NeuroRehabilitation OnLine (NROL)

NeuroRehabilitation OnLine (NROL) - a real time stroke rehabilitation delivery model offering online group therapy

Adam Partington, Neuro Rehabilitation OnLine Operational Lead, East Lancashire Hospitals NHS Trust; Neuro Rehabilitation Online (NROL)

Stroke survivors need intensive rehabilitation to regain function, but many cannot access enough therapy due to travel, time constraints, or a lack of local services and a shortage of therapists.

NeuroRehabilitation OnLine (NROL) enables patients to access therapy from home via online sessions, supported by a digital platform and app (Autonom-e).

NROL transforms community neurorehabilitation, enabling services to deliver more intensive, accessible, efficient and sustainable care to more patients within existing constraints.

The SBRI Healthcare programme enabled the evaluation of NROL and supported its expansion to improve patient access to rehabilitation services for stroke recovery. Findings showed that the NROL model, enhanced by the Autonom-e digital platform, delivers significant efficiency and productivity gains aligned with NHS priorities and NROL represents a scalable and replicable model across regions.

Patients receive approximately 4.6 times more therapy than standard of care through group-based digital sessions, allowing services to increase output without proportional increases in staffing. This allows for more efficient workforce use, with staff-to-patient ratios of 0.2–0.4, compared to near 1:1 in traditional care.

Clinical outcomes demonstrate clinical effectiveness alongside strong acceptability. 60–75% of patients improve or maintain their status, with 29–40% achieving clinically significant improvement. Functional outcomes also improve significantly, with 82–86% of patients showing improvement or stability. Patient experience is highly positive. Around 94% rate NROL as good or very good, 89% consider it important to their rehabilitation, and up to 91% value peer support.

NROL also generates significant resource savings. By removing clinician travel, the model avoids 37,000– 47,000 miles annually, frees 1,250–1,650 clinical hours, and delivers £22k–£28k in annual cost savings. It also contributes to sustainability, reducing carbon emissions by 11.5–15.2 tons of kgCO2 per year.

• Commissioned by Lancashire and South Cumbria ICB
• 5 jobs safeguarded
• Key partnerships developed with Elaros 24/7 (which will provide a Free lifetime digital system 'Autonom-e' licence), HIN North West Coast, Lancaster University, SameYou
• 11,523-15,213 kgCO2 saved annually alongside 37,777-47,311 miles of avoided travel
• Awarded Region Champion for 'Patient choice' at the NHS excellence awards
• Won an Advancing Healthcare Award for 'Best Collaboration across Clinical, Academia and Industry'

• 787 patients benefitted
• Patient experience was highly positive - 94% good or very good, 89% consider it important to their rehabilitation and 91% value peer support
• 60-75% improved or maintained quality of life >82-86% improved functional outcomes (across mobility, speech, confidence & wellbeing – improved motivation, self-management and reduced isolation)
• Pro-equity innovation that removes structural barriers, embeds digital inclusion, and adapts through patient feedback

• Implemented in 21 different therapy teams across 14 NHS hospitals
• 4.6x greater therapy intensity without the need for a proportional increase in staffing (staff-to-patient ratios of 0.2-0.4 vs ~1:1 in traditional care)
• Frees up to 1,658 clinical hours per year
• £22k-£28k annual cost savings – cost per contact reduced ~81% (from £59 to £11)
• Increased access and reduced waiting times
• Reduced admin through digital workflows

"Seeing patients empower each other changed the whole feel of rehab."

"NROL is increasing consistency between what is offered in face-to-face and online."

August 2026