Pilot Study on Comparisons Between the Effectiveness of Mobile Video-guided and Paper-based Home Exercise Programs of Patients With Stroke Randomized Controlled Trial
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      This is a pilot study and a randomized, controlled, assessor-blinded clinical trial for
      patients who will complete the inpatient Stroke Rehabilitation Program in the Department of
      Medical and Geriatrics of Tai Po Hospital and Shatin Hospital from June 2018 to March 2019.
      The objective of the study is to compare the effectiveness of video-guided exercise program
      and standard paperbased home exercise program on adherence of exercise, self-efficacy and
      improving functional outcomes in patients with stroke within 3-month follow-up.
    

Detailed description: 
      In Hong Kong, stroke patients would be referred to ambulatory services, such as geriatric day
      hospital, or domestic physiotherapy service to continue their stroke rehabilitation after
      discharge from hospital care. However, some patients could not attend ambulatory services due
      to vary difficulties, such as transportation and absence of carers. The low frequency of
      domestic physiotherapy service also reduced the effectiveness of rehabilitation of patients.
      Traditionally, for continuation of training at home, therapists would prescribe home
      exercises programs in paper-based format to stroke patients prior to discharge. However,
      evidence showed that written and pictorial home exercise prescription does not lead to better
      adherence to a home exercise programme compared to having no written and pictorial
      instructions for patients with stroke less than 4 months. It was suggested that the barriers
      to adherence of home exercise including low self-efficacy and delivery mode of training
      program. It is worthwhile for physiotherapists to investigate the mode of delivery to enhance
      exercise adherence and selfefficacy of post-discharge home exercise for patients with stroke.
      Recent survey concerning the development of smart technology revealed that 80% of global
      internet users owned a smart phone and 47% owned a tablet. Thus, the increasing accessibility
      of smart technology offers an opportunity to advance the mode of delivery of exercise program
      so as to benefit patients of stroke from increase the adherence and self-efficacy of home
      exercises. The evidences of using smart technology to enhance adherence of home exercise have
      reported inconsistent results. A study showed that home exercise programmes filmed on an
      electronic tablet, with an automated reminder, was not superior to standard paper-based home
      exercise programmes in terms of adherence, motor function, or satisfaction for patients
      recovering from stroke. In contrast, another study showed that people with musculoskeletal
      conditions adhere better to their home exercise programs when the programs are provided on an
      app with remote support compared to paper handouts; although the clinical importance of this
      added adherence is unclear. This is a pilot study and a randomized, controlled,
      assessor-blinded clinical trial for patients who will complete the inpatient Stroke
      Rehabilitation Program in the Department of Medical and Geriatrics of Tai Po Hospital and
      Shatin Hospital from June 2018 to March 2019. The objective of the study is to compare the
      effectiveness of video-guided exercise program and standard paperbased home exercise program
      on adherence of exercise, self-efficacy and improving functional outcomes in patients with
      stroke within 3-month follow-up. Eligible subjects will then be randomly assigned to either
      Intervention Group or Control Group in a 1:1 ratio.

      Investigators who are responsible for data collection will be blinded to the group
      allocation. Pre-discharge training sessions last for 10- 15 minutes will be provided to
      patients, and their carers if any, of both groups in order to make them familiar with the
      selected home exercises and the technique of using mobile phone to scan QR for intervention
      group. Participants allocated to the intervention group will be prescribed a set of exercise
      video with QR code provided in home exercise pamphlets and they have to perform the
      prescribed exercises under the guidance of video. On the other hand, participants in control
      group will be given instructions for their home exercise program in a traditional pamphlet
      includes photographs and instructions of exercise demonstration. The content of home exercise
      program in both groups is the same and is based on the recommendations from the National
      Stroke Foundation Clinical Guidelines, including mobilization exercise, strengthening
      exercise and balance training which is tailor-made for different mobility level of stroke
      patients. Suitability of participating home exercise program will be assessed by
      physiotherapists based on environmental risk, fall risk and competence of patients or carers
      in performing exercise with patients. The number of exercises prescribed, frequency and
      intensity of exercise varies from participants and will be determinated by physiotherapists.
      Outcome measures including self-reported exercise adherence, self-efficacy for exercise,
      Modified Functional Ambulatory Category and Modified Barthel Index will be assessed at 1 day,
      1 month and 3 month after discharged on phone follow-up basis by a blinded-assessor. We aim
      to recruit 28 participants in each group.
    

Intervention name(s): Stroke physiotherapy home exercise video
Intervention type(s): Behavioral
Intervention description(s): a set of exercise video with QR code provided in home exercise pamphlets
Other intervention name(s): exercise video
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized, controlled
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment