Early supported discharge by caregiver-mediated exercise and e-Health support after stroke - A proof-of-concept trial

Journal article


Van Den Berg, Maayken, Crotty, Maria, Liu, Enwu, Killington, Maggie, Kwakkel, Gert and van Wegen, Erwin. (2016) Early supported discharge by caregiver-mediated exercise and e-Health support after stroke - A proof-of-concept trial. Stroke. 47(7), pp. 1885 - 1892. https://doi.org/10.1161/STROKEAHA.116.013431
AuthorsVan Den Berg, Maayken, Crotty, Maria, Liu, Enwu, Killington, Maggie, Kwakkel, Gert and van Wegen, Erwin
Abstract

Background and Purpose
This proof-of-concept trial investigated the effects of an 8-week program of caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden.
Methods
Sixty-three hospitalized stroke patients (mean age 68.7, 64% female) were randomly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care. Primary outcome was the Stroke Impact Scale mobility domain. Secondary outcomes included length of stay, other Stroke Impact Scale domains, readmissions, motor impairment, strength, walking ability, balance, mobility, (extended) activities of daily living, psychosocial functioning, self-efficacy, quality of life, and fatigue. Additionally, caregiver’s self-reported fatigue, symptoms of anxiety, self-efficacy, and strain were assessed. Assessments were completed at baseline and at 8 and 12 weeks.
Results
Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility (P=0.6); however, carers reported less fatigue (4.6, confidence interval [CI] 95% 0.3–8.8; P=0.04) and higher self-efficacy (−3.3, CI 95% −5.7 to −0.9; P=0.01) at week 12. Per-protocol analysis, examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility (−9.8, CI 95% −20.1 to 0.4; P=0.06), significantly improved extended activities of daily living scores at week 8 (−3.6, CI 95% −6.3 to −0.8; P=0.01) and week 12 (3.0, CI 95% −5.8 to −0.3; P=0.03), a 9-day shorter length of stay (P=0.046), and fewer readmissions over 12 months (P<0.05).
Conclusions
Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice, resulting in improved patient-extended activities of daily living, reduced length of stay with fewer readmissions post stroke, and reduced levels of caregiver fatigue with increased feelings of self-efficacy. The current findings justify a larger definite phase III randomized controlled trial.
Clinical Trial Registration
URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613000779774

Keywordscaregiver-mediated exercises; e-health; exercise; home rehabilitation; stroke; telemedicine
Year2016
JournalStroke
Journal citation47 (7), pp. 1885 - 1892
PublisherLippincott Williams and Wilkins
ISSN0039-2499
Digital Object Identifier (DOI)https://doi.org/10.1161/STROKEAHA.116.013431
Scopus EID2-s2.0-84974834781
Page range1885 - 1892
Research GroupMary MacKillop Institute for Health Research
Place of publicationUnited States of America
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