title: Study protocol: home-based telehealth stroke care: a randomized trial for veterans.
abstract: BACKGROUND
  Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement.
  
  
  METHODS
  We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points.
  
  
  CONCLUSIONS
  For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans.
  
  
  BACKGROUND
  Clinical Trials.gov Identifier: NCT00384748.
authors.affiliation: Department of Veterans Affairs Health Services Research & Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA. neale.chumbler@va.gov
authors.forename: Neale R
authors.initials: NR
authors.lastname: Chumbler
authors.forename: Dorian K
authors.initials: DK
authors.lastname: Rose
authors.forename: Patricia
authors.initials: P
authors.lastname: Griffiths
authors.forename: Patricia
authors.initials: P
authors.lastname: Quigley
authors.forename: Nancy
authors.initials: N
authors.lastname: McGee-Hernandez
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Carlson
authors.forename: Phyllis
authors.initials: P
authors.lastname: Vandenberg
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Morey
authors.forename: Jon
authors.initials: J
authors.lastname: Sanford
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000379:methods*; D019033:Delivery of Health Care, Integrated / Q000379:methods; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D014481:United States; D014728:Veterans; D014743:Videotape Recording