title: Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient's home: study protocol of a randomized clinical trial.
abstract: BACKGROUND
  Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the Internet, can contribute to ensure that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance.
  
  
  METHODS
  A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups.
  
  
  CONCLUSIONS
  Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services.
authors.affiliation: École de réadaptation, Faculté de Médecine, Université de Montréal; CRIR CIUSSS du Centre-Sud-de-l'île-de-Montréal-Institut de réadaptation Gingras-Lindsay de Montréal site, Canada.
authors.forename: Dahlia
authors.initials: D
authors.lastname: Kairy
authors.affiliation: École de réadaptation, Faculté de Médecine, Université de Montréal; CRIR CIUSSS du Centre-Sud-de-l'île-de-Montréal-Institut de réadaptation Gingras-Lindsay de Montréal site, Canada.
authors.forename: Mirella
authors.initials: M
authors.lastname: Veras
authors.affiliation: School of Physical and Occupational Therapy, McGill University; CRIR CISSS de Laval Jewish Rehabilitation Hospital Site, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Archambault
authors.affiliation: CRIR CIUSSS du Centre-Sud-de-l'île-de-Montréal-Institut de réadaptation Gingras-Lindsay de Montréal site, Canada.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: École de réadaptation, Faculté de Médecine, Université de Montréal; CRIR CIUSSS du Centre-Sud-de-l'île-de-Montréal-Institut de réadaptation Gingras-Lindsay de Montréal site, Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Higgins
authors.affiliation: School of Physical and Occupational Therapy, McGill University; CRIR CISSS de Laval Jewish Rehabilitation Hospital Site, Canada.
authors.forename: Mindy F
authors.initials: MF
authors.lastname: Levin
authors.affiliation: École de réadaptation, Faculté de Médecine, Université de Montréal; CRIR CIUSSS du Centre-Sud-de-l'île-de-Montréal-Institut de réadaptation Gingras-Lindsay de Montréal site, Canada.
authors.forename: Lise
authors.initials: L
authors.lastname: Poissant
authors.affiliation: McGill University, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Raz
authors.affiliation: CISSS de Laval, Jewish Rehabilitation Hospital Site, Canada.
authors.forename: Franceen
authors.initials: F
authors.lastname: Kaizer
mesh_terms: D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D006699:Home Care Services; D006801:Humans; D011788:Quality of Life; D020127:Recovery of Function; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000191:economics / Q000379:methods*; D000069350:Telerehabilitation / Q000191:economics / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*; D014584:User-Computer Interface
keywords: Clinical; Neurorehabilitaiton; Protocol; Stroke; Telerehabilitation; Trial; Virtual reality