Abstract
BackgroundRecovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke.MethodsA multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up.ResultsDuring 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist.ConclusionsWe hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services.Trial registrationNetherlands Trial Register, NL7422. Registered 11 December 2018.
Highlights
Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home
Patients still experience an abrupt and disjointed care transition when professional support from an Early Supported Discharge (ESD) team dwindles and caregivers would benefit from more support and training [12]
The training program is developed to achieve important milestones for community ambulation [20, 21] and dyads are supported by a web-based telerehabilitation system with individualized goals, exercise videos and a messaging environment to communicate with their physiotherapist
Summary
Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Professional support tapers off and the majority of home-dwelling stroke patients are physically inactive [4]. Supported Discharge (ESD) services were developed to improve the transition and facilitate community reintegration by accelerating inpatient discharge and providing an equivalent level of rehabilitation at home [9]. Patients still experience an abrupt and disjointed care transition when professional support from an ESD team dwindles and caregivers would benefit from more support and training [12]. Strategies to improve mobility in the first months poststroke and smoothen the care transition are needed to facilitate and complement current ESD services
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