Feasibility and cost description of highly intensive rehabilitation involving new technologies in patients with post-acute stroke-a trial of the Swiss RehabTech Initiative

BACKGROUND There is a need to provide highly repetitive and intensive therapy programs for patients after stroke to improve sensorimotor impairment. The employment of technology-assisted training may facilitate access to individualized rehabilitation of high intensity. The purpose of this study was to evaluate the safety and acceptance of a high-intensity technology-assisted training for patients after stroke in the subacute or chronic phase and to establish its feasibility for a subsequent randomized controlled trial. METHODS A longitudinal, multi-center, single-group study was conducted in four rehabilitation clinics. Patients participated in a high-intensity 4-week technology-assisted trainings consisting of 3 to 5 training days per week and at least 5 training sessions per day with a duration of 45 min each. Feasibility was evaluated by examining recruitment, intervention-related outcomes (adherence, subjectively perceived effort and effectiveness, adverse events), patient-related outcomes, and efficiency gains. Secondary outcomes focused on all three domains of the International Classification of Functioning Disability and Health. Data were analyzed and presented in a descriptive manner. RESULTS In total, 14 patients after stroke were included. Participants exercised between 12 and 21 days and received between 28 and 82 (mean 46 ± 15) technology-assisted trainings during the study period, which corresponded to 2 to 7 daily interventions. Treatment was safe. No serious adverse events were reported. Minor adverse events were related to tiredness and exertion. From baseline to the end of the intervention, patients improved in several functional performance assessments of the upper and lower extremities. The efficiency gains of the trainings amounted to 10% to 58%, in particular for training of the whole body and for walking training in severely impaired patients. CONCLUSIONS Highly intensive technology-assisted training appears to be feasible for in- and outpatients in the subacute or chronic phase after stroke. Further clinical trials are warranted in order to define the most comprehensive approach to highly intensive technology-assisted training and to investigate its efficacy in patients with neurological disorders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03641651 at August 31st 2018

GINÁSTICA PARA TODOS NA REGIÃO METROPOLITANA DE BELO HORIZONTE: INFLUÊNCIA DE UM ESPORTE NÃO COMPETITIVO NA MELHORIA DA QUALIDADE DE VIDA DE SEUS PRATICANTES

This article is an extract from field research with a quantitative character in the final stage of data analysis. It seeks to identify whether Gymnastics for All contributes to the promotion of the quality of life and health of practitioners who develop regular work with this modality in the Metropolitan Region of Belo Horizonte, for this purpose the SF-36 questionnaire adapted for the study was applied to practitioners. Technicians and gymnasts replied that GfA collaborates to promote the participants' quality of life. The potential of GfA for collaboration in public policies was perceived, based both on the experience of researchers in sports management and on researchers in the area, as it improves important aspects in the motor, social and affective aspects, contributes to the promotion of quality of life and health population, as well as low operating cost.Este artículo es un extracto de la investigación de campo con un carácter cuantitativo en la etapa final del análisis de datos. Busca identificar si Gimnasia para Todos contribuye a la promoción de la calidad de vida y la salud de los profesionales que desarrollan un trabajo regular con esta modalidad en la Región Metropolitana de Belo Horizonte, para esto se aplicó a los practicantes. El cuestionario SF-36 adaptado para el estudio. Técnicos y gimnastas respondieron que GPT colabora para promover la calidad de vida de los participantes. Se percibió el potencial de GPT para la colaboración en políticas públicas, basado tanto en la experiencia de los investigadores en gestión deportiva como en los investigadores del área, ya que mejora aspectos importantes en los aspectos motores, sociales y afectivos, contribuye a la promoción de la calidad de vida y la salud población, así como bajo costo operativo.O presente artigo é extrato de pesquisa de campo com caráter quantitativo em fase final de análise de dados. Busca identificar se a Ginástica para Todos contribui para a promoção da qualidade de vida e saúde de praticantes que desenvolvem trabalho regular com essa modalidade na Região Metropolitana de Belo Horizonte, para isso foi aplicado aos praticantes o questionário SF-36 adaptado para o estudo. Técnicos e ginastas responderam que a GPT colabora para a promoção da qualidade de vida dos participantes. Percebeu-se o potencial da GPT para colaboração em políticas públicas, baseado tanto na experiência dos pesquisadores em gestão esportiva, quanto em pesquisadores da área, pois melhora valências importantes no aspecto motor, social e afetivo, contribui para promoção de qualidade de vida e saúde da população, assim como tem baixo custo operacional

Feasibility and cost description of highly intensive rehabilitation involving new technologies in patients with post-acute stroke : a trial of the Swiss RehabTech Initiative

Background: There is a need to provide highly repetitive and intensive therapy programs for patients after stroke to improve sensorimotor impairment. The employment of technology-assisted training may facilitate access to individualized rehabilitation of high intensity. The purpose of this study was to evaluate the safety and acceptance of a high-intensity technology-assisted training for patients after stroke in the subacute or chronic phase and to establish its feasibility for a subsequent randomized controlled trial. Methods: A longitudinal, multi-center, single-group study was conducted in four rehabilitation clinics. Patients participated in a high-intensity 4-week technology-assisted trainings consisting of 3 to 5 training days per week and at least 5 training sessions per day with a duration of 45min each. Feasibility was evaluated by examining recruitment, intervention-related outcomes (adherence, subjectively perceived efort and efectiveness, adverse events), patient related outcomes, and efciency gains. Secondary outcomes focused on all three domains of the International Classifcation of Functioning Disability and Health. Data were analyzed and presented in a descriptive manner. Results: In total, 14 patients after stroke were included. Participants exercised between 12 and 21days and received between 28 and 82 (mean 46±15) technology-assisted trainings during the study period, which corresponded to 2 to 7 daily interventions. Treatment was safe. No serious adverse events were reported. Minor adverse events were related to tiredness and exertion. From baseline to the end of the intervention, patients improved in several functional performance assessments of the upper and lower extremities. The efciency gains of the trainings amounted to 10% to 58%, in particular for training of the whole body and for walking training in severely impaired patients. Conclusions: Highly intensive technology-assisted training appears to be feasible for in- and outpatients in the subacute or chronic phase after stroke. Further clinical trials are warranted in order to define the most comprehensive approach to highly intensive technology-assisted training and to investigate its efficacy in patients with neurological disorders

Feasibility of an Application-Based Outpatient Rehabilitation Program for Stroke Survivors: Acceptability and Preliminary Results for Patient-Reported Outcomes

Background: The majority of stroke survivors experience long-term impairments. Regular physical activity and other lifestyle modifications play an important role in rehabilitation. Outpatient rehabilitation using telemedicine might be suitable to improve functional ability and long-term secondary prevention. The Strokecoach Intervention Program (SIP, Strokecoach GmbH, Cologne, Germany) comprises training, coaching and monitoring with the aim of improving or at least maintaining functional independence and preventing further stroke through more targeted physical activity. The SIP is provided as blended care, which refers to the integrated and coordinated delivery of healthcare services that combines traditional in-person interactions with technology-mediated interventions, optimizing the use of both face-to-face and virtual modalities to enhance patient outcomes. Objective: The aim of this study was to evaluate the acceptance of the SIP by the participants and its practical application, as well as to obtain initial indications of effects of the SIP on the basis of patient-related outcome measures, blood pressure measurements and recording of physical activity in parallel with the intervention. Methods: Data from individuals with stroke participating in the SIP were analyzed retrospectively. Within the SIP, participants received an application-based training program, were instructed to measure their blood pressure daily and to wear an activity tracker (pedometer). During the intervention period of either 6 or 12 weeks, the participants were supported and motivated by a personal coach via a messenger application. The primary outcomes of the analysis were recruitment, acceptance of and satisfaction with the SIP. Secondary outcomes included functional measures, mobility and health-related quality of life. Results: A total of 122 individuals with stroke could be recruited for the SIP. A total of 96 out of 122 were able to start the program (54% female, mean age 54.8 (SD = 13.1), 6.1 (SD = 6.6) years after stroke onset) and 88 completed the SIP. Participants wore the activity tracker on 66% and tracked their blood pressure on 72% of their intervention days. A further analyzed subgroup of 38 participants showed small improvements in patient-reported outcomes such as health-related quality of life (SF-36) with an increase of 12 points in the subdomain mental health, vitality (12.6) and physical functioning (9.1). However, no statistically significant improvements were found in other performance-based measures (Timed Up and Go test, gait speed). Conclusions: This study showed that a blended therapy approach for stroke survivors with mild to moderate impairments in the chronic phase is feasible and was highly accepted by participants, who benefitted from the additional coaching