Telerehabilitation After Stroke Using Readily Available Technology: A Randomized Controlled Trial

 Make sure that your therapists and doctors understand that you want 100% recovery. NOTHING LESS! Screaming may be required.

Telerehabilitation After Stroke Using Readily Available Technology: A Randomized Controlled Trial

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Nicola L. Saywell, PhD, Alain C. Vandal, PhD, Suzie Mudge, PhD, ...

First Published November 16, 2020 Research Article Find in PubMed 

https://doi.org/10.1177/1545968320971765

Article information

 

Abstract

Background

The number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation.

Objective

To investigate whether ACTIV improved physical function compared with usual care.

Methods

This 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants’ homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control.

Results

A total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P = .07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P = .04). Improvements in physical function were not maintained at the 12-month follow-up.

Conclusions

ACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.

Keywords telerehabilitation, stroke, randomized controlled trial

Introduction

International guidelines recommend that stroke rehabilitation should continue until agreed goals(THIS is the whole problem; The stroke medical team has dumbed down the goals to make sure the tyranny of low expectations can be met. 100% RECOVERY IS THE ONLY GOAL IN STROKE. GET THERE!) are reached, with regular reassessment to ensure gains are maintained.^1-3 Unfortunately, limited health budgets mean that this is unattainable for most publicly funded health services. Using standard mobile phones to deliver rehabilitation offers a potential solution. Mobile phones have been used to support people with coronary heart disease to modify risk⁴ and to increase physical activity in sedentary adults.⁵ However, the effectiveness of using mobile phones to deliver stroke rehabilitation to improve physical function and reduce the sedentary behavior that frequently occurs after hospital discharge⁶ has not been investigated.

The Augmented Community Telerehabilitation Intervention (ACTIV) is a structured 6-month program developed by a team of clinicians and researchers in neurological rehabilitation.⁷ The program uses a combination of face-to-face sessions, telephone contact, and text message reminders to support ongoing physical activity. The intervention was developed based on clinical expertise, the findings from a feasibility and acceptability trial,⁸ and theoretical principles drawn from Bandura’s theory of behavior change.⁹ A core tenet of Bandura’s theory is that people are motivated by anticipation of achievement and self-efficacy, which is defined as a person’s belief in their ability to effect change. Bandura asserted that people are proactive and aspirational, so planning to achieve challenging goals increases effort. In turn, this helps people persist in activities and leads to behavior change. The objective of the present study was to determine if ACTIV improved physical function for people with stroke compared with a usual care control group. Secondary objectives were the maintenance of any gains at 12 months and changes in physical performance, stroke self-efficacy, health outcomes, and quality of life.

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