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Early supported discharge by caregiver-mediated exercise and e-Health support after stroke - A proof-of-concept trial
Van Den Berg, Maayken Crotty, Maria Liu, Enwu Killington, Maggie Kwakkel, Gert van Wegen, Erwin
Van Den Berg, Maayken
Crotty, Maria
Liu, Enwu
Killington, Maggie
Kwakkel, Gert
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
Keywords
caregiver-mediated exercises, e-health, exercise, home rehabilitation, stroke, telemedicine
Date
2016
Type
Journal article
Journal
Stroke
Book
Volume
47
Issue
7
Page Range
1885-1892
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled