Abstract
AbstractBackgroundIntensity of practice and task and context specificity are key factors for improving functional outcome in stroke survivors. Novel methods are needed to augment intensity of practice with minimal use of resources and costs. Caregiver‐mediated exercises (CMEs) focused on mobility, in which a caregiver acts as an exercise coach and can increase the intensity of practice. There is preliminary evidence that CME can improve functional outcome, reduce length of stay, and allow early supported discharge, without an increase in caregiver burden. In the CARE4STROKE programme (C4S), CME therapy and e‐health support are combined to promote a smoother transition from the inpatient setting to the home environment, with active rehabilitation continuing in the community.The objective of this paper is to describe the content of the C4S intervention in detail and explain implementation of this intervention in practice using the Template for Intervention Description and Replication checklist.MethodsContent, timing and intensity of the programme, participant screening and selection, and intervention procedures were described using the Template for Intervention Description and Replication checklist. Mobility exercises and use of a video application on tablet/smartphone are explained. The role of the caregiver as provider of the intervention is illustrated.DiscussionC4S prescribes an additional exercise dose of 1,200 min and may be a promising novel and effective method to augment the pallet of therapeutic options for stroke rehabilitation. Important aspects for successful implementation are availability and suitability of a caregiver. Suggestions for additional use of e‐health technology are described.Implications for physiotherapy practiceThe presented description of C4S gives physical therapists practical guidelines to facilitate implementation of the CME intervention.
Highlights
Intensity of practice and task and context specificity are key factors of poststroke rehabilitation, because they can improve outcome in terms of mobility and activities of daily living (French et al, 2010; Galvin, Murphy, Cusack, & Stokes, 2008; Kwakkel, 2006; Kwakkel et al, 2004; Langhorne, Bernhardt, & Kwakkel, 2011; Lohse, Lang, & Boyd, 2014; Veerbeek et al, 2014; Veerbeek, Koolstra, Ket, van Wegen, & Kwakkel, 2011) and thereby facilitate early supported discharge (ESD; Fearon & Langhorne, 2012; Langhorne et al, 2011)
A systematic review of nine trials found very low to moderate quality evidence that Caregiver‐ mediated exercises (CMEs) can improve standing balance, walking distance, and quality of life, without increasing caregiver burden, suggesting that CME may augment the pallet of therapeutic options for rehabilitation after stroke (Vloothuis et al, 2016)
We used the TIDieR checklist to systematically describe in detail all key elements of the CARE4STROKE programme (C4S) intervention (Bernhardt et al, 2016; Hoffmann et al, 2013; Hoffmann et al, 2014; Hoffmann et al, 2015)
Summary
Intensity of practice and task and context specificity are key factors of poststroke rehabilitation, because they can improve outcome in terms of mobility and activities of daily living (French et al, 2010; Galvin, Murphy, Cusack, & Stokes, 2008; Kwakkel, 2006; Kwakkel et al, 2004; Langhorne, Bernhardt, & Kwakkel, 2011; Lohse, Lang, & Boyd, 2014; Veerbeek et al, 2014; Veerbeek, Koolstra, Ket, van Wegen, & Kwakkel, 2011) and thereby facilitate early supported discharge (ESD; Fearon & Langhorne, 2012; Langhorne et al, 2011). A systematic review of nine trials found very low to moderate quality evidence that CME can improve standing balance, walking distance, and quality of life, without increasing caregiver burden, suggesting that CME may augment the pallet of therapeutic options for rehabilitation after stroke (Vloothuis et al, 2016). None of these trials included e‐health technology such as telerehabilitation services to support treatment adherence or included exercise apps to support CME. Implications for physiotherapy practice: The presented description of C4S gives physical therapists practical guidelines to facilitate implementation of the CME intervention
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