Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial

Abstract

Background Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke. Methods A multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up. Results During 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist. Conclusions We hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services. Trial registration Netherlands Trial Register, NL7422. Registered 11 December 2018.

Research hotspots and trends of the tele-rehabilitation for stroke survivors based on CiteSpace: A review

“…The importance of caregivers in telerehabilitation interventions for stroke survivors has been noticed by investigators. [ 52 ] Previous studies have shown that caregivers of stroke patients are generally anxious and depressed, and they should be given psychological counseling and more social support. [ 53 , 54 ] Due to the increasing focus on adverse events in telerehabilitation interventions, caregiver care capacity, patient safety risk identification, and the role of caregivers in telerehabilitation interventions should continue to be of interest in future studies.…”

Face-to-face assessment versus tele-assessment of chronic stroke patients: do the results meet the needs?

“…Tele-medicine has been used for evaluation, rehabilitation, treatment, diagnosis, and follow-up purposes for the last 20 years in most medical specialties (23)(24)(25)(26)(27)(28). The key aim is to take care of the patients irrespective of their accessibility to health care services (23,26).…”

Telerehabilitation: Exploring the Untapped Potential

“…Telerehabilitation has also proved to be a viable option in the holistic treatment and management of various neurological disorders and pain. Telerehabilitation is effective in treating stroke patients, along with its cost-effectiveness [ 19 ]. Cognitive training through telerehabilitation can be used in the rehabilitation of patients with learning disabilities [ 20 ].…”

“…VRBT (virtual reality-supported balanced approach of telerehabilitation) improves balance and postural functions in patients with stroke with balance deficits and helps in the reduction of outpatient visits and cost-related issues [ 7 ]. It not only focuses on educating the patient but also focuses on educating the caregivers to provide the required rehabilitative exercises (caregiver-mediated exercises) to the patient [ 19 ].…”