Accepted for/Published in: JMIR Research Protocols
Date Submitted: May 7, 2019
Date Accepted: Feb 7, 2020
Date Submitted to PubMed: Feb 25, 2020
Optimization of upper extremity rehabilitation by combining telerehabilitation with an exergame in people with chronic stroke: a mixed-method study protocol
ABSTRACT
Background:
Exergames have the potential to provide an accessible, remote approach for post stroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed and lack of motivation to pursue exercise program, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant completion and adherence. Currently, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation.
Objective:
1) To determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life and motivation, in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program) 2) To examine the feasibility of using the technology with stroke participants at home 3) To identify the obstacles and facilitators for its use by stroke participants and therapists and understand the shared decision-making process.
Methods:
A mixed-methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct video conferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 stroke participants, randomly assigned to a control group (n=26, 2 months on-paper home exercise program: the graded repetitive arm supplementary program with no supervision) and an experimental group (n=26, 2 months home program using the technology). A blinded trained evaluator will be responsible for the face to face administration of the outcome measures. The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE in 28 everyday tasks), Stroke Impact Scale-16 (impact on quality of life) and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process (recruitment and retention rates), resources (exercise adherence, time spent with therapist,), management (technical problems)and scientific (safety, simple size) outcomes. Qualitative data will be collected by interviews with both participants and therapists.
Results:
We expect to: A) Collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke B) collect feasibility data with users at home (adherence, safety, technical difficulties, etc.) and C) identify the obstacles and facilitators for the technology use and understand the shared decision-making process.
Conclusions:
This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation. Clinical Trial: Clinicaltrials.gov (NCT03759106)
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