Early Supported Discharge by Caregiver-Mediated Exercises and e-Health Support After Stroke: A Proof-of-Concept Trial.
This proof-of-concept trial investigated the effects of an 8-week program of caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden.



Sixty-three hospitalized stroke patients (mean age 68.7, 64% female) were randomly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care. Primary outcome was the Stroke Impact Scale mobility domain. Secondary outcomes included length of stay, other Stroke Impact Scale domains, readmissions, motor impairment, strength, walking ability, balance, mobility, (extended) activities of daily living, psychosocial functioning, self-efficacy, quality of life, and fatigue. Additionally, caregiver's self-reported fatigue, symptoms of anxiety, self-efficacy, and strain were assessed. Assessments were completed at baseline and at 8 and 12 weeks.



Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility (P=0.6); however, carers reported less fatigue (4.6, confidence interval [CI] 95% 0.3-8.8; P=0.04) and higher self-efficacy (-3.3, CI 95% -5.7 to -0.9; P=0.01) at week 12. Per-protocol analysis, examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility (-9.8, CI 95% -20.1 to 0.4; P=0.06), significantly improved extended activities of daily living scores at week 8 (-3.6, CI 95% -6.3 to -0.8; P=0.01) and week 12 (3.0, CI 95% -5.8 to -0.3; P=0.03), a 9-day shorter length of stay (P=0.046), and fewer readmissions over 12 months (P<0.05).



Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice, resulting in improved patient-extended activities of daily living, reduced length of stay with fewer readmissions post stroke, and reduced levels of caregiver fatigue with increased feelings of self-efficacy. The current findings justify a larger definite phase III randomized controlled trial.



URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613000779774.
From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.). maayken.vandenberg@flinders.edu.au.
Maayken
M
van den Berg
From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
Maria
M
Crotty
From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
Enwu
E
Liu
From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
Maggie
M
Killington
From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
Gert
G
Kwakkel
From the Department of Rehabilitation, Aged and Extended Care, Flinders University, Australia (M.v.d.B., M.C., E.L., M.K.); VU University Medical Center, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and Neuroscience Campus Amsterdam, The Netherlands (G.K., E.v.W.); Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands (G.K.); and Department of Physical Therapy and Human Movement Sciences, Northwestern University Chicago, IL (G.K.).
Erwin
E
van Wegen
D000203:Activities of Daily Living; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology; D005081:Exercise Therapy; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D020407:Internet; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D011788:Quality of Life; D020377:Self Efficacy; D057566:Self Report; D012720:Severity of Illness Index; D000071939:Stroke Rehabilitation / Q000379:methods*; D017216:Telemedicine; D016896:Treatment Outcome
caregiver-mediated exercises; e-health; exercise; home rehabilitation; stroke; telemedicine