Please select the eligibility criteria that correspond to the clinical trial below.
Title: Stroke Prevention Rehabilitation Intervention Trial of Exercise - SPRITE - A Feasibility and Pilot Study
Brief Summary: BACKGROUND - Approximately 1,700 transient ischaemic attacks (TIAs) occur annually in NI with TIA survivors often being left with considerable functional impairment. TIA and strokes share common risk factors with cardiovascular disease. Cardiac rehabilitation post-myocardial infarction has shown significant reductions in morbidity and mortality, with home-based programmes producing better adherence and similar outcomes to hospital-and community-based programmes. However, the value of rehabilitation programmes for stroke prevention following a TIA or minor stroke is unclear.

AIMS - to determine if a novel rehabilitation programme, 'The Healthy Brain Rehabilitation Manual', for TIA/minor stroke patients can be developed, using MRC guidelines for developing complex health service interventions, from an approved home-based cardiac rehabilitation programme (the 'Heart Manual') and to undertake feasibility and pilot studies of the novel programme.

METHODS-All patients attending a TIA clinic in Belfast within 4 weeks of their first TIA/mild stroke will be invited to participate. The novel home-based programme manual will be developed following systematic reviews of the literature and qualitative exploration with the target population, using focus groups. A feasibility study will initially be undertaken lasting 6 weeks and then developed into a pilot trial of 12 weeks duration. The feasibility will recruit to 3 different treatments: (1) standard care; (2) standard care plus the manual; (3) standard care, manual plus a pedometer. Whilst for the pilot study there will also be 3 arms but this will include: 1) control group; 2) manual and pedometer supported by telephone follow-up with a GP; 3) manual and pedometer supported by telephone follow-up with a stroke nurse. Interviews and focus groups will be employed to assess the interventions' acceptability. The intervention, 'The Healthy Brain Rehabilitation Manual' will be refined and modified at all stages of the research.

CONCLUSIONS - The findings will inform the development of a novel secondary prevention programme, 'The Healthy Brain Rehabilitation Manual', for TIA/minor stroke patients and of a trial to test its effectiveness and longer-term potential to improve outcomes for TIA/stroke patients.


Options:
A: Inclusion Criteria:

1. Age ≥ 40 years;
2. Recent stroke (defined as stroke symptoms occurring within 4 weeks prior to admission into community hospitals);
3. Diagnosis of stroke made by clinician and/or supported by brain imaging;
4. Able to sit unsupported for 30 seconds;
5. Able to stand on the non-paretic leg for \>4 sec;
6. Able to walk at least 2m with maximum of 1 person assist;
7. Able to follow a 3-step command;
8. Living in the community before discharge and expected to be discharged home;
9. Has a caregiver.

Exclusion Criteria:

1. Has a pacemaker in-situ (because of possible interference of pacemakers by wireless electronic signals);
2. Unable to ambulate at least 150 feet prior to stroke, or intermittent claudication while walking less than 200 meters;
3. Serious cardiac conditions (hospitalization for myocardial infarction or heart surgery within 3 months, history of severe congestive heart failure, serious and unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities of daily living);
4. History of serious chronic obstructive pulmonary disease or oxygen dependence;
5. Severe weight bearing pain;
6. Pre-existing neurological disorders such as Parkinson's disease, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS) or severe dementia
7. History of major head trauma with severe residual deficits;
8. Lower extremity amputation;
9. Legal blindness or severe visual impairment;
10. Severe uncontrolled psychiatric illness such as psychosis, schizophrenia or medication refractory depression;
11. Life expectancy less than three months;
12. Severe arthritis or orthopedic problems that limit passive ranges of motion of lower extremity (knee flexion contracture of \> 10°, knee flexion ROM \< 90°, hip flexion contracture \> 25°, and ankle plantar flexion contracture \> 15°);
13. History of sustained alcoholism or drug abuse in the last six months;
14. Hypertension with systolic blood pressure greater than 200 mmHg and diastolic blood pressure greater than 110 mmHg at rest, that cannot be medically controlled into the resting range of 180/100 mmHg.
B: Inclusion Criteria:

* Has experienced a stroke in the last 12 months
* 50 years of age or older
* Living in the community with phone access
* Mild to moderate stroke severity (i.e., modified Rankin Scale score ranging from 1 to 4)
* Able to communicate in English

Exclusion Criteria:

* Stroke of non-vascular origin
* Actively engaged in formal stroke rehabilitation services
* Uncontrolled arrhythmias
* Significant musculoskeletal or other neurological condition
* Severe aphasia or dysarthria
* Not medically stable
* Pain or co-morbidities which would preclude activity
* Living in long-term residential care
* Cognitive impairment, dependent in activities of daily living, and no caregiver participation
C: Inclusion Criteria:

* 18 years of age or older
* male or female
* attendee at a participating TIA clinic within 4 weeks of a first suspected TIA
* diagnosed with a TIA or 'minor' stroke, due to atherosclerosis or small vessel occlusion (diagnosis based on the TOAST classification system (69)(70), following neurological examination and neuroimaging (32)).

Exclusion Criteria:

* patients who have experienced more than one TIA and/or stroke
* inability to give informed consent
* presenting after 4 weeks of their first suspected TIA and/or 'minor' stroke
* contra-indication for exercise training, based on guidelines of the American College of Sports Medicine(72)
D: Inclusion Criteria:

* individuals with sub-acute stroke attending in-patient rehabilitation at Toronto Rehab
* patients who have identified improving walking function as a rehabilitation goal
* patients who can walk without supervision at the time of recruitment into the study

Answer: C