Abstract
BackgroundIn New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent.Methods/designThis study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study.DiscussionThe lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home.Trial registrationACTRN12612000464864
Highlights
In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained
In New Zealand around 45,000 people live with stroke and only 30% are independent in activities of daily living [2,3]
A low level of physical activity over time leads to a gradual physical deterioration and loss of function, which has a detrimental impact on participation and quality of life (QoL) [5,6]
Summary
In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. There is evidence that even low intensity activity-based interventions improve independence in community-dwelling adults who have had a stroke and can positively influence QoL [11,12,13] It appears that ongoing participation in physical activity prevents the decline in functional independence commonly seen in people with stroke once their rehabilitation has ceased. A Cochrane review showed that people with stroke who received long-term rehabilitation (up to one year post-stroke) had increased odds of a positive outcome and were more likely to be independent in functional tasks [11]. The benefits gained during initial rehabilitation are often not sustained in the long term, as people reduce activity levels and cease engagement in exercise programmes, leading to functional deterioration [18]. The current study will be among the first to assess the benefits and costs of an intervention that uses telerehabilitation as part of the package
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