Open Access Study protocol

Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial

Nicola Saywell1*, Alain C Vandal12, Paul Brown5, H Carl Hanger3, Leigh Hale4, Suzie Mudge1, Stephan Milosavljevic4, Valery Feigin6 and Denise Taylor1

Author Affiliations

1 Health and Rehabilitation Research Institute, AUT University, Private Bag 92006, Auckland, 1142, New Zealand

2 Centre for Research, Knowledge and Information Management, Counties Manukau District Health Board, Auckland, New Zealand

3 Older Persons Health Specialist Services, Canterbury District Health Board, Christchurch, 8140, New Zealand

4 Centre for Physiotherapy Research, University of Otago, Dunedin, 9054, New Zealand

5 Health Sciences Research Institute, University of California, Merced, CA, 95343, USA

6 National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand

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Trials 2012, 13:233  doi:10.1186/1745-6215-13-233

Published: 5 December 2012

Abstract

Background

In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent.

Methods/design

This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study.

Discussion

The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home.

Trial registration

ACTRN12612000464864

Keywords:
Stroke; Telerehabilitation; Transition; Resources; Cost-effective; Exercise; Physiotherapy