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Currently submitted to: JMIR Research Protocols

Date Submitted: Jun 11, 2019
Open Peer Review Period: Jun 14, 2019 - Jun 28, 2019
(currently open for review)

Remotely supervised home-based intensive exercise intervention to improve balance, functional mobility and physical activity in survivors of moderate or severe TBI: a mixed-method study protocol

  • Jennifer O'Neil; 
  • Mary Egan; 
  • Shawn Marshall; 
  • Martin Bilodeau; 
  • Luc Pelletier; 
  • Heidi Sveistrup



Traumatic brain injury may impact an individual physically, cognitively, socially and emotionally. Poor balance, reduced mobility and low daily physical activity often will require ongoing physical rehabilitation intervention. Face-to-face specialized physiotherapy is not always accessible for individuals living in rural settings.


We will answer four questions: (1) What is the feasibility of a remotely supervised home-based intensive exercise intervention with survivors of moderate and severe TBI? (2) Does the frequency of remote supervision have an impact on the feasibility of completing a home-based intensive exercise program? (3) Does the frequency of remote supervision impact balance, functional mobility and physical activity? (4) What is the lived experience of remote supervision for both survivors and caregivers?


Four participants will complete two intensive, 4-week, five day-per-week, home-based exercise interventions remotely supervised via synchronous video-conference. Each exercise intervention will have a goal of 160-300 repetitions or 60 minutes of tailored exercises to promote neuroplasticity and be defined as an intensive home-based exercise intervention. An alternating single subject design will allow for the comparison between two frequencies of remote supervision, once weekly and five times weekly. Daily repeated outcome measures, pre-and post-intervention outcome measures, and 1- month follow-up outcome measures will be collected to explore the impact on feasibility and physical variables. Daily outcome measures include step count and Five Time Sit to Stand. Pre-post measures include assessment of quiet stance and the Community Balance and Mobility Scale. A semi-structured interview will be completed at the end of each intervention segment to document the lived experience of both survivors and their study partners. Finally, five questionnaires will be used to understand the overall experience: The Mayo-Portland MPAI-4, the Satisfaction with Life Scale, the Fall Efficacy Scale-International, the Interpersonal Behaviour Questionnaire and the System Usability Scale. Data will be analyzed following traditional single subject methods of analysis.


Ethics approval was received from both Bruyère Research Institute and University of Ottawa review board in March 2019. Recruitment is underway.


The proposed intervention is complex in nature due to the involvement of multiple technology sources and the inclusion of a complex dyad (survivors and caregivers) in a community setting. This type of research is timely given that alternative methods of physical intervention delivery are needed to facilitate gains in balance, mobility, physical activity among traumatic brain injury survivors with limited access to clinical care, and the quality of the patients’ experience.


Please cite as:

O'Neil J, Egan M, Marshall S, Bilodeau M, Pelletier L, Sveistrup H

Remotely supervised home-based intensive exercise intervention to improve balance, functional mobility and physical activity in survivors of moderate or severe TBI: a mixed-method study protocol

JMIR Preprints. 11/06/2019:14867

DOI: 10.2196/preprints.14867


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