The Feasibility and Effect of PACUTS on Health Promotion for Stroke Wheelchair User in Long-term Care Institution

Study Overview
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Brief Summary
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Most of the residents in long-term care institution were wheelchair users, however, it would limit the participation in physical activities, and thus increase the degree of disability as they excessively rely on wheelchair. Recently, with the development of rehabilitation technology, the clients can receive more individualized physical activities intervention. Moreover, using technology as an assistive modality would reduce the demand of manpower, and provide higher treatment intensity with repeated training and objective performance feedback. Based upon our previous study finding from the physical activity with computerized upper limb training system (PACUTS), we propose to build a training strategy of physical activity for stroke wheelchair user in long-term care institution and to analyze its feasibility as well as the treatment effects, in the next two years. The mixed method design will be applied. In the qualitative research, we will focus on the experience of physical activity training and subject's adoption and acceptance of the PACUTS. In terms of the quantitative research, 50 residents who currently live in long-term care institution will be recruited. Double-blinded randomized control-group pretest-posttest design will be conducted. In the experiment group, the participant will receive the intervention of PACUTS for 12 weeks/ 5 sessions per week/ 30 minutes, at least, per session. In terms of control group, the participant will receive a regular treatment program and physical activities scheduled by occupational therapist. This study is expected to contribute to build a training strategy with computerized upper limb training system which can helpfully promote the participation in physical activities and health outcomes for w/c residents living in long-term care institution.

Detailed Description
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In the past few years, the government has been focusing on community based care, the idea so-called aging-in-place. Therefore, the intervention model for residents in long-term care institution had been noticed by the researcher. Most of the residents in long-term care institution were wheelchair users, however, it would limit the participation in physical activities, and thus increase the degree of disability as they excessively rely on wheelchair. Recently, with the development of rehabilitation technology, the clients can receive more individualized physical activities intervention. Moreover, using technology as an assistive modality would reduce the demand of manpower, and provide higher treatment intensity with repeated training and objective performance feedback. Based upon our previous study finding from the physical activity with computerized upper limb training system (PACUTS), we propose to build a training strategy of physical activity for stroke wheelchair user in long-term care institution and to analyze its feasibility as well as the treatment effects, in the next two years. The mixed method design will be applied. In the qualitative research, we will focus on the experience of physical activity training and subject's adoption and acceptance of the PACUTS. Through in-depth interview, field notes and different interviewers, the qualitative data analysis with phenomenology design will be applied. In terms of the quantitative research, 50 residents who currently live in long-term care institution will be recruited. Double-blinded randomized control-group pretest-posttest design will be conducted. In the experiment group, the participant will receive the intervention of PACUTS for 12 weeks/ 5 sessions per week/ 30 minutes, at least, per session. In terms of control group, the participant will receive a regular treatment program and physical activities scheduled by occupational therapist. Participants will be assessed by outcome measures, including Time Up and Go Test, Box and Block Test, Grip Strength Assessment, the Ruff 2 & 7 Selective Attention Test, System Usability Scale, Barthel Index, SF-36 and the Falls Efficacy Scale-International. Descriptive statistics, independent-sample t test, paired-sample t test or mixed type 2-way ANOVA will be performed for data analysis. This study is expected to contribute to build a training strategy with computerized upper limb training system which can helpfully promote the participation in physical activities and health outcomes for w/c residents living in long-term care institution.

Official Title
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The Feasibility and Effect of Physical Activity With Computerized Upper Limb Training Strategy on Health Promotion for Stroke Wheelchair User in Long-term Care Institution

Conditions
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Stroke

Intervention / Treatment
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* Other: computer task intervention
* Other: conventional long-term care services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Currently living in a long-term care institution Stoke, onset over 6 months Wheelchair user Maintain sitting 30 minutes No cognition impairment Exclusion Criteria: Aphsia Dementia, Cancer and MS PNS impairment Cardiopulmonary dysfunction Visual impairment
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: computer intervention group<br>stroke subjects with wheelchair users completed computer screen tasks with affected arm or bilateral arm movement | Other: computer task intervention<br>* subject received programs for upper arm movement training with providing computer screen task activities<br>|
| Active Comparator: conventional long-term care services group<br>stroke subjects with wheelchair users receive conventional long-term care services | Other: conventional long-term care services<br>* stroke subjects with wheelchair users receive conventional long-term care services<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Box and Block Test | The Box and Block Test (BBT) measures unilateral gross manual dexterity. It is a quick, simple and inexpensive test. It can be used with a wide range of populations, including clients with stroke. | pre-test, post-test(Change from pre-test Box and Block Test after 6 weeks' intervention) | 
| Grip Strength Assessment | Grip strength is a measure of muscular strength or the maximum force/tension generated by one's forearm muscles. It can be used as a screening tool for the measurement of upper body strength and overall strength. | pre-test, post-test(Change from pre-test Grip Strength Assessment after 6 weeks' intervention) | 
| System Usability Scale | The System Usability Scale, or SUS, is a simple survey that provides a high-level score for the usability of a product. | only post-test(after 6 weeks' intervention) | 
| Moss Attention Rating Scale | The MARS was designed as an observational rating scale to provide a reliable, quantitative and ecologically valid measure of attention-related behavior after TBI. | pre-test, post-test(Change from pre-test Moss Attention Rating Scale after 6 weeks' intervention) | 
| upper limb endurance | can raise your hands several times in a minute | pre-test, post-test(Change from pre-test upper limb endurance after 6 weeks' intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Barthel Index | The Barthel Scale/Index (BI) is an ordinal scale used to measure performance in activities of daily living (ADL). Ten variables describing ADL and mobility are scored, a higher number being a reflection of greater ability to function independently following hospital discharge. | pre-test and post-test(after 6 weeks' intervention) | 
| The 12-Item Short Form Health Survey | The 12-item Short Form Health Survey (SF-12) as a shorter alternative of the SF-36 is largely used in health outcomes surveys. | pre-test and post-test(after 6 weeks' intervention) | 
| Falls Efficacy Scale-International | are measures of fear of falling or, more properly, concerns about falling, which are suitable for use in research and clinical practice. | pre-test and post-test(after 6 weeks' intervention) |