Abstract
ObjectivesHome-based physiotherapy interventions to improve post-stroke mobility are successful in high-income countries. These programs require less resources compared to center-based programs. However, feasibility of such an intervention in a low and middle-income setting remains unknown. Therefore, the SunRISe (Stroke Rehabilitation In Suriname) study aimed to assess feasibility and preliminary effectiveness of a home-based semi-supervised physiotherapy intervention to promote post-stroke mobility in a low resource setting.DesignProspective randomized controlled trial.MethodsChronic stroke patients were recruited and randomized into either an intervention group (IG (N = 20)) or a control group (CG (N = 10)). The IG received a 3-days-a-week home-based physiotherapy program that was supervised in the first 4 weeks and tele-supervised during the second 4 weeks. The physiotherapy program consisted of walking as well as functional and mobilization exercises. The CG received usual care. Feasibility outcome measures included adherence, patient satisfaction and safety. Efficacy measures included functional exercise tolerance (six-minute walking test (6MWT), functional balance (Berg Balance Score (BBS), upper extremity (UE) function (Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire), and UE strength ((non-)paretic handgrip (HG) strength). Two-way analysis of variance was used for data analysis.ResultsThirty participants (61.8 ± 9.2 years old, 13 men) were enrolled in the study. The intervention was completed by 14 participants (70%). Adherence was affected by rainy season associated infrastructural problems (n = 2), the medical status of participants (n = 3) and insufficient motivation to continue the program without direct supervision (n = 1). No adverse events were noted and participants were satisfied with the program. Functional exercise tolerance (57.2 ± 67.3m, p = 0.02) and UE function (-9.8 ± 15.2, p = 0.04) improved in the IG compared to no change in the CG. HG strength was unaltered and a ceiling effect occurred for BBS.ConclusionOur home-based semi-supervised physiotherapy intervention seems safe, associated with moderate to high levels of engagement and patient satisfaction and results in functional improvements.
Highlights
Stroke rehabilitation reduces the risk for recurrent stroke, improves mobility, independency during Activities of Daily Life (ADL) as well as quality of life [1–7]
A home-based physiotherapy intervention to promote post-stroke mobility associated infrastructural problems (n = 2), the medical status of participants (n = 3) and insufficient motivation to continue the program without direct supervision (n = 1)
Functional exercise tolerance (57.2 ± 67.3m, p = 0.02) and UE function (-9.8 ± 15.2, p = 0.04) improved in the intervention group (IG) compared to no change in the CG
Summary
Stroke rehabilitation reduces the risk for recurrent stroke, improves mobility, independency during Activities of Daily Life (ADL) as well as quality of life [1–7]. Home-based and tele-physiotherapy programs are of increasing interest and appear to have a high success rate for improving post-stroke mobility [6, 7, 12–14, 16, 17]. Their applicability in LMIC has yet to be documented [6] since most of these home-based physiotherapy studies have been conducted in High Income Countries (HIC) [6, 7, 12, 16, 19–22]. Few studies have looked in to this in a LMIC setting; the ATTEND home-based rehabilitation trial (India) [23], the SMART tele-rehabilitation trial (India and Nigeria), [24] the RECOVER trial (China) [25] and feasibility study F@ce (Uganda) [26] The latter comprised of an 8-week mobile phone supported, family-centered intervention that was found to improve ADL and self-efficacy of ADL.
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