Tele-Rehabilitation Pilot Evaluation Study

Study Overview
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Brief Summary
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A proof of concept randomized controlled trial (RCT) only evaluated the National University of Singapore's (NUS) T-Rehab tele-rehabilitation (TR) system at a home setting where rehabilitation was provided on an individual level. The previous RCT was also limited to stroke patients. In addition to stroke, there are many other conditions (such as fractures, lower limb joint replacement, musculoskeletal conditions) require and benefit from rehabilitation. The primary aims of the pilot evaluation study are: (i) To document patient adherence to TR, compared to usual care (ii) To estimate the extent to which TR improves functional status, compared to usual care and (iii) To estimate the cost effectiveness of TR, compared to usual care in eight different health conditions in Singapore.

Detailed Description
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This is a 12-week quasi-experimental trial of a tele-rehabilitation program involving seven sites and up to 600 adults in Singapore.

Official Title
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Tele-Rehabilitation Pilot Evaluation Study

Conditions
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Fractures, Bone, Stroke, Lower Limb Joint Replacement (Hip or Knee), Lower Limb Amputation, Pneumonia, Fall, Deconditioning, Musculoskeletal Conditions (e.g., Tendinitis, Capsulitis)

Intervention / Treatment
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* Behavioral: Tele-rehabilitation
* Behavioral: Usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: at least 21 years of age Admitted into an inpatient or outpatient rehabilitation unit, nursing home or day care centre for an acute or chronic disability Deemed by any members of the multi-disciplinary rehabilitation team to potentially able to safely receive and benefit from rehabilitation post-discharge Cognitively able to understand and follow instructions (the Abbreviated Mental Test's score of 6 or above (out of 10). Exclusion Criteria: Patients with previous seizure episodes Patients with limb musculoskeletal pain of at least moderate intensity (visual analogue Scale > 6 out of 10) Patients with pacemakers.

Ages Eligible for Study
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Minimum Age: 21 Years

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: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tele-rehabilitation<br>Tele-rehabilitation via iPad. | Behavioral: Tele-rehabilitation<br>* There are five different categories of exercise in the rehabilitation program, which combines both physiotherapy (Category 1 to 4) and occupational therapy components (Category 5). Each tele-therapy session could cover all five categories of exercises. Progression of levels within each exercise within each category should be determined by the tele-therapist and in consultation with the participant.<br>|
| Active Comparator: Usual care<br>Usual rehabilitation care, prescribed by rehabilitation therapists at participating centers and performed by participants at participating centers. | Behavioral: Usual care<br>* Usual rehabilitation care (e.g., PT, OT and ST), prescribed by rehabilitation therapists at participating centers and performed by participants at participating centers.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adherence to rehabilitation over the course of a 2 week trial period | Adherence to the prescribed rehabilitation and exercise therapy will be measured over 12 weeks | At 12-weeks post-rehabilitation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| EQ-5D | Perceived Health Status and Quality of Life | 12-weeks | 
| CESD | The Center for Epidemiological Studies Depression Scale | 12-weeks | 
| IADL | The Lawton Instrumental Activities of Daily Living (IADL) Scale | 12-weeks | 
| Barthel Index | Barthel Index of Activities of Daily Living | 12-weeks | 
| Health Service Utilization | Use of Health Services over the past three months | 12-weeks |