title: Family-led rehabilitation after stroke in India: the ATTEND trial, study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Globally, most strokes occur in low- and middle-income countries, such as India, with many affected people having no or limited access to rehabilitation services. Western models of stroke rehabilitation are often unaffordable in many populations but evidence from systematic reviews of stroke unit care and early supported discharge rehabilitation trials suggest that some components might form the basis of affordable interventions in low-resource settings. We describe the background, history and design of the ATTEND trial, a complex intervention centred on family-led stroke rehabilitation in India.
  
  
  METHODS
  The ATTEND trial aims to test the hypothesis that a family-led caregiver-delivered home-based rehabilitation intervention, designed for the Indian context, will reduce the composite poor outcome of death or dependency at 6 months after stroke, in a multicentre, individually randomized controlled trial with blinded outcome assessment, involving 1200 patients across 14 hospital sites in India.
  
  
  CONCLUSIONS
  The ATTEND trial is testing the effectiveness of a low-cost rehabilitation intervention that could be widely generalizable to other low- and middle-income countries.
  
  
  BACKGROUND
  Clinical Trials Registry-India CTRI/2013/04/003557 . Australian New Zealand Clinical Trials Registry ACTRN12613000078752 . Universal Trial Number U1111-1138-6707.
authors.affiliation: Research and Development, George Institute for Global Health India, Unit 301, Second Floor ANR Centre, Road No 1, Banjara Hills, Hyderabad, Telangana, India. malim@georgeinstitute.org.in.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alim
authors.affiliation: The George Institute for Global Health, Sydney, Australia. rlindley@georgeinstitute.org.au.|Sydney Medical School, University of Sydney, Sydney, Australia. rlindley@georgeinstitute.org.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindley
authors.affiliation: Christian Medical College, Ludhiana, Punjab, India. cfelix@georgeinstitute.org.in.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Felix
authors.affiliation: Christian Medical College, Ludhiana, Punjab, India. dorcasattend@gmail.com.
authors.forename: Dorcas Beulah Chandramathy
authors.initials: DB
authors.lastname: Gandhi
authors.affiliation: Christian Medical College, Ludhiana, Punjab, India. sjvmv1947@gmail.com.
authors.forename: Shweta Jain
authors.initials: SJ
authors.lastname: Verma
authors.affiliation: Indian Institute of Public Health, Hyderabad, India. deepak.k@iiphh.org.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Tugnawat
authors.affiliation: Indian Institute of Public Health, Hyderabad, India. anuradha.s@iiphh.org.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Syrigapu
authors.affiliation: The George Institute for Global Health, Sydney, Australia. canderson@georgeinstitute.org.au.|Sydney Medical School, University of Sydney, Sydney, Australia. canderson@georgeinstitute.org.au.|Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia. canderson@georgeinstitute.org.au.
authors.forename: Craig Stuart
authors.initials: CS
authors.lastname: Anderson
authors.affiliation: Department of Physiotherapy, Father Muller Medical College, Mangalore, India. physioram2002@gmail.com.
authors.forename: Ramaprabhu Krishnappa
authors.initials: RK
authors.lastname: Ramamurthy
authors.affiliation: University of Glasgow, Glasgow, UK. Peter.Langhorne@glasgow.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
authors.affiliation: Indian Institute of Public Health, Hyderabad, India. murthy.gvs@iiphh.org.
authors.forename: Gudlavalleti Venkata Satyanarayana
authors.initials: GV
authors.lastname: Murthy
authors.affiliation: School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India. brsham@gmail.com.
authors.forename: Bindiganavale Ramaswamy
authors.initials: BR
authors.lastname: Shamanna
authors.affiliation: The George Institute for Global Health, Sydney, Australia. mhackett@georgeinstitute.org.au.|Sydney Medical School, University of Sydney, Sydney, Australia. mhackett@georgeinstitute.org.au.|University of Central Lancashire, Preston, Lancashire, UK. mhackett@georgeinstitute.org.au.
authors.forename: Maree Lisa
authors.initials: ML
authors.lastname: Hackett
authors.affiliation: Research and Development, George Institute for Global Health India, Unit 301, Second Floor ANR Centre, Road No 1, Banjara Hills, Hyderabad, Telangana, India. pmaulik@georgeinstitute.org.in.|The George Institute for Global Health, Oxford University, Oxford, UK. pmaulik@georgeinstitute.org.in.
authors.forename: Pallab Kumar
authors.initials: PK
authors.lastname: Maulik
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia. lisa.harvey@sydney.edu.au.
authors.forename: Lisa Anne
authors.initials: LA
authors.lastname: Harvey
authors.affiliation: The George Institute for Global Health, Sydney, Australia. sjan@georgeinstitute.org.|Sydney Medical School, University of Sydney, Sydney, Australia. sjan@georgeinstitute.org.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: The George Institute for Global Health, Sydney, Australia. hliu@georgeinstitute.org.au.|Sydney Medical School, University of Sydney, Sydney, Australia. hliu@georgeinstitute.org.au.
authors.forename: Hueiming
authors.initials: H
authors.lastname: Liu
authors.affiliation: University of Nottingham, Nottingham, UK. marion.walker@nottingham.ac.uk.
authors.forename: Marion
authors.initials: M
authors.lastname: Walker
authors.affiliation: University of Leeds, Leeds, UK. a.forster@leeds.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Forster
authors.affiliation: Christian Medical College, Ludhiana, Punjab, India. jeyarajpandian@hotmail.com.
authors.forename: Jeyaraj Durai
authors.initials: JD
authors.lastname: Pandian
mesh_terms: D017028:Caregivers; D002985:Clinical Protocols; D005190:Family; D006801:Humans; D007194:India; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018401:Sample Size; D000071939:Stroke Rehabilitation