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.

Download Full-text

Effectiveness of a balance training home exercise programme for adults with haemophilia: a pilot study

Haemophilia ◽

10.1111/j.1365-2516.2009.02110.x ◽

2010 ◽

Vol 16 (1) ◽

pp. 162-169 ◽

Cited By ~ 22

Author(s):

K. HILL ◽

M. FEARN ◽

S. WILLIAMS ◽

L. MUDGE ◽

C. WALSH ◽

...

Keyword(s):

Pilot Study ◽

Balance Training ◽

Exercise Programme ◽

Home Exercise ◽

Haemophilia A ◽

Home Exercise Programme

Download Full-text

Safety of a home exercise programme in patients with polymyositis and dermatomyositis: a pilot study

Rheumatology ◽

10.1093/rheumatology/38.7.608 ◽

1999 ◽

Vol 38 (7) ◽

pp. 608-611 ◽

Cited By ~ 79

Author(s):

H Alexanderson

Keyword(s):

Pilot Study ◽

Exercise Programme ◽

Home Exercise ◽

Home Exercise Programme

Download Full-text

P125 The Irish Lung Fibrosis Association's 2000 Steps A Day Challenge: A Pilot Study To Evaluate A Novel Home Exercise Programme For Lung Fibrosis Patients

Thorax ◽

10.1136/thoraxjnl-2014-206260.266 ◽

2014 ◽

Vol 69 (Suppl 2) ◽

pp. A133-A134

Author(s):

N. Cassidy ◽

I. Byrne ◽

D. Danaher ◽

J. Egan

Keyword(s):

Pilot Study ◽

Lung Fibrosis ◽

Exercise Programme ◽

Home Exercise ◽

Home Exercise Programme

Download Full-text

The addition of a supervised exercise class to a home exercise programme in the treatment of patients with knee osteoarthritis following corticosteroid injection: A pilot study

International Musculoskeletal Medicine ◽

10.1179/1753615412y.0000000008 ◽

2012 ◽

Vol 34 (4) ◽

pp. 159-165

Author(s):

Kate Hawkins ◽

Fery Ghazi

Keyword(s):

Pilot Study ◽

Knee Osteoarthritis ◽

Corticosteroid Injection ◽

Exercise Programme ◽

Home Exercise ◽

Supervised Exercise ◽

Home Exercise Programme ◽

Exercise Class

Download Full-text

Can an online exercise prescription tool improve adherence to home exercise programmes in children with cerebral palsy and other neurodevelopmental disabilities? A randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-040108 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040108

Author(s):

Rowan W Johnson ◽

Sian A Williams ◽

Daniel F Gucciardi ◽

Natasha Bear ◽

Noula Gibson

Keyword(s):

Exercise Prescription ◽

Controlled Trial ◽

Intervention Group ◽

Exercise Programme ◽

Home Exercise ◽

Control Group ◽

Neurodevelopmental Disabilities ◽

Home Exercise Programme ◽

Exercise Programmes ◽

Randomised Controlled

ObjectiveDetermine the adherence to and effectiveness of an 8-week home exercise programme for children with disabilities delivered using Physitrack, an online exercise prescription tool, compared with traditional paper-based methods.DesignSingle-blinded, parallel-groups, randomised controlled trial (RCT).SettingIntervention took place in participants’ homes in Western Australia.ParticipantsChildren aged 6 to 17 years, with neurodevelopmental disabilities including cerebral palsy (CP), receiving community therapy services.InterventionAll participants completed an individualised home exercise programme, which was delivered to the intervention group using Physitrack and conventional paper-based methods for the control group.Primary outcome measuresAdherence to exercise programme, goal achievement and exercise performance.Secondary outcome measuresEnjoyment, confidence and usability of Physitrack.ResultsFifty-four participants with CP (n=37) or other neurodevelopmental disabilities (n=17) were recruited. Fifty-three were randomised after one early withdrawal. Forty-six completed the 8-week programme, with 24 in the intervention group and 22 in the control group. There was no difference between the two groups for percentage of exercises completed (intervention (n=22): 62.8% (SD 27.7), control (n=22): 55.8% (SD 19.4), between group mean difference −7.0% (95% CI: −21.6 to 7.5, p=0.34)). Both groups showed significant improvement in their self-rated performance of individualised goal activities, however there was no statistically significant difference between groups for goal achievement, quality of exercise performance, enjoyment, confidence or preferred method of delivery. There were no adverse events.ConclusionPhysitrack provides a therapist with a new means of providing an exercise programme with online tools such as exercise videos, but our preliminary findings indicate that it may be no better than a traditional paper-based method for improving exercise adherence or the other outcomes measured. Exercise programmes remain an intervention supported by evidence, but a larger RCT is required to fully evaluate online delivery methods.Trial registration detailsAustralian New Zealand Clinical Trials Registry; ACTRN12616000743460.

Download Full-text

Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study

Clinical Rehabilitation ◽

10.1177/0269215518817080 ◽

2018 ◽

Vol 33 (3) ◽

pp. 473-484 ◽

Cited By ~ 10

Author(s):

Lorna Paul ◽

Linda Renfrew ◽

Jennifer Freeman ◽

Heather Murray ◽

Belinda Weller ◽

...

Keyword(s):

Multiple Sclerosis ◽

Outcome Measures ◽

Exercise Programme ◽

Home Exercise ◽

Walk Test ◽

Web Based ◽

Randomized Controlled ◽

Home Exercise Programme ◽

Minute Walk ◽

Over Time

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with multiple sclerosis. Design: Multi-centre, randomized controlled, feasibility study. Setting: Three multiple sclerosis out-patient centres. Participants: A total of 90 people with multiple sclerosis (Expanded Disability Status Scale 4–6.5). Interventions: Participants were randomized to a six-month individualized, home exercise programme delivered via web-based physiotherapy ( n = 45; intervention) or a sheet of exercises ( n = 45; active comparator). Outcome measures: Outcome measures (0, three, six and nine months) included adherence, two-minute walk test, 25 foot walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40%–63% and 53%–71% in the intervention and comparator groups. There was no difference in the two-minute walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at six-month Intervention-81.6(32.75)m, Comparator-74.8(36.16)m. There were no significant changes over time in other outcome measures except the EuroQol-5 Dimension at six months which decreased in the active comparator group. For a difference of 8(17.4)m in two-minute walk test between groups, 76 participants/group would be required (80% power, P > 0.05) for a future randomized controlled trial. Conclusion: No changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants.

Download Full-text

Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215516680856 ◽

2016 ◽

Vol 31 (8) ◽

pp. 1068-1077 ◽

Cited By ~ 18

Author(s):

Kellie B Emmerson ◽

Katherine E Harding ◽

Nicholas F Taylor

Keyword(s):

Randomized Controlled Trial ◽

Upper Limb ◽

Controlled Trial ◽

Exercise Programme ◽

Home Exercise ◽

Smart Technology ◽

Randomized Controlled ◽

Home Exercise Programme ◽

Standard Paper ◽

Exercise Programmes

Objective: To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription. Design: Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes. Setting: A community rehabilitation programme within a large metropolitan health service. Subjects: Patients with stroke with upper limb deficits, referred for outpatient rehabilitation. Interventions: Participants were randomly assigned to the control (paper-based home exercise programme) or intervention group (home exercise programme filmed on an electronic tablet, with an automated reminder). Both groups completed their prescribed home exercise programme for four weeks. Main measures: The primary outcome was adherence using a self-reported log book. Secondary outcomes were change in upper limb function and patient satisfaction. Results: A total of 62 participants were allocated to the intervention ( n = 30) and control groups ( n = 32). There were no differences between the groups for measures of adherence (mean difference 2%, 95% CI −12 to 17) or change in the Wolf Motor Function Test log transformed time (mean difference 0.02 seconds, 95% CI −0.1 to 0.1). There were no between-group differences in how participants found instructions ( p = 0.452), whether they remembered to do their exercises ( p = 0.485), or whether they enjoyed doing their exercises ( p = 0.864). Conclusions: The use of smart technology was not superior to standard paper-based home exercise programmes for patients recovering from stroke. This trial design was registered prospectively with the Australian and New Zealand Clinical Trials Register, ID: ACTRN 12613000786796. http://www.anzctr.org.au/trialSearch.aspx

Download Full-text

Movement pattern training compared with standard strengthening and flexibility among patients with hip-related groin pain: results of a pilot multicentre randomised clinical trial

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2019-000707 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000707 ◽

Cited By ~ 2

Author(s):

Marcie Harris-Hayes ◽

Karen Steger-May ◽

Allyn M Bove ◽

Stefanie N Foster ◽

Michael J Mueller ◽

...

Keyword(s):

Clinical Trial ◽

Muscle Strength ◽

Groin Pain ◽

Physical Therapist ◽

Movement Pattern ◽

Randomised Clinical Trial ◽

Exercise Programme ◽

Home Exercise ◽

Treatment Protocols ◽

Patient Reported

Study designPilot, multicentre randomised clinical trial (RCT).ObjectivesAssess viability of performing a definitive RCT and compare preliminary effects of movement pattern training (MoveTrain) and strengthening/flexibility (Standard) to improve function in people with chronic hip-related groin pain (HRGP).BackgroundTo determine the best physical therapist-led intervention for patients with HRGP, we must understand treatment effects of different treatment modes.MethodsForty-six patients (17M:29F; 29±5.3 years; body mass index 25.6±6.3 kg/m2) with HRGP were randomised. MoveTrain included task-specific training to optimise biomechanics during daily tasks. Standard included strengthening/flexibility. Treatment included 10 visits/12 weeks and home exercise programme (HEP). Primary outcomes for feasibility were recruitment, retention, treatment adherence and treatment fidelity. Secondary outcomes were patient-reported function (Hip disability and Osteoarthritis Outcome Score (HOOS)), lower extremity kinematics and hip muscle strength.ResultsWe achieved target recruitment, and retention was excellent (91%). Patient session attendance was high (93%); however, reported HEP adherence (62%) was lower than expected. Physical therapists’ adherence to treatment protocols was high (90%). Patients demonstrated high treatment receipt; 91% of exercises performed were rated independent. Both groups demonstrated clinically important improvements in function (HOOS) and muscle strength; however, there were no between-group differences (HOOS subscales, p≥0.13, strength, p≥0.34). Compared with Standard, MoveTrain demonstrated greater reductions in hip adduction (p=0.016) and pelvic drop (p=0.026) during a single leg squat. No adverse events were noted.ConclusionOur experience in completing this RCT confirmed that a larger, multicentre RCT is feasible and highlighted modifications we will implement to optimise the future RCT.Trial registration numberNCT02913222.

Download Full-text