Home-based Telehealth Stroke Care: A Randomized Trial for Veterans
Cerebrovascular Accident
About this trial
This is an interventional treatment trial for Cerebrovascular Accident focused on measuring Cerebrovascular Accident, Rehabilitation, Telemedicine
Eligibility Criteria
Inclusion Criteria:
- Have acute ischemic or hemorrhagic stroke within the preceding twenty-four months, defined as "a rapid onset event of vascular origin reflecting a focal disturbance of cerebral function, excluding isolated impairments of higher function and persisting longer than 24 hours";
- age between 45-90;
- discharge to the community;
- cognitively intact (score of 6/10 or greater on the Short Portable Mental Status Questionnaire);
- discharge motor Functional Independence Measure (FIM) score of 17-88 (i.e., maximal assistance on no more than 4 motor activities of daily living (ADLs) as the most severe stroke included and modified independence at least 2 motor ADLs as the least severe); able to follow 3-step command; signed VHA Medical Media release form; concurrence by the patient's physician;
- and informed consent
Exclusion Criteria:
Unable to provide informed consent
Sites / Locations
- Atlanta VA Medical and Rehab Center, Decatur
- Richard Roudebush VA Medical Center, Indianapolis
- VA Medical Center, Durham
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Tele-visit Group
Usual Care Group
TR intervention targets safe functional mobility within a home environment and consists of: 1) exercise targeting underlying stroke-related impairment and 2) adaptive strategies targeting external factors to help compensate for disability. TR uses a combination of tele-video visits, an in-home messaging device, and telephone contact over a 3-month study period. A video camera is used in the home to provide visual and audio to a therapist located at the base hospital. An interactive, in-home messaging device is used to facilitate adherence with treatment recommendations and to screen for depression, falls, and difficulty with self-care. This allows evaluations of problem areas during tele-visits, rapid response to new functional problems.
Patients randomized to the Usual Care group receive routine VA care, as directed by their physicians. Therapy services are tracked via a weekly diary for the entire 6 month study period. In this weekly diary, patients in both the usual care and intervention group will record receipt of therapy. Usual Care group will be asked whether they exercised, and if so how frequently. They will be administered telephone interviews at baseline, 3-and 6-months. The interview outcome measures are FONEFIM, Late-Life Function and Disability Instrument, Falls Self Efficacy Scale and Stroke Specific Patient Satisfaction with Care. In addition, sociodemographics, stroke severity, length of time since stroke onset, and depression at baseline will be measured.