Integrated care improves risk-factor modification after stroke: initial results of the Integrated Care for the Reduction of Secondary Stroke model Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home Effects of Telerehabilitation on Physical Function and Disability for Stroke Patients: A Randomized, Controlled Trial Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial. Study protocol of the YOU CALL - WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke Randomised controlled trial of an education and support package for stroke patients and their carers The YOU CALL–WE CALL Randomized Clinical Trial: Impact of a Multimodal Support Intervention After a Mild Stroke Measuring Outcomes in People Who Have Had a Stroke and Their Carers: Can the Telephone Be Used? Bidirectional and Multi-User Telerehabilitation System: Clinical Effect on Balance, Functional Activity, and Satisfaction in Patients with Chronic Stroke Living in Long-Term Care Facilities Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial Multicenter Randomized Controlled Trial of an Outreach Nursing Support Program for Recently Discharged Stroke Patients Does telephone follow-up improve blood pressure after minor stroke or TIA? Comparison of Finger Tracking Versus Simple Movement Training via Telerehabilitation to Alter Hand Function and Cortical Reorganization After Stroke Complex Versus Simple Ankle Movement Training in Stroke Using Telerehabilitation: A Randomized Controlled Trial Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. Reducing depression in stroke survivors and their informal caregivers: a randomized clinical trial of a Web-based intervention. Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial Risk factor management and depression post-stroke: The value of an integrated model of care Incidence of Atrial Fibrillation after Percutaneous Closure of Patent Foramen Ovale and Small Atrial Septal Defects in Patients Presenting with Cryptogenic Stroke Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. Expanding the role of the stroke nurse: a pragmatic clinical trial. [The lifestyle modification coaching program for secondary stroke prevention]. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial. Family Intervention: Telephone Tracking (FITT): A Pilot Stroke Outcome Study
Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 OBJECTIVES First , to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program ; second , to compare the subjective experiences ; and third , to contrast the costs of both programs . DESIGN Single-blind , r and omized , controlled trial . SETTING Neurorehabilitation unit . PARTICIPANTS Chronic out patients with stroke ( N=30 ) with residual hemiparesis . INTERVENTIONS Twenty 45-minute training sessions with the telerehabilitation system , conducted 3 times a week , in the clinic or in the home . MAIN OUTCOME MEASURES First , Berg Balance Scale for balance assessment . The Performance-Oriented Mobility Assessment balance and gait subscales , and the Brunel Balance Assessment were secondary outcome measures . Clinical assessment s were conducted at baseline , 8 weeks ( posttreatment ) , and 12 weeks ( follow-up ) . Second , the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences . Third , cost ( in dollars ) . RESULTS Significant improvement in both groups ( in-clinic group [ control ] and a home-based telerehabilitation group ) from the initial to the final assessment in the Berg Balance Scale ( ηp(2)=.68 ; P=.001 ) , in the balance ( ηp(2)=.24 ; P=.006 ) and gait ( ηp(2)=.57 , P=.001 ) subscales of the Tinetti Performance-Oriented Mobility Assessment , and in the Brunel Balance Assessment ( control : χ(2)=15.0 ; P=.002 ; experimental : χ(2)=21.9 ; P=.001 ) . No significant differences were found between the groups in any balance scale or in the feedback question naires . With regard to subjective experiences , both groups considered the VR system similarly usable and motivating . The in-clinic intervention result ed in more expenses than did the telerehabilitation intervention ( $ 654.72 per person ) . CONCLUSIONS First , VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions , both complemented with a conventional therapy program ; second , the usability of and motivation to use the 2 interventions can be similar ; and third , telerehabilitation interventions can involve savings that vary depending on each scenario Background More than 60 % of new strokes each year are " mild " in severity and this proportion is expected to rise in the years to come . Within our current health care system those with " mild " stroke are typically discharged home within days , without further referral to health or rehabilitation services other than advice to see their family physician . Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention , community reintegration , medication counselling and problem solving with regard to specific concerns that arise . Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization . The purpose of this study is to assess the effectiveness , for individuals who experience a first " mild " stroke , of a sustainable , low cost , multimodal support intervention ( comprising information , education and telephone support ) - " WE CALL " compared to a passive intervention ( providing the name and phone number of a re source person available if they feel the need to ) - " YOU CALL " , on two primary outcomes : unplanned-use of health services for negative events and quality of life . Method / Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites . Baseline measures will be taken within the first month after stroke onset . Participants will be stratified according to comorbidity level and r and omised to one of two groups : YOU CALL or WE CALL . Both interventions will be offered over a six months period . Primary outcomes include unplanned use of heath services for negative event ( frequency calendar ) and quality of life ( EQ-5D and Quality of Life Index ) . Secondary outcomes include participation level ( LIFE-H ) , depression ( Beck Depression Inventory II ) and use of health services for health promotion or prevention ( frequency calendar ) . Blind assessors will gather data at mid-intervention , end of intervention and one year follow up . Discussion If effective , this multimodal intervention could be delivered in both urban and rural environments . For example , existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics , make this intervention , if effective , deliverable and sustainable . Trial Registration IS RCT Objective Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education . This study aim ed to evaluate the effects of an education package which utilised both strategies on the knowledge , health and psychosocial outcomes of stroke patients and carers . Design Multisite , r and omised trial comparing usual care with an education and support package . Setting Two acute stroke units . Participants Patients and their carers ( N=138 ) were r and omised ( control n=67 , intervention n=71 ) of which data for 119 participants ( control n=59 , intervention n=60 ) were analysed . Intervention The package consisted of a computer-generated , tailored written information booklet and verbal reinforcement provided prior to , and for 3 months following , discharge . Outcome measures Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors . The primary outcome was stroke knowledge ( score range : 0–25 ) . Secondary outcomes were : self-efficacy ( 1–10 ) , anxiety and depression ( 0–21 ) , ratings of importance of information ( 1–10 ) , feelings of being informed ( 1–10 ) , satisfaction with information ( 1–10 ) , caregiver burden ( carers ) ( 0–13 ) and quality of life ( patients ) ( 1–5 ) . Results Intervention group participants reported better : self-efficacy for accessing stroke information ( adjusted mean difference ( MD ) of 1.0 , 95 % CI 0.3 to 1.7 , p=0.004 ) ; feeling informed ( MD 0.9 , 95 % CI 0.2 to 1.6 , p=0.008 ) ; and satisfaction with medical ( MD 2.0 , 95 % CI 1.1 to 2.8 , p<0.001 ) ; practical ( MD 1.1 , 95 % CI 0.3 to 1.9 , p=0.008 ) , services and benefits ( MD 0.9 , 95 % CI 0.1 to 1.8 , p=0.036 ) and secondary prevention information ( MD 1.7 , 95 % CI 0.9 to 2.5 , p<0.001 ) . There was no significant effect on other outcomes . Conclusions Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information , but other outcomes were not significantly affected . Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies . Background — Comparison of a multimodal intervention WE CALL ( study initiated phone support/information provision ) versus a passive intervention YOU CALL ( participant can contact a re source person ) in individuals with first mild stroke . Methods and Results — This study is a single-blinded r and omized clinical trial . Primary outcome includes unplanned use of health services ( participant diaries ) for adverse events and quality of life ( Euroquol-5D , Quality of Life Index ) . Secondary outcomes include planned use of health services ( diaries ) , mood ( Beck Depression Inventory II ) , and participation ( Assessment of Life Habits [ LIFE-H ] ) . Blind assessment s were done at baseline , 6 , and 12 months . A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time , with a significance level of 0.01 . We enrolled 186 patients ( WE=92 ; YOU=94 ) with a mean age of 62.5±12.5 years , and 42.5 % were women . No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures ( effect sizes ranged from 0.25 to 0.7 ) . The only significant change for both groups from 6 months to 1 year ( n=139 ) was in the social domains of the LIFE-H ( increment in score , 0.4/9±1.3 [ 95 % confidence interval , 0.1–0.7 ] ; effect size , 0.3 ) . Qualitatively , the WE CALL intervention was perceived as reassuring , increased insight , and problem solving while decreasing anxiety . Only 6 of 94 ( 6.4 % ) YOU CALL participants availed themselves of the intervention . Conclusions — Although the 2 groups improved equally over time , WE CALL intervention was perceived as helpful , whereas YOU CALL intervention was not used . Clinical Trial Registration — URL : http://www.controlled-trials.com . Unique identifier : IS RCT N95662526 Abstract Purpose : Telephone interviews may be a cost-effective alternative to administering stroke outcome measures for people who are living in the community following a stroke , but there is a lack of research that has compared the different modes of administering outcome measures . The aim of this study was to determine whether telephone administration of selected stroke outcome measures result ed in significantly different results to face-to-face administration of the same outcome measures . Method : Nineteen participants who were taking part in a r and omised controlled trial ( RCT ) evaluating the effectiveness of a postdischarge education and support package for stroke patients and their carers were recruited for this study . Participants had the RCT follow-up outcome measures , at 3 months post discharge , administered by both telephone and face-to-face . Participants were r and omised to receive either the telephone or face-to-face administration first and a period of 2 weeks separated the two administrations . Outcome measures were the Knowledge of Stroke Question naire , a stroke self-efficacy question naire , Hospital Anxiety and Depression Scale , Stroke and Aphasia Quality of Life Scale , and the Caregiver Strain Index . Results : There were no significant differences between scores obtained on any of the outcome measures that were administered by telephone and face-to-face ( P > .05 ) . Conclusion : The telephone can be used to administer the outcome measures that were evaluated in this study to stroke patients and carers . These findings may be of benefit to stroke research ers and clinicians who wish to incorporate the use of telephone measures into the follow-up care of stroke patients and their carers Background The application of internet technology for telerehabilitation in patients with stroke has developed rapidly . Objective The current study aim ed to evaluate the effect of a bidirectional and multi-user telerehabilitation system on balance and satisfaction in patients with chronic stroke living in long-term care facilities ( LTCFs ) . Method This pilot study used a multi-site , blocked r and omization design . Twenty-four participants from three LTCFs were recruited , and the participants were r and omly assigned into the telerehabilitation ( Tele ) and conventional therapy ( Conv ) groups within each LTCF . Tele group received telerehabilitation but the Conv group received conventional therapy with two persons in each group for three sessions per week and for four weeks . The outcome measures included Berg Balance Scale ( BBS ) , Barthel Index ( BI ) , and the telerehabilitation satisfaction of the participants . Setting A telerehabilitation system included “ therapist end ” in a laboratory , and the “ client end ” in LTCFs . The conventional therapy was conducted in LTCFs . Results Training programs conducted for both the Tele and Conv groups showed significant effects within groups on the participant BBS as well as the total and self-care scores of BI . No significant difference between groups could be demonstrated . The satisfaction of participants between the Tele and the Conv groups also did not show significant difference . Conclusions This pilot study indicated that the multi-user telerehabilitation program is feasible for improving the balance and functional activity similar to conventional therapy in patients with chronic stroke living in LTCFs Background The incidence of strokes in industrialized nations is on the rise , particularly in the older population . In Canada , a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home . Thus , there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke . To meet this dem and , telerehabilitation , particularly from a service center to the patient ’s home , is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home . Methods / Design This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation . To be included in the study , participants will : 1 ) not be referred to an Intensive Functional Rehabilitation Unit , 2 ) have a Rankin score of 2 or 3 , and 3 ) have a balance problem ( Berg Balance Scale score between 46 and 54 ) . Participants will be r and omly assigned to either the teletreatment group or the home visits group . Except for the delivery mode , the intervention will be the same for both groups , that is , a personalized Tai Chi-based exercise program conducted by a trained physiotherapist ( 45-minute session twice a week for eight consecutive weeks ) . The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation . The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale . Secondary outcomes include physical and psychological capacities related to balance and mobility , participants ’ quality of life , satisfaction with services received , and cost-effectiveness associated with the provision of both types of services . Study /trial registration Clinical Trials.gov : Background and Purpose — Many stroke patients and informal carers experience a decreased quality of life after discharge home and are dissatisfied with the care received . We assessed the effectiveness of an outreach nursing care program . Methods — In a multicenter trial , 536 stroke patients were r and omized at discharge to st and ard care ( n=273 ) or st and ard care plus outreach care ( n=263 ) . The outreach care consisted of 3 telephone calls and 1 home visit within 5 months after discharge by 1 of 13 stroke nurses . Patients were masked for the trial objectives . Six months after discharge , they assessed the 2 primary outcomes : quality of life ( Short Form 36 [ SF-36 ] ) and dissatisfaction with care . Secondary measures of outcome were disability , h and icap , depression , anxiety , and use of health care services and secondary prevention drugs . Informal carers assessed strain , and social support . Analysis was by intention to treat . Results — Twelve patients died  before follow-up , 38 declined outcome assessment , and 486 completed the primary outcome assessment s. Outreach care patients had better scores on the SF-36 domain “ Role Emotional ” than controls ( mean difference 7.9 [ 95 % confidence limit , 0.1 to 15.7 ] ) . No statistically significant differences were found on the other primary outcome measures . For secondary outcomes , no statistically significant differences were found , except that intervention patients used fewer rehabilitation services ( relative risk , 0.66 [ 0.44 to 1.00 ] ) and had lower anxiety scores ( median difference 1 [ 0.19 to 2.79 ] ) . Conclusions — This outreach nursing stroke care was not effective in improving quality of life and dissatisfaction with care of recently discharged patients BACKGROUND hypertension is a common risk factor for stroke/transient ischaemic attack ( TIA ) and there is good evidence that blood pressure ( BP ) control prevents recurrent stroke . We investigated whether telephone follow-up ( TFU ) improved risk factor management in hypertensive patients after stroke/TIA . METHODS we conducted a r and omised controlled trial and assigned hypertensive patients within 1 month of stroke or TIA to receive usual care ( n = 27 ) or usual care plus regular TFU ( n = 29 ) . Primary outcome was the difference in 12 h ambulatory systolic BP change from baseline to 6 months ( DeltaSBP ) in both groups . TFU at 7 days , 1 , 2 and 4 months included patient-focussed education and goal setting . RESULTS mean baseline BP was 145/83 mm Hg ( st and ard deviation ( SD ) 21/14 ) . There was no significant difference in DeltaSBP over 6 months with TFU . Median DeltaSBP was 0 mm Hg ( interquartile range 19.5 ) in the TFU group and 3.0 mm Hg ( 20 ) fall in the usual care group ( P = 0.29 ) . Post hoc analysis showed that statin use increased from baseline to 6 months ( P = 0.02 ) and cholesterol was significantly lower at 6 months in all patients ( mean reduction 0.95 mmol/l ; P < 0.001 ) . CONCLUSION our study found TFU that promoted patient-led management of risk factors did not improve BP control over 6-month follow-up in primary care after stroke/TIA Objective . To compare 2 telerehabilitation training strategies , repetitive tracking movements versus repetitive simple movements , to promote brain reorganization and recovery of h and function . Methods . Twenty subjects with chronic stroke and 10 degrees of voluntary finger extension were r and omly assigned to receive 1800 telerehabilitation trials over 2 weeks of either computerized tracking training ( track group ) with the affected finger and wrist involving temporospatial processing to achieve accuracy or movement training ( move group ) with no attention to accuracy . Following movement training , the move group crossed over to receive an additional 2 weeks of tracking training .  Behavioral changes were measured with the Box and Block test , Jebsen Taylor test , and finger range of motion , along with a finger-tracking activation paradigm during fMRI . Results . The track group showed significant improvement in all 4 behavioral tests ; the move group improved in the Box and Block and Jebsen Taylor tests . The improvement for the track group in the Box and Block and Jebsen Taylor tests did not surpass that for the move group . A consistent group pattern of brain reorganization was not evident . The move group , after crossing over , did not show further significant improvements . Conclusion . Telerehabilitation may be effective in improving performance in subjects with chronic stroke .  Tracking training with reinforcement to enhance learning , however , did not produce a clear advantage over the same amount of practice of r and om movements . Two weeks of training may be insufficient to demonstrate a behavioral advantage and associated brain reorganization Background Telerehabilitation allows rehabilitative training to continue remotely after discharge from acute care and can include complex tasks known to create rich conditions for neural change . Objectives The purpose s of this study were : ( 1 ) to explore the feasibility of using telerehabilitation to improve ankle dorsiflexion during the swing phase of gait in people with stroke and ( 2 ) to compare complex versus simple movements of the ankle in promoting behavioral change and brain reorganization . Design This study was a pilot r and omized controlled trial . Setting Training was done in the participant 's home . Testing was done in separate research labs involving functional magnetic resonance imaging ( fMRI ) and multi-camera gait analysis . Patients Sixteen participants with chronic stroke and impaired ankle dorsiflexion were assigned r and omly to receive 4 weeks of telerehabilitation of the paretic ankle .  Intervention Participants received either computerized complex movement training ( track group ) or simple movement training ( move group ) . Measurements Behavioral changes were measured with the 10-m walk test and gait analysis using a motion capture system . Brain reorganization was measured with ankle tracking during fMRI . Results Dorsiflexion during gait was significantly larger in the track group compared with the move group . For fMRI , although the volume , percent volume , and intensity of cortical activation failed to show significant changes , the frequency count of the number of participants showing an increase versus a decrease in these values from pretest to posttest measurements was significantly different between the 2 groups , with the track group decreasing and the move group increasing . Limitations Limitations of this study were that no follow-up test was conducted and that a small sample size was used . Conclusions The results suggest that telerehabilitation , emphasizing complex task training with the paretic limb , is feasible and can be effective in promoting further dorsiflexion in people with chronic stroke OBJECTIVE Telerehabilitation enables a remotely controlled programme to be used to treat motor deficits in post-stroke patients . The effects of this telerehabilitation approach were compared with traditional motor rehabilitation methods . DESIGN R and omized single-blind controlled trial . PATIENTS A total of 36 patients with mild arm motor impairments due to ischaemic stroke in the region of the middle cerebral artery . METHODS The experimental treatment was a virtual reality-based system delivered via the Internet , which provided motor tasks to the patients from a remote rehabilitation facility . The control group underwent traditional physical therapy for the upper limb . Both treatments were of 4 weeks duration . All patients were assessed one month prior to therapy , at the commencement and termination of therapies and one month post-therapy , with the Fugl-Meyer Upper Extremity , the ABILH AND and the Ashworth scales . RESULTS Both rehabilitative therapies significantly improved all outcome scores after treatment , but only the Fugl-Meyer Upper Extremity scale showed differences in the comparison between groups . CONCLUSION Both strategies were effective , but the experimental approach induced better outcomes in motor performance . These results may favour early discharge from hospital sustained by a telerehabilitation programme , with potential beneficial effects on the use of available re sources PURPOSE / OBJECTIVES To develop and test the efficacy of a Web-based intervention for alleviating depression in male stroke survivors ( SSs ) and their spousal caregivers ( CGs ) that blends both peer and professional support . DESIGN AND METHODS The research consisted of an intervention protocol evaluated by a focus group of rehabilitation professionals , a " think aloud " session conducted with female stroke CGs , and a usability test of the intervention 's online features with 7 female stroke CGs . Efficacy of the final protocol was tested in a 2-group r and omized clinical trial with a sample of 32 CG-SS dyads . The CGs in the intervention condition received an online group intervention . Intervention components were based on the Stress Process Model . Those CGs in a control condition received minimal support with individualized access to relevant online information . Measures of depression , as well as the secondary outcomes of mastery , self-esteem , and social support , were obtained from SSs and CGs at pretest , posttest , and 1-month later . RESULTS At posttest and 1 month later , CGs in the intervention condition reported significantly lower depression than CGs in the control condition with baseline depression controlled . There was no significant effect on depression among SSs . Although no significant treatment effects for either SSs or CGs were found on the secondary outcomes , posttreatment changes on some constructs were significantly correlated with change in depression . CONCLUSIONS / IMPLICATION S CGs benefit from Web-based programs that help them better underst and both their emotional needs and those of the SS Objective : To evaluate whether enhanced secondary prevention more significantly influences readiness to change health behaviour after minor stroke/transient ischaemic attack , compared with conventional stroke secondary prevention . Design : Single-blind r and omized control trial . Setting : Rural district general hospital outpatient clinic . Subjects : Fifteen women and 37 men with a mean age of 68.3 years with first minor stroke or transient ischaemic attack . Interventions : The intervention group received ‘ enhanced secondary prevention ’ ( additional advice , motivational interviewing and telephone support ) to change health behaviour . Both groups received ‘ conventional care ’ which included advice given during routine care . Main measures : The primary outcome was ‘ readiness to change behaviour ’ measured using a vali date d stroke specific score based on the transtheoretical model . Secondary outcomes were the Hospital Anxiety and Depression Scale , and self-reported alcohol consumption , smoking behaviour , exercise frequency , and fruit and vegetable consumption . Results : Analysis of the data for the 52 participants showed no statistical difference in the groups for the primary outcome of readiness to change behaviour . Statistically significant improvements for change in self-reported exercise were demonstrated ( P = 0.007 ) ; to 2—3 times per week in the intervention group compared to 0—1 times per week in the control group , and in fruit and vegetable consumption ( P = 0.033 ) ; to 10 portions of fruit and vegetables consumed per week in the intervention group compared to 1 or 2 portions a week for the control group . No evidence of a difference between groups was seen for alcohol consumption or Hospital Anxiety and Depression Scale . Conclusions : While no difference was demonstrated between the groups for readiness to change behaviour , a clinical ly significant effect in reported exercise behaviour and diet were demonstrated in the intervention group . This interesting finding indicates a dissonance between the behaviour scale and actual behaviour change , potentially indicating a lack of sensitivity of the scale to detect a change in this patient group BACKGROUND AND PURPOSE Shared care initiatives , albeit commonly utilised in managing other chronic conditions have not been implemented in the area of stroke in Australia . The aims of this project were to adopt a shared care approach for stroke survivors comparing an experimental " shared-care " group with a " treatment-as-usual " control group in reference to the normalization or reversal of vascular risk factors and the detection and management of post-stroke depression . METHODS A r and omised controlled experimental research design was implemented with participants r and omized to an intervention or control group and followed over a 12-month period . The treatment group consisted of a r and omly selected group of patients  , discharged from an acute stroke unit and transferred into the shared care model . Risk factors for stroke and depression were compared between the two groups . RESULTS Of 97 patients originally included in the study , 17 dropped out . At 12 months , 80 patients remained for analysis ( 35 in the intervention group and 45 in the control group ) . The findings demonstrated positive trends for patients within the intervention group that were not found within the control group . The percentage of intervention patients reaching target systolic blood pressure ( sBP ) of 140 mmHg after 12 months tended to be greater than in the control group ( p=0.11 , NS ) . In the intervention group , at 12 months , the total cholesterol greater than 5.18 mmol/L was 12.5 % compared to 58.8 % at discharge . In contrast this trend was not so distinct in the control group ( 57.7 % to 42.9 % ) . The percentage of patients reaching target ( recommended ) total cholesterol of 5.18 mmol/L was significantly greater in the shared care patients intervention group relative to the control group ( p=0.02 ) . The average number of walks per week was also significantly greater in intervention group compared to the control group ( p=0.048 ) . Moreover , 45 % of the control group screened as depressed compared with 20 % of the intervention group at 12 months ( p=0.06 ) . CONCLUSIONS This study demonstrates that major risk factors for recurrent stroke and vascular disease in general are better managed with the shared care model than with usual post-discharge care . The significantly reduced depression as found on the screening PHQ9 at 12 months indicated that the intervention was beneficial not only in the detection of depression but also treatment Objective The occurrence of atrial fibrillation after percutaneous closure of a patent foramen ovale for cryptogenic stroke has been reported in a variable percentage of patients . However , its precise incidence and mechanism are presently unclear and remain to be eluci date d. Design Prospect i ve follow-up study . Patients Ninety-two patients undergoing a percutaneous patent foramen ovale closure procedure ( closure group ) for cryptogenic stroke were compared with a similar group of 51 patients , who were medically treated . Methods A systematic arrhythmia follow-up protocol to assess the incidence of AF was performed including a 7-day event-loop recording at day 1 , after 6 and 12 months in patients of the closure group and compared with those of the medically treated group . Results The incidence of AF was similar in both study groups during a follow-up of 12 months , including 7·6 % ( 95 % CI : 3·1–15·0 % ) in the closure and 7·8 % ( 95 % CI : 2·18–18·9 % ) in the medically treated group ( P = 1·0 ) . The presence of a large patent foramen ovale was the only significant risk factor for the occurrence of AF as demonstrated by a multivariate Cox regression analysis ( 95 % CI , 1·275–20·018 ; P = 0·021 ) . Conclusions Our findings indicate that patients with cryptogenic stroke and patent foramen ovale have a rather high incidence of AF during a follow-up of 12 months . Atrial fibrillation occurred with a similar frequency whether the patent foramen ovale/atrial septal defect was successfully percutaneously closed or was medically managed . The presence of a large patent foramen ovale was the only significant predictor of AF occurrence during follow-up OBJECTIVES to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager  would experience , compared to usual post-hospital care , better health-related quality of life ( HRQL ) , fewer emergency room visits and less non-elective hospitalisations . DESIGN a stratified , balanced , evaluator-blinded , r and omised clinical trial . SETTING five university-affiliated acute-care hospitals in Montreal , Quebec , Canada . PARTICIPANTS persons ( n = 190 ) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health care supervision post-discharge because of low function , co-morbidity , or isolation . INTERVENTION for 6 weeks following hospital discharge a nurse stroke care manager maintained contact with patients through home visits and telephone calls design ed to coordinate care with the person 's personal physician and link the stroke survivor into community-based stroke services . MEASUREMENTS the primary outcome was the Physical Component Summary ( PCS ) of the Short-Form (SF)-36 survey . A secondary outcome was utilisation of health services . Also measured was the impact of stroke on functioning . Measurements were made at hospital discharge ( baseline ) , following the 6-week intervention and at 6-months post-stroke . RESULTS the average age of the participants was 70 years .  Discharge was achieved on average 12 days post-stroke and most participants had had a stroke of moderate severity . There were no differences between groups on the primary outcome measure , health services utilisation , or any of the secondary outcome measures . CONCLUSION for this population , there was no evidence that this type of passive case management inferred any added benefit in terms of improvement in health-related quality of life or reduction in health services utilisation and stroke impact , than usual post-discharge management We conducted a r and omized controlled multicentre trial to investigate the feasibility of a telerehabilitation intervention for arm/h and function ( the Home Care Activity Desk [ HCAD ] training ) in a home setting . Usual care was compared to HCAD training . The hypothesis was that the clinical outcomes of the HCAD intervention would be at least the same as those measured after a period of usual care for patients with stroke , traumatic brain injury ( TBI ) and multiple sclerosis ( MS ) with respect to their arm/h and function . Eighty-one patients with affected arm/h and function result ing from either stroke , MS or TBI were recruited in Italy , Spain and Belgium ; 11 were lost during follow-up ( 14 % ) . The outcome measures were the Action Research Arm Test ( ARAT ) and the Nine Hole Peg Test ( NHPT ) . There were no significant differences between the two groups on the outcome measures ( ARAT and NHPT ) ; in both groups , patients maintained or even improved their arm/h and function . The HCAD training was found to be as feasible as usual care in terms of clinical outcomes , and both therapists and patients were satisfied with the HCAD intervention . A telerehabilitation intervention using HCAD may increase the efficiency of care The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , which includes a checklist and a flow diagram , is a guideline developed to help authors improve the reporting of the findings from r and omized controlled trials . It was up date d most recently in 2010 . Its primary focus is on individually r and omized trials with 2 parallel groups that assess the possible superiority of one treatment compared with another . The CONSORT Statement has been extended to other trial design s such as cluster r and omization , and recommendations for noninferiority and equivalence trials were made in 2006 . In this article , we present an up date d extension of the CONSORT checklist for reporting noninferiority and equivalence trials , based on the 2010 version of the CONSORT Statement and the 2008 CONSORT Statement for the reporting of abstract s , and provide illustrative examples and explanations for those items that differ from the main 2010 CONSORT checklist . The intent is to improve reporting of noninferiority and equivalence trials , enabling readers to assess the reliability of their results and conclusions AIMS This paper reports a study evaluating whether exp and ing a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery . BACKGROUND Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation , although this is limited by the constraints of service organization . METHODS A pragmatic r and omized controlled trial was undertaken . Patients with a diagnosis of stroke were r and omized to receive continued support from a stroke nurse ( n = 87 ) or usual care and follow-up ( n = 89 ) after discharge from hospital . Patients were recruited from two hospitals in the north-west of Engl and from November 1999 to April 2001 .  Patient dependence ( Barthel Index ) , general health ( Nottingham Health Profile ) , activities of living ( Frenchay Activity of Living Index ) , depression ( Beck Depression Inventory ) and carer strain ( Carer Strain Index ) were assessed at 3 and 12 months after stroke . RESULTS The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months ( median difference 42.6 , P = 0.012 ) , and in particular reduced negative emotional reaction ( P = 0.037 ) and perceived social isolation ( P = 0.002 ) . In addition , the intervention reduced carer strain at 3 months ( P = 0.045 ) , and reduced deterioration in physical dependence from 3 to 12 months ( P = 0.049 ) . CONCLUSION The provision of continued intervention from a stroke nurse after discharge from hospital , focusing on education and support , has tangible benefits for patients and carers PURPOSE The purpose of this study was to investigate the effects of the lifestyle modification coaching program on self efficacy , lifestyle and physiologic indexes related to the recurrence of stroke in patients with stroke . METHODS Sixty-one patients with stroke registered with a stroke center participated in this study . Of the participants , 32 were assigned to the experimental group and 29 to the control group .  Self efficacy , alcohol drinking , smoking , physical activity , BMI ( body mass index ) , WHR ( waist-hip ratio ) , blood lipid level , and blood pressure were measured both for the baseline , as well as after intervention . The lifestyle modification coaching program consisted of an 8-week telecoaching session following face-to-face education . The control group received only the face-to-face education . RESULTS There were significant differences in physical activities , WHR , blood pressure within and between groups after intervention . The lifestyle modification coaching program had significant influences on blood pressure even after gender , age , and physical activity had been adjusted . CONCLUSION The results of the study indicate that lifestyle modification coaching program is effective for physical activity , abdominal obesity and blood pressure . Therefore it can be used by nurses in hospitals and communities as one of the secondary stroke prevention programs for patients with stroke The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating OBJECTIVE To evaluate the effectiveness of an intervention using video to deliver therapy at home for patients with stroke . DESIGN R and omized controlled trial . SETTING The neurology ward and rehabilitation medicine department of a tertiary hospital . PARTICIPANTS Patients with stroke ( N=90 ) . There were 44 patients in the intervention group and 46 patients in the control group . INTERVENTIONS The intervention group received a combination of at-home rehabilitation guided by a digital videodisk containing therapy techniques and twice-monthly outpatient follow-up for 3 months . The conventional therapy group ( control ) attended weekly outpatient therapy sessions . MAIN OUTCOME MEASURES The primary outcome measure was the modified Barthel Index ( MBI ) score . The secondary measures were the incidence of poststroke complications and the Caregiver Strain Index . RESULTS At 3 months , there were no significant differences with regard to the number of patients with improved MBI score , complication rate , or Caregiver Strain Index score between the 2 groups . Both groups had significant increases in the MBI score at 3 months ( P<.001 for both groups ) . Regression analysis revealed that only stroke severity significantly influenced the MBI score ( P<.001 ) , complication rate ( P<.01 ) , and caregiver stress level ( P<.05 ) . CONCLUSIONS Video-based therapy at home for post-acute stroke patients is safe , does not negatively impact independence , and is not stressful for caregivers Abstract Objective : The goal of this study was to preliminarily test the efficacy of a telephone intervention , Family Intervention : Telephone Tracking , design ed to assist stroke survivors and their primary caregivers during the first 6 months after stroke . Method : Forty-nine stroke survivors and their caregivers were r and omly assigned to treatment as usual or treatment as usual plus the telephone intervention . Global outcomes are reported for health care utilization , family functioning , and general functioning . Results : Family and general functioning were positively and significantly changed at 3 and 6 months . Health care utilization was positively and significantly changed at 3 months . Conclusion : Findings suggest that the model has the potential to decrease health care utilization and improve quality of life for stroke survivors and their caregivers . Further study is warranted
BACKGROUND Telerehabilitation is an alternative way of delivering rehabilitation services .
Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location .
The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve .
However , it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face .
OBJECTIVES To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with ( 1 ) in-person rehabilitation ( when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face ) ; or ( 2 ) no rehabilitation .
Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self care and domestic life and improved mobility , health-related quality of life , upper limb function , cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation .
Additionally , we aim ed to report on the presence of adverse events , cost-effectiveness , feasibility and levels of user satisfaction associated with telerehabilitation interventions .