NCT00384748

Brief Summary

The purpose of the proposed study is to examine a Tele-rehabilitation (TR) intervention that uses tele-health technology to improve outcomes of stroke patients after discharge to home. The primary aim is to determine the effect of TR on physical function, and secondarily to determine the effect on disability, falls-related self-efficacy, and patient satisfaction.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
48

participants targeted

Target at P25-P50 for phase_2

Timeline
Completed

Started Nov 2008

Geographic Reach
1 country

3 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

October 3, 2006

Completed
3 days until next milestone

First Posted

Study publicly available on registry

October 6, 2006

Completed
2.1 years until next milestone

Study Start

First participant enrolled

November 1, 2008

Completed
2.1 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

December 1, 2010

Completed
6 months until next milestone

Study Completion

Last participant's last visit for all outcomes

June 1, 2011

Completed
3.4 years until next milestone

Results Posted

Study results publicly available

November 10, 2014

Completed
Last Updated

November 24, 2014

Status Verified

November 1, 2014

Enrollment Period

2.1 years

First QC Date

October 3, 2006

Results QC Date

October 22, 2014

Last Update Submit

November 12, 2014

Conditions

Cerebrovascular Accident

Keywords

Cerebrovascular AccidentRehabilitationTelemedicine

Outcome Measures

Primary Outcomes (1)

  • Physical Function as Measured by Telephone Version of FIM

    The FONEFIM was developed as a telephonic alternative and yields good concordance to the in-person, performance based FIM.12 The motor subscale of the FONEFIM (Motor FONEFIM) consists of 13 items encompassing four categories: 1) self-care; 2) sphincter control; 3) transfers; and 4) locomotion. Each item is scored on an ordinal scale from 1= total dependence to 7 = total independence. Possible scores range from 13 to 91, with higher scores indicating greater independence. The scoring considers the use of adaptive equipment and/or the extent of personal assistance or supervision required to complete the task.

    6-month

Study Arms (2)

Tele-visit Group

EXPERIMENTAL

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.

Behavioral: TR interventionBehavioral: In-home messaging device.

Usual Care Group

ACTIVE COMPARATOR

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.

Behavioral: Usual care

Interventions

TR interventionBEHAVIORAL

The 3 tele-visits will occur within 5 weeks post randomization. Telephone call visits will occur during weeks 2, 4, 6, 8 and 12. One additional tele-visit may be scheduled as needed. The first visit is devoted to mobility assessment, goal-setting. The second visit is to review the current exercise component. Visit 3 focuses on functional mobility using adaptive strategy component.

Also known as: Tele-visit intervention
Tele-visit Group
In-home messaging device.BEHAVIORAL

The purpose of this aspect of the intervention is to screen for unforeseen problems and to reinforce adherence to the recommended treatment. It will be used to interface with patients daily, but briefly. The in-home messaging device, which resembles a caller ID box is attached to the home telephone line and electrical outlet. Installation of the equipment involves connecting it to the phone line and plugging it into an electrical outlet. The teletherapist receives the clinical data from the in-home messaging device via the internet on a daily basis. It is used to screen for depression, lower extremity strength, self-care tasks and mobility, falls and exercise adherence.

Tele-visit Group
Usual careBEHAVIORAL

Routine VA care.

Usual Care Group

Eligibility Criteria

Age45 Years - 90 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • 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

You may not qualify if:

  • Unable to provide informed consent

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (3)

Atlanta VA Medical and Rehab Center, Decatur

Decatur, Georgia, 30033, United States

Location

Richard Roudebush VA Medical Center, Indianapolis

Indianapolis, Indiana, 46202-2884, United States

Location

VA Medical Center, Durham

Durham, North Carolina, 27705, United States

Location

Related Publications (5)

  • Lutz BJ, Chumbler NR, Lyles T, Hoffman N, Kobb R. Testing a home-telehealth programme for US veterans recovering from stroke and their family caregivers. Disabil Rehabil. 2009;31(5):402-9. doi: 10.1080/09638280802069558.

    PMID: 18720112RESULT

  • Chumbler NR, Rose DK, Griffiths P, Quigley P, McGee-Hernandez N, Carlson KA, Vandenberg P, Morey MC, Sanford J, Hoenig H. Study protocol: home-based telehealth stroke care: a randomized trial for veterans. Trials. 2010 Jun 30;11:74. doi: 10.1186/1745-6215-11-74.

    PMID: 20591171RESULT

  • Chumbler NR, Morey M, Quigley P, Rose D, Sanford J, Hoenig H. Tele-rehabilitation for Stroke Care: A Randomized Trial for Veterans. [Abstract]. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2010 May 1; 16 Suppl 1:s30.

    RESULT

  • Chumbler NR, Morey MC, Griffiths P, Quigley P, Haley JA, Rose DK, Sanford J, Hoenig H. The Effects of a Stroke Telerehabilitation In-Home Intervention on Function and Disability: Preliminary Results of a Randomized Clinical Trial. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2011 Mar 1; 42(3):e76.

    RESULT

  • Chumbler NR, Quigley P, Li X, Morey M, Rose D, Sanford J, Griffiths P, Hoenig H. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke. 2012 Aug;43(8):2168-74. doi: 10.1161/STROKEAHA.111.646943. Epub 2012 May 24.

    PMID: 22627983RESULT

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular DisordersBrain DiseasesCentral Nervous System DiseasesNervous System DiseasesVascular DiseasesCardiovascular Diseases

Results Point of Contact

Title
Neale Chumbler, PhD
Organization
University of Georgia
chumbler@uga.edu
706-369-5975

Study Officials

  • Neale R. Chumbler, PhD MA BS

    Richard Roudebush VA Medical Center, Indianapolis

    PRINCIPAL INVESTIGATOR

  • Patricia A Quigley, PhD MPH

    James A. Haley Veterans Hospital

    PRINCIPAL INVESTIGATOR

Publication Agreements

PI is Sponsor Employee
No
Restrictive Agreement
No

Study Design

Study Type
interventional
Phase
phase 2
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
FACTORIAL
Sponsor Type
FED
Responsible Party
SPONSOR

Study Record Dates

First Submitted

October 3, 2006

First Posted

October 6, 2006

Study Start

November 1, 2008

Primary Completion

December 1, 2010

Study Completion

June 1, 2011

Last Updated

November 24, 2014

Results First Posted

November 10, 2014

Record last verified: 2014-11

Locations

US(3)