Home-based Telehealth Stroke Care: A Randomized Trial for Veterans
Condition: Cerebrovascular Accident
MeSH terms: Stroke
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of the proposed study is to examine a Tele-rehabilitation (TR) intervention that
      uses tele-health technology to improve outcomes of stroke patients after discharge to home.
      The primary aim is to determine the effect of TR on physical function, and secondarily to
      determine the effect on disability, falls-related self-efficacy, and patient satisfaction.
    

Detailed description: 
      Stroke patients clearly benefit from intensive, coordinated, inpatient care. At the same
      time, there is considerable interest in ways to reduce hospital lengths of stay. Early
      discharge rehabilitation programs require coordinated, well-organized home-based
      rehabilitation, and lack of sufficient information about the home setting impedes successful
      rehabilitation. Unfortunately, resources for in-home rehabilitation are limited. The goal of
      TR is to improve functional mobility using a multifaceted rehabilitation intervention via two
      types of telehealth technology. Tele-video is used to carry out an in-home assessment of
      functional mobility, to make treatment recommendations, and to provide periodic goal-oriented
      reassessment, modifying the treatment plan as the patient improves. Tele-video uses a video
      camera with a home health aide in the patient's home to provide visual and audio to a
      therapist located at the base hospital. It is used to carry out an in-home assessment of
      functional mobility, to make treatment recommendations, and to provide periodic goal-oriented
      reassessment, modifying the treatment plan as the patient improves. An interactive, in-home
      messaging device is used to facilitate adherence with treatment recommendations and to screen
      for interval problems (depression, falls, and difficulty with self-care).

      This is a Phase II, 2-arm, 3-site Randomized Controlled Trial (RCT). A total of 120 veterans
      with recent onset of ischemic or hemorrhagic stroke who are discharged to the community will
      be randomly assigned to one of two groups: (a) TR; and (b) Usual Care. Dependent variables
      (physical function, disability, falls-related self-efficacy, and patient satisfaction) will
      be measured at baseline, 3-, and 6-months via telephone interviews by the study coordinator
      located at the CIEBP who will be blinded to the study group assignment of the patient.
    

Intervention name(s): TR intervention; In-home messaging device.; Usual care
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The 3 tele-visits will occur within 5 weeks post randomization. Telephone call visits will occur during weeks 2, 4, 6, 8 and 12. One additional tele-visit may be scheduled as needed. The first visit is devoted to mobility assessment, goal-setting. The second visit is to review the current exercise component. Visit 3 focuses on functional mobility using adaptive strategy component.; The purpose of this aspect of the intervention is to screen for unforeseen problems and to reinforce adherence to the recommended treatment. It will be used to interface with patients daily, but briefly. The in-home messaging device, which resembles a caller ID box is attached to the home telephone line and electrical outlet. Installation of the equipment involves connecting it to the phone line and plugging it into an electrical outlet. The teletherapist receives the clinical data from the in-home messaging device via the internet on a daily basis. It is used to screen for depression, lower extremity strength, self-care tasks and mobility, falls and exercise adherence.; Routine VA care.
Other intervention name(s): Tele-visit intervention
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cerebrovascular Accident; Rehabilitation; Telemedicine