Abstract
Background and purposeWe designed an 8-week caregiver-mediated exercise program with e-health support after stroke (CARE4STROKE) in addition to usual care with the aim to improve functional outcome and to facilitate early supported discharge by increasing the intensity of task specific training.MethodsAn observer-blinded randomized controlled trial in which 66 stroke patient-caregiver couples were included during inpatient rehabilitation. Patients allocated to the CARE4STROKE program trained an additional amount of 150 minutes a week with a caregiver and were compared to a control group that received usual care alone. Primary outcomes: self-reported mobility domain of the Stroke Impact Scale 3.0 (SIS) and length of stay (LOS). Secondary outcomes: motor impairment, strength, walking ability, balance, mobility and (Extended) Activities of Daily Living of patients, caregiver strain of caregivers, and mood, self-efficacy, fatigue and quality of life of both patients and caregivers. Outcomes were assessed at baseline, 8 and 12 weeks after randomization.ResultsNo significant between-group differences were found regarding SIS-mobility after 8 (β 6.21, SD 5.16; P = 0.229) and 12 weeks (β 0.14, SD 2.87; P = 0.961), and LOS (P = 0.818). Significant effects in favor of the intervention group were found for patient’s anxiety (β 2.01, SD 0.88; P = 0.023) and caregiver’s depression (β 2.33, SD 0.77; P = 0.003) post intervention. Decreased anxiety in patients remained significant at the 12-week follow-up (β 1.01, SD 0.40; P = 0.009).ConclusionsThis proof-of concept trial did not find significant effects on both primary outcomes mobility and LOS as well as the secondary functional outcomes. Treatment contrast in terms of total exercise time may have been insufficient to achieve these effects. However, caregiver-mediated exercises showed a favorable impact on secondary outcome measures of mood for both patient and caregiver.Clinical trial registrationNTR4300, URL– http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4300.
Highlights
Stroke rehabilitation aims to reduce long-term dependency and to allow patients to return to the community. [1] Meta-analyses have shown that increased intensity of training leads to better functional outcome in stroke patients. [2, 3] resources for rehabilitation services after stroke are becoming increasingly scarce and it proves to be difficult to offer a sufficient dose of exercise therapy. [4] alternative treatment strategies are needed to increase the amount of exercise therapy without increasing healthcare costs. [5, 6] Caregiver-mediated exercises, in which stroke patients perform exercises with a caregiver, may be a promising approach
Caregivermediated exercises showed a favorable impact on secondary outcome measures of mood for both patient and caregiver
Caregiver-mediated exercises after stroke: A randomized controlled trial to usual care alone, we found no differential effect with respect to the primary outcome measures of self-perceived mobility (SIS-mobility) and length of stay (LOS)
Summary
Stroke rehabilitation aims to reduce long-term dependency and to allow patients to return to the community. [1] Meta-analyses have shown that increased intensity of training leads to better functional outcome in stroke patients. [2, 3] resources for rehabilitation services after stroke (mostly staff) are becoming increasingly scarce and it proves to be difficult to offer a sufficient dose of exercise therapy. [4] alternative treatment strategies are needed to increase the amount of exercise therapy without increasing healthcare costs. [5, 6] Caregiver-mediated exercises, in which stroke patients perform exercises with a caregiver, may be a promising approach. [11] A recent phase IV trial in 14 hospitals in India failed to show positive effects of a family-led rehabilitation program on the modified Rankin Scale (mRS) when compared to usual care. In this program, rehabilitation professionals were educated to train nominated family members. We designed an 8-week caregiver-mediated exercise program with e-health support after stroke (CARE4STROKE) in addition to usual care with the aim to improve functional outcome and to facilitate early supported discharge by increasing the intensity of task specific training
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