Objective Many unmet rehabilitation needs of patients with stroke can be addressed effectively using technology. However, technological solutions have not yet been seamlessly incorporated into clinical care. The purpose of this pilot study was to examine how to bridge the gaps between the recovery process, technology, and clinical practice to impact stroke rehabilitation meaningfully. Design Semi-structured interviews using a grounded theory approach with purposive sampling of 17 diverse expert providers in acute care, inpatient, and outpatient stroke rehabilitation settings. Common themes were identified from qualitative analyses of the transcribed conversations to develop a guiding framework from the emerging concepts. Results Four core themes emerged that addressed major barriers in stroke rehabilitation and technology-assisted solutions to overcome these barriers: 1) accessibility to quality rehabilitation, 2) adaptability to patient differences, 3) accountability or compliance with rehabilitation, and 4) engagement with rehabilitation. Conclusion The results suggest a four-pronged framework, the A3E framework which stands for Accessibility, Adaptability, Accountability and Engagement, to comprehensively address existing barriers in providing rehabilitation services. This framework can guide technology developers and clinicians in designing and deploying technology-assisted rehabilitation solutions for post-stroke rehabilitation, particularly using tele-rehabilitation. Corresponding author: Preeti Raghavan, MD, Address: 600 North Wolfe Street, Phipps Bldng. Suite 182, Baltimore, MD 21287. Phone number: 410-955-0703. Email: praghav3@jhmi.edu Acknowledgement of Funding: This work is supported in part by the National Science Foundation grants DRK-12 DRL: 1417769, ITEST DRL: 1614085, and RET Site EEC: 1542286; and NY Space Grant Consortium grant 76156-10488. Conflict(s)-of-Interest/Disclosure(s): All authors have completed the ICMJE uniform disclosure and declare no support from any organization for the submitted work; VK and PR have an issued patent on Game-based Sensorimotor Rehabilitator; PR reports consulting for Mirrored Motion Works, Inc., outside the submitted work. No other relationships or activities appear to have influenced the submitted work. Anna Palumbo is in training. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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