Feasibility of an individualised, task-oriented, video-supported home exercise programme for arm function in patients in the subacute phase after stroke: protocol of a randomised controlled pilot study

IntroductionStroke rehabilitation guidelines suggest a high-frequency task-oriented training at high intensity. A targeted and self-paced daily training with intermittent supervision is recommended to improve patients’ self-management and functional output. So far, there is conflicting evidence concerning the most effective home-training delivery method.Methods and analysisThe purpose of this pilot study is to compare the feasibility and preliminary effects of task-oriented home-exercises in patients in the subacute stage after stroke. Twenty-four patients will be randomised (1:1) to a Video group (a) or Paper group (b) of an individualised, task-oriented home-training (50 min, 6×/week, for 4 weeks) based on Wulf and Lewthwaite’s Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory of motor learning. Patient-relevant goals will be identified using Goal Attainment Scaling and exercises progressively adapted. Semistructured interviews and a logbook will be used to monitor adherence, arm use and acceptability. Primary outcome will be the feasibility of the methods and a full-scale trial employing predefined feasibility criteria (recruitment, retention and adherence rates, patients’ satisfaction with the home-exercise programme and their progress, affected hand use and acceptance of the intervention). Assessed at baseline, post intervention and 4-week follow-up, secondary outcomes include self-perceived hand and arm use, actual upper extremity function and dexterity, hand strength, independence in activities of daily living and health-related quality of life. Interview data will be analysed using qualitative content analysis. Medians (ranges) will be reported for ordinal data, means (SD) for continuous and frequency (percentage) for nominal data.Ethics and disseminationThis study follows the Standard Protocol Items: Recommendations for Interventional Trials-Patient-Reported Outcome (PRO) Extension guideline. Ethical approval was received from the Ethics Committee of the Medical University of Innsbruck, Austria (1304/2020). Written informed consent will be obtained from all participants prior to data collection. Study results will be disseminated to participating patients, patient organisations, via the clinic’s homepage, relevant conferences and peer-reviewed journals.Trial registration numberDRKS-ID: DRKS00023395.Study protocol, second revision, 5 December 2021.

The Relationship between Wellness and Stress of Home Training Mediating Effect

The purpose of this study was to analyze the mediated effects of home training between wellness and stress in three areas. Recently, the number of people who do home training has increased rapidly due to lack of outdoor activities in the aftermath of COVID-19. Thus, in this study, we understand the effect of three types of wellness on home training and stress and conducted an analysis focusing on the mediated effects of home training between wellness and stress. In order to obtain the above results, this study surveyed a total of 389 students and officials related to physical education at S University from July 5 to July 23, 2021. First, among the three types of wellness, physical and emotional wellness have a positive effect on home training, but social wellness has no significant effect on home training. Second, all three types of wellness have been shown to have a positive effect on stress. Third, home training has been shown to serve as a partial mediator between the other two types (physical wellness, emotional wellness) and stress, excluding social wellness. The implications of this study are to determine the role of the mediated effects of home training in the relationship between wellness and stress. Through this, it was found that higher physical and emotional wellness has a positive effect on trying home training, and more home training has a positive effect on stress. It also found that social wellness has a positive effect on stress, but not on trying to train flaws.

Readiness of cardiosurgical patients for digital rehabilitation programs

Introduction To date, the methods of remote rehabilitation using the mobile applications for smartphones are increasingly introduced for a particular category of cardiac patients worldwide. Such programs are of a particular relevance due to a higher accessibility for a patient which is provided by the flexibility of the patients' home training schedule and the possibility of constant communication with a cardiologist and rehabilitation therapist. Purpose To study the readiness of the patients to participate in the remote digital cardiac rehabilitation program. Methods 265 patients (180 (68%) men and 85 (32%) women) undergone a cardiac surgery and staying at the cardiac surgery department were examined. The mean age of the patients was 67±11.9 years. 157 (59%) patients undergone coronary artery bypass grafting (CABG), 73 (34%) patients – heart valves surgery, 13 (5%) patients – simultaneous CABG and heart valves surgery and 5 (2%) – hybrid CABG with carotid endarterectomy. Prior to the discharge from the first inpatient rehabilitation stage (10–12 days after cardiac surgery), all the patients underwent a survey. The survey was conducted using a designed questionnaire including 5 questions, the answers to which determined the patients' awareness of the necessity and the structure of postoperative remote rehabilitation using the digital technologies, as well as the willingness and the possibility to participate in these programs. Results Analyzing the results obtained from the survey it turned out that the majority of patients (258 (97%)) believe that they need cardiac rehabilitation. However, only 86 (32%) patients answered positively to the question about their readiness to participate in remote digital rehabilitation programs. When analyzing the reasons for such a low readiness of patients to participate in remote programs it turned out that 98 (37%) patients didn't have smartphones. 10 (4%) patients despite the presence of a smartphone, refused to participate referring to their inability to use considering themselves incapable of learning it. 71 (27%) patients simply refused claiming that they don't understand the necessity for remote cardiac rehabilitation. Conclusions Thus, only a small number of the patients (32%) are ready to participate in remote digital programs of cardiac rehabilitation. A considerable amount of the patients (37%) can't afford to participate in a remote rehabilitation program only due to the absence of the smartphone and 27% of the patients are not ready to participate in a remote cardiac rehabilitation program not understanding the importance of distance cardiac rehabilitation for them. Funding Acknowledgement Type of funding sources: None.

Not out-of-reach: Engaging the older old isolated African Americans with and without MCI

The Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTrials.gov: NCT02871921) is a multi-center randomized, 12-month efficacy study. There is converging evidence that social isolation is a risk factor of cognitive decline and dementia. We hypothesized that increasing social interaction in older adults with normal cognition or mild cognitive impairment (MCI) could improve or sustain cognitive function through internet-based conversational engagement. African Americans (AA) are at higher risk for developing dementia but their participation in clinical trials is low. Objectives: (1) discuss the effective outreach process to recruit urban AA older old adults (mean targeted age of 80+); (2) describe how we retained participants in a yearlong study using technology-based interventions. The most successful outreach and recruitment sources were the voter registration mass mailings and the Healthier Black Elders Research Center. Successful recruitment methods included: hiring diverse staff, compensating participants’ time, and adjusting research protocols for opting out of MRIs and genetic saliva samples. Technology intervention strategies included: providing user-friendly Chromebooks and free internet connections, simple instructions with pictures, vision and hearing correction, and in-home training with technology support backup. During the pandemic, we could assists participants in learning to use the laptop remotely. Over 12,000 subjects were contacted, which led to 39 randomized participants. Our retention rate thus far is over 75%. This demonstrates that AA older adults are reachable, willing to participate in research and able to use communication technology with appropriate supports for long-term sustainable interaction that may improve cognition and health equity.

Virginia’s Response to the Nursing Home COVID Action Network

The Virginia Geriatric Education Center’s GWEP recruited 195 of Virginia's 273 eligible nursing homes, using two Project ECHO Nursing Home Training Centers located at George Mason University and Virginia Commonwealth University. These sessions promoted collaboration, allowed for sharing of successes and challenges, and nurtured quality improvement projects. Our next steps are to survey Virginia’s nursing homes to see if they are interested in future ECHO sessions with other topics. We plan to share these results with the Institute for Healthcare Improvement so that we may be able to continue to enhance this national network of Training Centers with faculty and staffing dedicated to quality assurance and performance improvement. The program has initiated new collaborations with nursing homes across many healthcare disciplines, strengthened connections between nursing homes and research institutions, and will help foster innovative ways to collaborate in this post-pandemic virtually connected world.