title: Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent.
  
  
  METHODS
  This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study.
  
  
  CONCLUSIONS
  The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home.
  
  
  BACKGROUND
  ACTRN12612000464864.
authors.affiliation: Health and Rehabilitation Research Institute, AUT University, Private Bag 92006, Auckland, 1142, New Zealand. nsaywell@aut.ac.nz
authors.forename: Nicola
authors.initials: N
authors.lastname: Saywell
authors.forename: Alain C
authors.initials: AC
authors.lastname: Vandal
authors.forename: Paul
authors.initials: P
authors.lastname: Brown
authors.forename: H Carl
authors.initials: HC
authors.lastname: Hanger
authors.forename: Leigh
authors.initials: L
authors.lastname: Hale
authors.forename: Suzie
authors.initials: S
authors.lastname: Mudge
authors.forename: Stephan
authors.initials: S
authors.lastname: Milosavljevic
authors.forename: Valery
authors.initials: V
authors.lastname: Feigin
authors.forename: Denise
authors.initials: D
authors.lastname: Taylor
mesh_terms: D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D017048:Health Care Costs; D006801:Humans; D009520:New Zealand; D057240:Patient Preference; D026741:Physical Therapy Modalities / Q000191:economics; D011788:Quality of Life; D020127:Recovery of Function; D012107:Research Design; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome