title: Translating knowledge for action against stroke--using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke).
abstract: BACKGROUND
  Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world's sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70% mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.
  
  
  METHODS
  Movies4Stroke will be a randomized control, outcome assessor blinded, parallel group, single center superiority trial. Participants with an acute stroke, medically stable, with mild to moderate disability and having a stable primary caregiver will be included. After obtaining informed consent the stroke survivor-caregiver dyad will be randomized. Intervention participants will have the movie program software installed in their phone, desktop, or Android device which will allow them to receive, view and repeat 5-minute videos on stroke-related topics at admission, discharge and first and third months after enrollment. The control arm will receive standard of care at an internationally accredited center with defined protocols. The primary outcome measure is medication adherence as ascertained by a locally validated Morisky Medication Adherence Scale and control of major risk factors such as blood pressure, blood sugar and blood cholesterol at 12 months post discharge. Secondary outcome measures are post-stroke complications and mortality, caregiver knowledge and change in functional outcomes after acute stroke at 1, 3, 6, 9 and 12 months. Movies4Stroke is designed to enroll 300 participant dyads after inflating 10% to incorporate attrition and non-compliance and has been powered at 95% to detect a 15% difference between intervention and usual care arm. Analysis will be done by the intention-to-treat principle.
  
  
  CONCLUSIONS
  Movies4Stroke is a randomized trial testing an application aimed at supporting caregivers and stroke survivors in a LMIC with no rehabilitation or chronic support systems.
  
  
  BACKGROUND
  NCT02202330 (28 January 2015).
authors.affiliation: Section of Neurology, Department of Medicine, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan. ayeesha.kamal@aku.edu.
authors.forename: Ayeesha Kamran
authors.initials: AK
authors.lastname: Kamal
authors.affiliation: Stroke Service, the International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health), Aga Khan University, Karachi, Pakistan. adeel.khoja@gmail.com.
authors.forename: Adeel
authors.initials: A
authors.lastname: Khoja
authors.affiliation: Aga Khan University, Karachi, Pakistan. bushra.usmani.M11@student.aku.edu.
authors.forename: Bushra
authors.initials: B
authors.lastname: Usmani
authors.affiliation: Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan. abdul.muqeet@akdn.org.
authors.forename: Abdul
authors.initials: A
authors.lastname: Muqeet
authors.affiliation: Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan. fabiha.zaidi@akdn.org.
authors.forename: Fabiha
authors.initials: F
authors.lastname: Zaidi
authors.affiliation: Movies for Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. masood.ahmed.akram@gmail.com.
authors.forename: Masood
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Movies for Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. schoudhry89@gmail.com.
authors.forename: Saadia
authors.initials: S
authors.lastname: Shakeel
authors.affiliation: Section of Neurology, Department of Medicine, Aga Khan University and Director, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan. nabila.soomro@aku.edu.
authors.forename: Nabila
authors.initials: N
authors.lastname: Soomro
authors.affiliation: Stroke Service, Department of Medicine, Aga Khan University, Karachi, Pakistan. ambreen.gowani@aku.edu.
authors.forename: Ambreen
authors.initials: A
authors.lastname: Gowani
authors.affiliation: Department of Psychiatry, Aga Khan University, Karachi, Pakistan. nargis.asad@aku.edu.
authors.forename: Nargis
authors.initials: N
authors.lastname: Asad
authors.affiliation: Section of Diabetes, Endocrinology and Metabolism, Department of Medicine, Aga Khan University, Karachi, Pakistan. asma.ahmed@aku.edu.
authors.forename: Asma
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan. saleem.sayani@akdn.org.
authors.forename: Saleem
authors.initials: S
authors.lastname: Sayani
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. iqbal.azam@aku.edu.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Azam
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. sarah.saleem@aku.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
mesh_terms: D017028:Caregivers; D040421:Cell Phone; D001330:Electronic Data Processing; D006801:Humans; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D059039:Standard of Care; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D017741:Survivors; D057170:Translational Research, Biomedical; D014741:Video Recording
references.citation: Annu Rev Public Health. 2015 Mar 18;36:483-505
references.pmid: 25581147
references.citation: Health Educ Q. 1988 Summer;15(2):175-83
references.pmid: 3378902
references.citation: J Rehabil Res Dev. 2002 May-Jun;39(3):385-94
references.pmid: 12173758
references.citation: Lancet. 2011 May 14;377(9778):1693-702
references.pmid: 21571152
references.citation: J Hum Hypertens. 2006 Jan;20(1):83-5
references.pmid: 16151442
references.citation: Int J Stroke. 2012 Jan;7(1):94-9
references.pmid: 22111894
references.citation: J Cardiovasc Transl Res. 2014 Nov;7(8):677-91
references.pmid: 25209729
references.citation: Lancet. 2013 Jun 29;381(9885):2291-7
references.pmid: 23684259
references.citation: Lancet. 2011 Jul 2;378(9785):31-40
references.pmid: 21705069
references.citation: Lancet. 2013 Jun 29;381(9885):2281-90
references.pmid: 23684257
references.citation: J Clin Nurs. 2008 Feb;17(3):403-11
references.pmid: 17419788
references.citation: Cochrane Database Syst Rev. 2011;(10):CD008179
references.pmid: 21975778
references.citation: Bull World Health Organ. 1976;54(5):541-53
references.pmid: 1088404
references.citation: Telemed J E Health. 2012 Oct;18(8):613-20
references.pmid: 23061642
references.citation: PLoS Med. 2013;10(2):e1001382
references.pmid: 23424286
references.citation: BMC Res Notes. 2012 Feb 09;5:89
references.pmid: 22321339
references.citation: BMJ Open. 2013 May 08;3(5):null
references.pmid: 23657469
references.citation: Lancet. 2013 Dec 21;382(9910):2069-76
references.pmid: 24054816
references.citation: Lancet Neurol. 2009 Apr;8(4):355-69
references.pmid: 19233729
references.citation: Milbank Q. 2005;83(4):731-57
references.pmid: 16279965
references.citation: Lancet. 2013 Jun 22;381(9884):2193-206
references.pmid: 23684254
references.citation: J Health Commun. 2004;9 Suppl 1:13-9
references.pmid: 14960401
references.citation: Neurology. 2013 Feb 12;80(7):677-84
references.pmid: 23400318
references.citation: Lancet Neurol. 2012 Mar;11(3):261-71
references.pmid: 22341034
references.citation: Stroke. 2011 Jan;42(1):227-76
references.pmid: 20966421
references.citation: PLoS Med. 2013;10(2):e1001395
references.pmid: 23468597
references.citation: Expert Rev Cardiovasc Ther. 2010 Nov;8(11):1587-98
references.pmid: 21090934
references.citation: BMC Neurol. 2015;15:54
references.pmid: 25880843
references.citation: Lancet. 2011 Aug 20;378(9792):648-9
references.pmid: 21549420
references.citation: Expert Rev Cardiovasc Ther. 2012 Dec;10(12):1471-80
references.pmid: 23253272
references.citation: Med J Malaysia. 2012 Jun;67(3):251-2
references.pmid: 23082411
references.citation: Blood Press. 1992 Aug;1(2):113-9
references.pmid: 1366259