Telerehabilitation in the Home Versus Therapy In-Clinic for Patients With Stroke
|ClinicalTrials.gov Identifier: NCT02360488|
Recruitment Status : Completed
First Posted : February 10, 2015
Last Update Posted : October 24, 2018
|Condition or disease||Intervention/treatment||Phase|
|Stroke||Device: Telerehabilitation Therapy Behavioral: In-Clinic Therapy||Phase 1|
Substantial evidence indicates that occupational and physical therapy improves outcomes after stroke, and that larger doses are associated with superior outcomes. However, many patients receive suboptimal doses of therapy for reasons that include cost, access, and difficulty with travel. This problem is likely to increase with time given the aging of the population and the increased rate with which patients survive stroke. Telehealth, defined as the delivery of health-related services and information via telecommunication technologies, has enormous potential to address this unmet need.
The current study will test the effectiveness of a novel home-based telehealth system designed to improve motor recovery and patient education after stroke. A total of 124 subjects (the number may be larger depending on the rate of subject dropout) with arm motor deficits 4-36 weeks after a stroke due to ischemia or to intracerebral hemorrhage will be randomized to receive 6 weeks of intensive arm motor therapy (a) in a traditional in-clinic setting or (b) via in-home telerehabilitation (rehabilitation services delivered to the subject's home via an internet-connected computer). The intensity, duration, and frequency of this therapy will be identical across the two groups, with subjects in both treatment arms receiving 36 sessions (18 supervised and 18 unsupervised), 80 minutes each (including a 10 minute break), over 6 weeks. The primary endpoint is within-subject change in the arm motor Fugl-Meyer (FM) score from the Baseline Visit to 30 Day Follow-Up Visit. Arm motor status is the focus here because it is commonly affected by stroke, is of central importance to many human functions, and is strongly linked to disability and well being after stroke.
Telerehabilitation will be evaluated using an assessor-blind, randomized, non-inferiority study design. This study seeks to establish comparable efficacy between the two treatment arms based upon a non-inferiority margin of 2.05 points on the arm motor Fugl-Meyer scale. Key study features include enrollment of a diverse stroke population, standardized and blinded outcomes assessment, a standardized treatment protocol, covariate-adaptive randomization, and use of an active comparator that is matched for duration, frequency, and intensity of therapy. The FDA has determined that this investigation is a non-significant risk device study.
A minimum of 5 clinical sites will participate in this study. Each clinical site will conduct all testing and treatment at a single central site, although each clinical site is encouraged to recruit subjects from their referral hospitals. At the central study site, an Assessment Therapist will perform all study testing, blinded to treatment assignment (the subject by necessity is not blinded), while a Treatment Therapist will provide in-clinic therapy as well as direct home-based telerehabilitation. Potential enrollees may be identified through any of several routes, for example, during the acute stroke admission at the clinical site or a referral hospital, during inpatient rehabilitation at the clinical site or a referral hospital, or through other means of community-based recruitment. Study conduct will be highly standardized, including selecting therapy content, delivering therapy, and testing.
The current study aims to critically evaluate the utility of a telehealth approach to motor therapy and stroke education. Telehealth has enormous potential to address unmet needs in the growing population of stroke survivors.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||124 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
|Official Title:||Telerehabilitation in the Home Versus Therapy In-Clinic for Patients With Stroke An Assessor-blind, Randomized, Non-inferiority Trial|
|Study Start Date :||September 2015|
|Actual Primary Completion Date :||April 2018|
|Actual Study Completion Date :||April 2018|
Experimental: Telerehabilitation Therapy
The Telerehabilitation arm of this study will deliver rehabilitation treatment sessions via an in-home internet-connected computer. A major component of the system is the use of games to promote therapeutically relevant movements. The subject will perform daily assigned home-based telerehabilitation games and exercises and 5 minutes of stroke education, all guided by the telerehabilitation system.During half of the sessions, therapists will initiate a videoconference with the subject's telerehabilitation system to discuss progress, issues, and revise treatment plans as needed.
Device: Telerehabilitation Therapy
18 days of supervised sessions via videoconference and 18 days of unsupervised sessions.
Active Comparator: In-Clinic Therapy
The in-clinic arm of this study will deliver half of the rehabilitation treatment sessions at a study site providing traditional outpatient therapy, continuously supervised by a licensed therapist. The unsupervised therapy sessions will take place in the patient's home, and will be guided by an individualized booklet generated and printed by the Treatment Therapist and distributed to the subject during the first in-clinic therapy visit. The content of the unsupervised therapy sessions will be matched to the same exercise and training components provided during the subject's in-clinic supervised therapy sessions. In addition, at the start of each of the unsupervised sessions, all subjects will receive 5 minutes of stroke education.
Behavioral: In-Clinic Therapy
18 days of therapist supervised sessions and 18 days of unsupervised in home sessions.
- arm motor Fugl-Meyer (FM) score [ Time Frame: from the Baseline Visit to the 30 Day Follow Up Visit ]Evaluates and measures arm motor recovery in post-stroke hemiplegic patients
- Box and Block Test [ Time Frame: from the Screening Visit to the 30 Day Follow Up Visit ]Assesses unilateral gross manual dexterity
- Stroke Impact Scale-Hand Domain [ Time Frame: from the Baseline Visit to the 30 Day Follow Up Visit ]Assesses arm function status following stroke
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02360488
|United States, California|
|University of California, Irvine|
|Irvine, California, United States, 92697|
|UCSD Stroke Center|
|San Diego, California, United States, 92103|
|United States, Florida|
|Brooks Rehabilitation Clinical Research Center|
|Jacksonville, Florida, United States, 32216|
|United States, Georgia|
|Emory Rehabilitation Hospital|
|Atlanta, Georgia, United States, 30322|
|United States, Illinois|
|Rehabilitation Institute of Chicago|
|Chicago, Illinois, United States, 60611|
|United States, Massachusetts|
|Spaulding Rehabilitation Hospital|
|Charlestown, Massachusetts, United States, 02129|
|United States, New Jersey|
|Kessler Institute for Rehabilitation|
|Saddle Brook, New Jersey, United States, 07663|
|United States, New York|
|New York, New York, United States, 10029|
|Burke Rehabilitation Hospital|
|White Plains, New York, United States, 10605|
|United States, Ohio|
|MetroHealth Rehabilitation Institute of Ohio|
|Cleveland, Ohio, United States, 44109|
|United States, South Carolina|
|MUSC Center for Rehabilitation Research in Neurological Conditions|
|Charleston, South Carolina, United States, 29425|
|United States, Washington|
|Harborview Medical Center|
|Seattle, Washington, United States, 98104|
|Principal Investigator:||Steven C Cramer, MD||University of California, Irvine|