Discussion
disability, cognitive impairment, ’
ADVERSE EVENTS
In the present study, we explored the efficiency and effectiveness of a telerehabilitation model with an asynchronous modality, named ABILITY, to deliver rehabilitation care in a well-characterized cohort of subjects with mild to moderate stages of the AD continuum. We found that the ABILITY telerehabilitation treatment efficiently guarantees patients’ adherence to the treatment, an adaptable level of difficulty, and a usable and safe experience.Concerning adherence, the ABILITY group fully followed six weeks of intervention at home, while the active control group trended towards disengagement after the fourth week. Also, the adaptability of the cognitive activities of the ABILITY program guaranteed a perception of balance between perceived own and the required ability to perform planned sessions. On the contrary, we registered a perceived unbalanced level of difficulty in the paper-and-pencil activities during the last sessions in the control group. These results demonstrate the beneficial effect of delivering telerehabilitation both for the engagement of patients and for the potential management of the rehabilitation activity over time, in accordance with the literature [The ABILITY system was judged as usable by caregivers and patients, although learnability was lower for the latter, indicating a higher amount of time to learn how to use the product. This is not unexpected since the level of cognitive impairment has been demonstrated to be inversely related to everyday technology usage [Moreover, safety, an essential efficiency component, was confirmed because no adverse events were registered during the trial. Our effectiveness pilot findings suggested the ABILITY treatment effect at multidimensional levels, both in the short and long term. In fact, our data revealed a major impact of the treatment at T1 in the ABILITY group compared to the TAU group, not only at the global cognitive level but also in language, motor perceptual, and neurocognitive memory domains. Interestingly, we observed that only the ABILITY group maintained these latter effects over the follow-up period, suggesting the long-term capacity of the benefits provided by the treatment, especially in the global cognitive level and language domain. On the contrary, although following the conventional recommendations for continuity of care, the control group worsened cognitive functioning over time. These 1-year follow-up results align with a previous study [The maintenance of the cognitive level for one year was also reflected by behavioral symptoms, whose frequency differed between groups after one year, with a considerable worsening in the control group, as reported by the caregivers. Consistent effects of ABILITY rehabilitation were also observed for caregivers, who reported decreased perception of distress related to the carer’s assistance, in line with a recent study investigating frailty in older adults [These findings are relevant in that they likely suggest, for the first time with a 1-year trial, the potential of telerehabilitation with an asynchronous approach capable of scaling up rehabilitation to a broader population of patients outside the clinic. In fact, ABILITY telerehabilitation enables remote monitoring, feedback, and the modification of individualized patient-centered rehabilitation over time according to the patient’s actual progress.Our study is limited to pilot evidence, and future studies need to confirm the results with a broader sample of people with a more varied degree of disability. Also, future telerehabilitation trials should include a phase of familiarization with technologies for the participants before starting the rehabilitation program. This would minimize the potential lack of familiarity with technology in older people, thus enhancing human-technology interaction. Moreover, an additional comparison between usual care clinic treatment and home-based personalized programs will be helpful for future analyses of costs and access. Finally, further contributions will also address the subjective experience of patients and caregivers during home-based personalized programs adopting a mixed (qualitative-quantitative) model approach.The results from this pilot randomized controlled study suggest ABILITY telerehabilitation is efficient and likely effective. The proposed treatment is a promising intervention for enhancing environmental, social, and functional resources and preserving cognitive abilities.