Title: Development and pilot evaluation of a web-supported programme of Constraint Induced Therapy following stroke (LifeCIT)
Funder: Department of Health (England)

Abstract: Background Persisting non-use of the hemiplegic upper limb is a common and disabling consequence of stroke. Constraint Induced Therapy (CIT) has recently been shown to improve upper limb function, but is currently rarely implemented in the NHS. CIT involves restricting use of the unaffected limb (using a mitt) and encouraging use of the hemiplegic limb for several hours a day (using repetitive exercises and normal activities). Barriers to implementation include insufficient resources to provide supervised clinic-based CIT, and lack of patient confidence and motivation to carry out CIT alone at home. We have developed a web-based software tool (the LifeGuide) that could be used to provide and monitor motivating individualised programmes for home-based CIT with online therapist support. Aims 1. With patients, carers and therapists, develop ‘LifeCIT’, a web-based programme for CIT combined with personalised activities, automated progress-relevant advice and online therapist support. 2. Conduct a pilot study of LifeCIT to: a) assess the effects of the intervention on: upper limb function; stroke-related quality of life and achievement of personal goals; b) estimate the effect size of the intervention compared with usual care and identify appropriate methodology; c) establish compliance (LifeCIT and usual care) d) carry out a preliminary evaluation of the relative economic costs and benefits of this method of providing rehabilitation following stroke. 3. Use qualitative methods to identify and address the acceptability and feasibility of implementing the LifeCIT programme. Plan of Investigation To develop the intervention we will recruit and work with two successive user groups (each of at least 6 patients, 3 carers and 3 therapists) to work with us to develop the intervention. Interviews, diaries and observation will be used to gain feedback to optimise the intervention. For the pilot study we will recruit 40-60 recently discharged patients with upper limb hemiplegia from 3 centres and randomise them to receive the LifeCIT intervention or usual care. Assessment at baseline, post-treatment (3 weeks) and follow-up (6 months) will include: patient-reported measures of everyday limb use and quality of life and blinded independent evaluation of motor function. We will also conduct a preliminary economic evaluation and a qualitative study of patient, carer and therapist experiences. Potential Impact Assuming that we can develop a therapy programme that is acceptable, feasible and potentially cost-effective, following definitive evaluation in a multi-centre RCT this programme could be easily rolled out to all suitable UK patients. To ensure that it can be widely implemented the programme will require only equipment available in many homes (PC and internet) and that can be readily provided (C-MIT). The LifeCIT intervention will provide structured support for carrying out CIT to patients (assisted where possible by carers) and therapists, removing the need for specialist therapist training. Consequently, this study can potentially pioneer a new, cost-effective approach to providing support for patients who would benefit from more intensive rehabilitation than can currently be provided.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;6.7 PHYSICAL
Health categories: STROKE