AUTHOR=Kamalakannan Sureshkumar , Karunakaran Vijay , Balaji Ashwin , Vijaykaran Aadi Sai , Ramachandran Sivakumar , Nagarajan Ramakumar 

TITLE=Evaluation of the feasibility and acceptability of ReWin—A digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.936787

DOI=10.3389/fneur.2022.936787

ISSN=1664-2295

ABSTRACT=Background: Developing culturally appropriate, scalable interventions to meet the growing needs for stroke rehabilitation is a significant problem of public health concern. Therefore, systematic development and evaluation of a scalable, inclusive, technology-driven solution for community-based stroke care are of immense public health importance in India. ReWin is a digital therapeutics platform that was developed systematically. 
Objectives:
To assess the feasibility and acceptability of ReWin intervention in an Indian context.
Methods:
Design: Mixed-methods research design.
Setting: Participant’s home and rehabilitation centers. Participants were selected from rehabilitation centers in South India.
Participants: 10 stroke survivors and their caregivers, as well as 4 rehabilitation service providers were recruited for phase 1. 30 stroke survivors who were treated and discharged from the hospital, and their caregivers as well as 10 rehabilitation service providers were recruited for Phase 2.
Intervention: ‘ReWin is a digital therapeutic platform with the provider and patient app for the rehabilitation of physical disabilities following stroke was piloted. 
Process: In the first phase, the preliminary intervention was field-tested with 10 stroke survivors and four rehabilitation service providers for 2 weeks. In the second phase, the finalised intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers as well as to 10 rehabilitation service providers for 4 weeks.
Outcome measures:
Primary outcomes: (1) operational difficulties in using the ReWin intervention; (2) feasibility and acceptability of the ReWin intervention in an Indian setting. 

Results: Field-testing identified operational difficulties related to 1. Therapeutic content; 2. Format; 3. Navigation; 4. Connectivity, 5. Video-streaming, 6. Language; and 6. Comprehensibility of the animated content. Findings from the pilot testing showed that the ReWin intervention was feasible and acceptable. 40% of the stroke survivors and caregivers rated ReWin intervention as excellent. Another 45% of the stroke survivors and caregivers as well as 90% of the stroke care providers rated ReWin intervention as very good based on its overall credibility, usability, and user-friendliness. 

Conclusions: It is critical to amalgamate ReWin and other evidence-based interventions for rehabilitation to innovate scalable solutions and promote universal health coverage for stroke care worldwide.