Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia : A randomised controlled trial

Journal article


Hassett, Leanne, van den Berg, Maayken, Lindley, Richard I., Crotty, Maria, McCluskey, Annie, van der Ploeg, Hidde P., Smith, Stuart T., Schurr, Karl, Howard, Kirsten, Hackett, Maree L., Killington, Maggie, Bongers, Bert, Togher, Leanne, Treacy, Daniel, Dorsch, Simone, Wong, Siobhan, Scrivener, Katharine, Chagpar, Sakina, Weber, Heather, ... Sherrington, Catherine. (2020). Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia : A randomised controlled trial. PLoS Medicine. 17(2), pp. 1-24. https://doi.org/10.1371/journal.pmed.1003029
AuthorsHassett, Leanne, van den Berg, Maayken, Lindley, Richard I., Crotty, Maria, McCluskey, Annie, van der Ploeg, Hidde P., Smith, Stuart T., Schurr, Karl, Howard, Kirsten, Hackett, Maree L., Killington, Maggie, Bongers, Bert, Togher, Leanne, Treacy, Daniel, Dorsch, Simone, Wong, Siobhan, Scrivener, Katharine, Chagpar, Sakina, Weber, Heather, Pinheiro, Marina, Heritier, Stephane and Sherrington, Catherine
Abstract

Background
Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation.

Methods and findings
We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0–3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0–3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference −0.2, 95% CI −2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%–19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes.

Conclusions
In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted.

Trial registration
The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628

Year2020
JournalPLoS Medicine
Journal citation17 (2), pp. 1-24
PublisherNLM (Medline)
ISSN1549-1676
Digital Object Identifier (DOI)https://doi.org/10.1371/journal.pmed.1003029
Scopus EID2-s2.0-85079623046
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-24
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online18 Feb 2020
Publication process dates
Accepted22 Jan 2020
Deposited30 Jul 2021
Permalink -

https://acuresearchbank.acu.edu.au/item/8w703/digitally-enabled-aged-care-and-neurological-rehabilitation-to-enhance-outcomes-with-activity-and-mobility-using-technology-amount-in-australia-a-randomised-controlled-trial

Download files


Publisher's version
  • 6
    total views
  • 0
    total downloads
  • 1
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

An audit of physiotherapists’ documentation on physical activity assessment, promotion and prescription to older adults attending out-patient rehabilitation
Paim, Tatiana, Low-Choy, Nancy, Dorsch, Simone and Kuys, Suzanne. (2020). An audit of physiotherapists’ documentation on physical activity assessment, promotion and prescription to older adults attending out-patient rehabilitation. Disability and Rehabilitation. pp. 1-7. https://doi.org/10.1080/09638288.2020.1805644
Functional electrical stimulation+iPad-based music therapy for upper limb recovery after stroke : Study protocol for a mixed methods randomised controlled trial
Silveira, Tanya Marie, Dorsch, Simone, Thompson, Grace and Tamplin, Jeanette. (2020). Functional electrical stimulation+iPad-based music therapy for upper limb recovery after stroke : Study protocol for a mixed methods randomised controlled trial. Nordic Journal of Music Therapy. pp. 1-24. https://doi.org/10.1080/08098131.2020.1795704
Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke : A systematic review
Scrivener, Katharine, Dorsch, Simone, McCluskey, Annie, Schurr, Karl, Graham, Petra L., Cao, Zheng, Shepherd, Roberta and Tyson, Sarah. (2020). Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke : A systematic review. Journal of Physiotherapy. 66(4), pp. 225-235. https://doi.org/10.1016/j.jphys.2020.09.008
Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke : A randomised trial
de Sousa, Davide G., Harvey, Lisa A., Dorsch, Simone, Varettas, Bronwyn, Jamieson, Serena, Murphy, Abby and Giaccari, Sarah. (2019). Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke : A randomised trial. Journal of Physiotherapy. 65(3), pp. 152-158. https://doi.org/10.1016/j.jphys.2019.05.007
Goal-oriented instructions increase the intensity of practice in stroke rehabilitation compared with non-specific instructions : A within-participant, repeated measures experimental study
Hillig, Tessa Rose, Ma, Haotian and Dorsch, Simone. (2019). Goal-oriented instructions increase the intensity of practice in stroke rehabilitation compared with non-specific instructions : A within-participant, repeated measures experimental study. Journal of Physiotherapy. 65(2), pp. 95-98. https://doi.org/10.1016/j.jphys.2019.02.007
In inpatient rehabilitation, large amounts of practice can occur safely without direct therapist supervision : An observational study
Dorsch, Simone, Weeks, Kevin, King, Laura and Polman, Etesa. (2019). In inpatient rehabilitation, large amounts of practice can occur safely without direct therapist supervision : An observational study. Journal of Physiotherapy. 65(1), pp. 23-27. https://doi.org/10.1016/j.jphys.2018.11.004
Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review
Simone Dorsch, Louise Ada and Daniella Alloggia. (2018). Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. Journal of Physiotherapy. 64(2), pp. 84-90. https://doi.org/10.1016/j.jphys.2018.02.012
Interventions involving repetitive practice improve strength after stroke: A systematic review
Davide G. de Sousa, Lisa A Harvey, Simone Dorsch and Joanne V Glinsky. (2018). Interventions involving repetitive practice improve strength after stroke: A systematic review. Journal of Physiotherapy. 64(4), pp. 210-221. https://doi.org/10.1016/j.jphys.2018.08.004
Feasibility of a nurse-led weekend group exercise program for people after stroke
Scrivener, Katharine, Tourany, Raymond, McNamara-Holmes, Mary, Schurr, Karl, Dorsch, Simone and Dean, Catherine. (2017). Feasibility of a nurse-led weekend group exercise program for people after stroke. Stroke Research and Treatment. 2017, pp. 1 - 7. https://doi.org/10.1155/2017/4574385
Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: A protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial
Hassett, Leanne, van den Berg, Maayken, Lindley, Richard I., Crotty, Maria, McCluskey, Annie, van der Ploeg, Hidde P., Smith, Stuart T., Schurr, Karl, Killington, Maggie, Bongers, Bert, Howard, Kirsten, Heritier, Stephane, Togher, Leanne, Hackett, Maree, Treacy, Daniel, Dorsch, Simone Lise, Wong, Siobhan, Scrivener, Katharine, Chagpar, Sakina, ... Sherrington, Catherine. (2016). Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: A protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial. BMJ Open. 6(6), pp. 1 - 9. https://doi.org/10.1136/bmjopen-2016-012074
EMG-triggered electrical stimulation is a feasible intervention to apply to multiple arm muscles in people early after stroke, but does not improve strength and activity more than usual therapy: A randomized feasibility trial
Dorsch, Simone Lise, Ada, Louise and Canning, Colleen. (2014). EMG-triggered electrical stimulation is a feasible intervention to apply to multiple arm muscles in people early after stroke, but does not improve strength and activity more than usual therapy: A randomized feasibility trial. Clinical Rehabilitation. 28(5), pp. 482 - 490. https://doi.org/10.1177/0269215513510011
The strength of the ankle dorsiflexors has a significant contribution to walking speed in people who can walk independently after stroke : an observational study
Dorsch, Simone, Ada, Louise, Canning, Colleen, Al-Zharani, Matar and Dean, Catherine. (2012). The strength of the ankle dorsiflexors has a significant contribution to walking speed in people who can walk independently after stroke : an observational study. Archives of Physical Medicine and Rehabilitation. 93(6), pp. 1072 - 1076. https://doi.org/10.1016/j.apmr.2012.01.005
Group exercise can improve participants' mobility in an outpatient rehabilitation setting: A randomized controlled trial
Sherrington, Catherine, Pamphlett, Patricia I., Jacka, Jennifer A., Olivetti, Lynnette M., Nugent, Julie A., Hall, Jillian M., Dorsch, Simone Lise, Kwan, Marcella Mun-San and Lord, Stephen R.. (2008). Group exercise can improve participants' mobility in an outpatient rehabilitation setting: A randomized controlled trial. Clinical Rehabilitation. 22(6), pp. 493 - 502. https://doi.org/10.1177/0269215508087994
Strengthening interventions increase strength and improve activity after stroke: a systematic review
Ada, Louise, Dorsch, Simone Lise and Canning, Colleen G.. (2006). Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy. 52(4), pp. 241 - 248. https://doi.org/10.1016/S0004-9514(06)70003-4