGRESS-Plus score of 7.05 (SD=2.06), minimum score of 0 and maximum score of 14. Despite their importance to health outcomes, education, social capital and socioeconomic status were reported by less than 5% of studies. The most commonly reported equity factors were age, disability and gender. There were no significant differences in reporting by technology used, target of the intervention (upper or lower limb), sample size, location, number of comparison groups and sample size. Variation in equity reporting was not explained through multiple linear regression factors. There was a small positive correlation between the year of publication and the PROGRESS-Plus score (r=.26, n=87, p<0.05).Discussion: Few studies of digital rehabilitation interventions considered several key equity factors, including those recognised to precipitate digital exclusion and influence health.