Stroke is a major cause of disability, and the burden of stroke is increasing given increasing survival rates. Rehabilitation therapy after stroke therefore remains a major national concern, with an annual cost of several billion dollars. While rehabilitation therapy of increased intensity and duration have been firmly linked with improved patient outcomes, many patients do not receive this due to issues such as cost and access. Methods are needed to deliver stroke rehabilitation in a maximally efficient manner. A telehealth solution might be useful to address these issues. This study aims to determine if telerehabilitation is comparably efficacious with outpatient clinic therapy, using a single-blind, randomized, non-inferiority study design. The primary endpoint is the change in arm motor status from baseline to 1 month post-therapy. A pilot study found that telerehab performed well at increasing patient knowledge on stroke prevention and risk factor control. The current study will confirm this result and will determine whether these gains in knowledge extend to real world improvement in two hard endpoints relevant to stroke patient outcomes: body weight and blood pressure control. Because compliance with many forms of therapy is often limited, hypotheses related to inter-subject differences in compliance will be tested. The long-term goal of this program is to develop a comprehensive system for delivery of telerehabilitation in the home that increases access to high intensity therapy using an economically sound approach, and thereby improves patient outcomes. The current proposal is a major step in this direction.

Public Health Relevance

Stroke is major cause of disability. New methods are needed to help patients with recent stroke. The current study will evaluate a system that provides post-stroke rehabilitation using telehealth methods.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01NS091951-04
Application #
9317545
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Vivalda, Joanna
Project Start
2014-09-15
Project End
2018-07-31
Budget Start
2017-08-01
Budget End
2018-07-31
Support Year
4
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of California Irvine
Department
Neurology
Type
Schools of Medicine
DUNS #
046705849
City
Irvine
State
CA
Country
United States
Zip Code
92617
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Genthe, Katlin; Schenck, Christopher; Eicholtz, Steven et al. (2018) Effects of real-time gait biofeedback on paretic propulsion and gait biomechanics in individuals post-stroke. Top Stroke Rehabil 25:186-193
Kesar, Trisha M; Stinear, James W; Wolf, Steven L (2018) The use of transcranial magnetic stimulation to evaluate cortical excitability of lower limb musculature: Challenges and opportunities. Restor Neurol Neurosci 36:333-348