Abstract
BackgroundThe incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home.Methods/DesignThis non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants’ quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services.Study/trial registrationClinicalTrials.gov: NCT01848080
Highlights
The incidence of strokes in industrialized nations is on the rise, in the older population
The results demonstrated the intervention was effective for improving balance and reducing fear of falling [33]
Allowing for a drop-out rate of 10%, this sample size will provide a power of 80% to demonstrate the non-inferiority of Tai Chi provided by telerehabilitation compared to Tai Chi provided in person at home, with a two-group one-sided test at the 2.5% level
Summary
The incidence of strokes in industrialized nations is on the rise, in the older population. There is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Stroke sequelae can include sensorimotor, cognitive and perceptual impairments, which directly affect mobility and balance and drastically increase the risk of falls [3,4]. Balance and ambulation problems are the most important fall risk factors following a stroke [5,6,7]. Balance is considered to be one of the most promising reversible risk factors to reduce falls [8,9]
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