December 14, 2020
By: Brian Harris, CEO & Co-Founder, MedRhythms
The COVID-19 pandemic has severely impacted stroke survivors across all phases of recovery, and with far-reaching consequences. The increase in the number of stroke patients presenting to hospital and care facilities as well as the significantly interrupted progress in management of stroke recovery have left acute, subacute and chronic populations more vulnerable than ever. As early interventions are considered key for a strong recovery, COVID-exacerbated barriers to receiving care are negatively impacting stroke survivors’ long-term health and wellbeing, leaving those in earlier phases of recovery in particular with little recourse. In searching for ways to provide continuity of care for stroke survivors during the ongoing pandemic, digital therapeutics present a unique opportunity to "close the gaps” in recovery management and rehabilitative care.
A 2020 meta-analysis published by the National Library of Medicine showed that during the pandemic, emergent stroke care, including the number of stroke alerts, reperfusions, and mechanical thrombectomies, was reduced by 36%, 31%, and 22%, respectively. Attempting to explain this reduction, The Neurohospitalist Society postulated that “the etiology of this phenomenon is either strict ‘social distancing’ that some people may misperceive to exclude even emergent situations, or fears of contracting the virus while hospitalized.” Now, months in the future and still embroiled in the same crisis, we have even more evidence from around the world to corroborate these hypotheses. For example, the UK Stroke Association’s recent survey of more than 2,000 stroke survivors and their families showed that 29% of patients who suffered a stroke during the pandemic admitted that they delayed calling health care services because of fear of contracting COVID-19 if admitted to the hospital.
While these are legitimate concerns during a pandemic, seeking medical attention during or after a stroke has shown to significantly improve outcomes and save lives. That said, as providers struggle to encourage individuals experiencing stroke symptoms to seek medical attention, stroke survivors who have opted to receive care – in some cases – have reported receiving lower quality care, in part due to the reallocation of resources to COVID-19 patients. The UK Stroke Association found that, of those who had a stroke in 2019 (before the pandemic), 34% said the quality of the care they received declined during the pandemic.
In analyzing the impact that COVID-19 has had on stroke care, less often considered is how subacute populations have been affected by limited access to rehab facilities and other forms of non-emergent care. According to the UK Stroke Association, while 70% of stroke survivors felt satisfied with care received in the hospital, half had therapy appointments or home care visits cancelled or postponed and 55% did not feel safe to go to scheduled appointments. Even when outpatient centers are open, stroke survivors’ access may remain limited due to a variety of factors, such as access to safe transportation, ability to pay and motivation. For those who are able to access in-person therapy during this time, interventions may be less effective, given that traditional physical therapy interventions often rely on hands-on protocols and therapists are doing their best to remain at safe distances during their sessions.
Because digital therapeutics provide the opportunity to administer personalized care at a distance, they represent an important “missing link” in our current approach to stroke recovery management. Imagine that a stroke survivor had been relying on neurologic music therapy to improve their gait, but once the pandemic hit, they became unable to attend in-person therapy sessions. Instead of “pressing pause” on their recovery and missing a valuable window of time, the stroke survivor could use a digital therapeutic intervention comprised of clinical-grade sensors, AI-driven software and personalized music to assist them while they continue their recovery process from a safe social distance. Because subacute stroke survivors had long reported barriers to proper rehabilitative care prior to the pandemic and certainly will continue to afterward, digital therapeutics present not only a solution to providing care during this uncertain time, but also a long-term solution for any stroke survivor who may find care to be more effective in a home-based setting, where they can engage with their recovery on their own terms. The widespread availability of a digitally-driven approach to recovery for stroke survivors would increase care access dramatically—patients in rural areas, patients without personal transportation, patients without caregivers, patients who are anxious about recovery and therefore more comfortable at home, etc. could all access high quality care that would be otherwise out of reach.
This pandemic has reminded us that the system for treating stroke survivors post-discharge has areas for improvement. While it’s important for health care systems to implement protocols that mitigate risk of virus transmission and to devote the time, attention and resources necessary to fighting the pandemic, we can’t overlook the impact of the pandemic on patients without COVID-19—namely, stroke survivors. Combatting the COVID-19 pandemic is vital to the state of public health but doing so should not come at the expense of those who already occupy a vulnerable place in our society. It is imperative that we revisit the usual standards of care to protect patients and caregivers, preserve critical care capacity, and to embrace deep transformation of health care systems in order to make high-quality care a reality for all.