title: A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale.
abstract: Stroke is the leading cause of death and disability in rural China. For stroke patients residing in resource-limited rural areas, secondary prevention and rehabilitation are largely unavailable, and where present, are far below evidence-based standards.
  
  
  
  This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery, and evaluate its feasibility and effectiveness in rural China.
  
  
  
  This 2-year randomized controlled trial is being conducted in 2-3 county hospitals located in northwest, northeast, and southwest China. Eligible and consenting stroke inpatients (200 in total) have been recruited and randomized into either a control or intervention group. Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group. They also provide telephone follow-up care three times post discharge. The recruitment, baseline, intervention, follow-up care, and evaluation are guided by the RECOVER mobile phone app specifically designed for this study.
  
  
  
  The primary outcome is patients' Barthel Index (activities of daily living: mobility, self-care, and toileting) at 6 months. Process and economic evaluation will also be conducted.
  
  
  
  The results of our study will generate initial high-quality evidence to improve stroke care in resource-scarce settings. If proven effective, this innovative care delivery model has the potential to improve the health and function of stroke patients, relieve caregiver burden, guide policy-making, and advance translational research in the field of stroke care.
authors.affiliation: Global Health Institute, Duke University, Durham, USA Global Health Research Center, Duke Kunshan University, Kunshan, China The George Institute for Global Health at Peking University Health Science Center, Beijing, China lijing.yan@duke.edu sjp562013@163.com.
authors.forename: Lijing L
authors.initials: LL
authors.lastname: Yan
authors.affiliation: Global Health Research Center, Duke Kunshan University, Kunshan, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Clinical Epidemiology, China Medical University, Shenyang, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhou
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xie
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Luo
authors.affiliation: Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China.
authors.forename: Ninghua
authors.initials: N
authors.lastname: Wang
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindley
authors.affiliation: School of Public Health, Ningxia Medical University, Yinchuan, China.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: School of Public Health, Ningxia Medical University, Yinchuan, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Li
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Liu
authors.affiliation: Southern Nazarene University, Bethany, OK, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Peoples
authors.affiliation: Global Health Institute, Duke University, Durham, USA School of Nursing, Duke Clinical Research Institute, Duke University, Durham, USA.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.affiliation: Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China Peking University Clinical Research Institute, Beijing, China.
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Clinical Epidemiology, China Medical University, Shenyang, China.
authors.forename: Jingpu
authors.initials: J
authors.lastname: Shi
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers; D002681:China; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity; D009726:Nurses; D010865:Pilot Projects; D012424:Rural Population; D012648:Self Care / Q000191:economics / Q000379:methods; D012984:Software; D000071939:Stroke Rehabilitation / Q000191:economics / Q000379:methods; D013689:Telephone; D016896:Treatment Outcome; D055815:Young Adult
keywords: Barthel Index; Stroke; family caregivers; nurses; rehabilitation; rural China