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StrokeNCT03122626

Does a Group, Task-oriented Community-based Exercise Program Improve Everyday Function in People With Stroke?

A study testing Together in Movement and Exercise (TIME) Program in people with Stroke and Balance, run by University of Toronto at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

After a stroke, people find it difficult to perform everyday activities independently, like getting dressed, preparing meals, and shopping, limiting their independence and requiring the assistance of a family member, friend or a home care worker. Losing one's independence can decrease quality of life. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stroke, Balance, Mobility Limitation
What is being tested?
Together in Movement and Exercise (TIME) Program
Could I receive a placebo?
No, everyone receives an active treatment
How many people
33 participants
Where
1 siteCanada
Study dates
2 Feb 2017to 30 May 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Clinical diagnosis of stroke recorded in the health record;
  • Age ≥ 18 years;
  • Living at home for at least 3 months;
  • Ability to walk a minimum of 10 metres with or without walking aids without assistance from another person;
  • Ability to follow verbal instructions or demonstrations of the exercises;
  • Ability to speak and read English; and
  • Willingness to obtain medical clearance from a healthcare provider and sign a liability waiver.

Who cannot join

  • Self-reported involvement in another formal exercise or rehabilitation program;
  • Conditions or symptoms preventing participation in exercise (e.g., unstable cardiovascular disease, significant joint pain);
  • Cognitive or behavioural deficits that would prevent cooperation within a group;
  • Self-reported ability to walk more than 20 minutes without a seated rest; and
  • Self-reported ability to manage environmental barriers (curbs, ramps, and stairs) with relative ease.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • University of Toronto, Department of Physical Therapy

    Toronto, Ontario, M5G 1V7

Other trials in Canada

About this study

Official title: Increasing Access to Community-based Task-oriented Exercise Programs Through Healthcare-recreation Partnerships to Improve Function Post-stroke: Feasibility of a 2-group Randomized Controlled Trial Protocol

After a stroke, people find it difficult to perform everyday activities independently, like getting dressed, preparing meals, and shopping, limiting their independence and requiring the assistance of a family member, friend or a home care worker. Losing one's independence can decrease quality of life. Functional exercise classes run by physical therapists where people with stroke practice getting in and out of a chair, stepping, and walking, can improve the ability to balance, walk, and do everyday activities. These classes are not commonly available in community centres, mainly because fitness instructors do not receive training in how to run exercise classes for people with stroke. Therefore there is a need to make these functional exercise programs available in local community centres.

The objective of this project is to test procedures for running a large study to see whether people with stroke improve their ability to do everyday activities after participating in functional group exercise classes for 12 weeks in local community centres. If ability to do everyday activities improves, the investigators wish to see if the improvement is still present 3, 6 and 9 months later. Physical therapists at a nearby hospital will teach fitness instructors how to run the exercise class, help out during the classes, and answer questions by email or phone. Before conducting the larger Canada-wide study, it is important to determine the interest in such a program, the acceptability of the evaluations and the costs associated with the program, the degree of improvements resulting from the program, and if fitness instructors are able to run the program as planned.

Read more

In Toronto, London and Pembroke, Canada, managers at a hospital and a nearby recreation centre have agreed to help run the exercise program. A recruiter will ask people with stroke who can walk and are being discharged home from the hospital whether they can be called about the study. People with stroke and a caregiver who agree to participate in the study will complete four evaluations when they enter the study, and 3, 6, and 12 months later. At each evaluation, people with stroke will perform tests of balance and walking, and complete questionnaires about their mood, participation in valued activities, and quality of life. After the first evaluation, the investigators will use a process like flipping a coin, to see if the person with stroke will begin the exercise program immediately or 12 months later. The investigators will call people each month to ask if a fall occurred. The investigators will interview exercise participants, family members and hospital/recreation staff at the end of the study to ask about the experiences.

This project is unique because the program combines the expert knowledge and skills of physical therapists and fitness instructors. The exercise program involves practicing everyday movements, making the exercises easy for fitness instructors and people with stroke to learn. Each exercise has multiple levels of difficulty so the instructor can adapt exercises to how the person is feeling. The exercise program does not require expensive equipment (e.g. chairs, stepping stools) and therefore can be offered in most community centres. Finally, an extensive network of hospitals providing stroke care and community centres run by recreation organizations exists in Canada. Thus, if this program is beneficial, it could easily be made widely available.

With the number of Canadians living with the consequences of stroke increasing every year, access to a functional exercise programs in local community centres will improve their ability to function and live independently in the community and reduce the burden on family or caregivers and on the healthcare system.

Being tested
Together in Movement and Exercise (TIME) Program
Keywords
stroke, community-based exercise program, task-oriented exercise, group exercise program, healthcare-recreation partnership, randomized controlled pilot trial, mixed methods
Medical subject headings
Stroke, Mobility Limitation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Together in Movement and Exercise (TIME) ProgramBehavioural

    The TIME program is an evidence-based, standardized, progressive, licensed exercise program developed by physical therapists at the Toronto Rehabilitation Institute-University Health Network.

Study groups in NCT03122626
Study groupRoleWhat they receive
Experimental GroupExperimentalThe intervention is a group, task-oriented exercise program involving two 1-hour exercise classes per week for 12 weeks. The class involves a seated warm-up, repetitive, progressive practice of functional balance and mobility tasks, and a seated cool down. The warm-up consists of active range-of-motion exercises, aerobic exercise, leg loading, stretching, and sit-to-stand training. The cool-down involves exercises with an emphasis on stretching and relaxation. Tasks are organized in a 3-station circuit completed by participants grouped by overall ability: Superstation 1: walking, aerobic training, and wall work (standing and reaching, wall push-ups); Superstation 2: standing weight shifts, coordinated with stepping and lunging; and Superstation 3: tap-ups, step-ups, and heel/toe raises, hamstring curls, marching-on-the-spot, and mini-squats. Participants are instructed to be physically active by walking in their neighbourhood, practicing the program exercises, or using the stairs.
Receives: Behavioral: Together in Movement and Exercise (TIME) Program
Wait-listed Control GroupNo interventionThe control group will receive usual care which will be monitored and is expected to consist of provision of a home exercise program and information on community resources according to current best practices. At the end of the study period, participants in the control group will be offered to participate in the 3-month exercise program.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Subjective Index of Physical and Social Outcome (SIPSO)

    10-item, self-report questionnaire. 2 subscales: physical function (5 items), social function (5 items)

    Measured: Change from baseline to 3 months.

  2. Nottingham Extended Activities of Daily Living (NEADL)

    22-item, self-report performance of instrumental ADL in 4 categories: mobility, kitchen, domestic, and leisure.

    Measured: Change from baseline to 3 months.

Secondary outcomes (43)
  1. Barthel Index

    10-item, self-report or objective measure to assess level of independence in ability to perform basic activities of daily living

    Measured: 5 Baseline, 3 months, 6 months, and 12 months

  2. EuroQol five dimensions questionnaire

    5-item, self report questionnaire to assess health utility

    Measured: Baseline, 3 months, 6 months, and 12 months

  3. Stroke Impact Scale

    59-item, self-report, 8 scales: strength, hand function, activities of daily living, mobility, communication, emotion, memory and thinking, participation.

    Measured: Baseline, 3 months, 6 months, and 12 months

  4. Berg Balance Test

    14-items, objective measure designed to assess static balance and fall risk in adult populations

    Measured: Baseline, 3 months, 6 months, and 12 months

  5. Activities-specific Balance Confidence (ABC) Scale

    16-item, self-report; level of confidence in doing activities without losing balance or becoming unsteady

    Measured: Baseline, 3 months, 6 months, and 12 months

  6. 30-second Timed Sit-to-stand Test

    Number of full sit-to-stands as possible in 30 seconds starting from a sitting position in a chair of standard height (43.2 cm) with no arm-rests

    Measured: Baseline, 3 months, 6 months, and 12 months

  7. 6-Minute Walk Test

    Maximum distance walked in 6 minutes (standard encouragement each minute) on a straight 30-metre path.

    Measured: Baseline, 3 months, 6 months, and 12 months

  8. 10-metre Walk Test

    Time taken to walk the middle 10 m of a 14-m walkway at a comfortable and maximum pace

    Measured: Baseline, 3 months, 6 months, and 12 months

  9. Life Space Assessment questionnaire

    6-item, self-report. Indicate zones of the home, the neighborhood and the community that have been accessed in the past 3 days; the frequency of visit to these places and the use of auxiliary devices/ assistance

    Measured: Baseline, 3 months, 6 months, and 12 months

  10. Canadian Study of Health and Aging-Clinical Frailty Scale

    Indicates level of frailty of an individual based on impairments in mobility, function and self-rated health

    Measured: Baseline, 3 months, 6 months, and 12 months

  11. Trail Making Test

    Trails A consists of paper with circled numbers (from 1-25). Participants connect circles in numerical order as fast as possible.

    Trails B consists of paper with circled numbers and letters. Participants connect numbers and letters in order, alternating between numbers and letters.

    Measured: Baseline, 3 months, 6 months, and 12 months

  12. Geriatric Depression Scale-Short Version

    15-item, self-report. Response options are yes or no. Depressive responses are assigned a score of 1 point. Item-level scores are summed to yield a total score that is used to classify the level of depressive symptoms.

    Measured: Baseline, 3 months, 6 months, and 12 months

  13. Occurrence of injurious falls

    Participants are provided monthly falls calendar, coordinator contacts monthly to obtain details of any falls

    Measured: Monthly, Months 1-12

  14. Number of healthcare services utilized

    Primary care, Outpatient care, Inpatient care, Community care; Data are routinely collected and can be obtained from the Institute of Clinical and Evaluative Sciences (ICES) 6 months following the study end date

    Measured: 12 months

  15. Type of healthcare services utilized

    Primary care, Outpatient care, Inpatient care, Community care; Data are routinely collected and can be obtained from the Institute of Clinical and Evaluative Sciences (ICES) 6 months following the study end date

    Measured: 12 months

  16. Number of homecare services

    Monthly details of services used

    Measured: Monthly, Months 1-12

  17. Type of homecare services

    Monthly details of services used

    Measured: Monthly, Months 1-12

  18. Blood Pressure

    Systolic/Diastolic Pressure

    Measured: Baseline, 3 months, 6 months, and 12 months

  19. Heart Rate

    Heart rate

    Measured: 0.5 minutes

  20. Mobility aid type

    Types of mobility aids used

    Measured: Baseline, 3 months, 6 months, and 12 months

  21. Mobility aid number

    Number of mobility aids used

    Measured: Baseline, 3 months, 6 months, and 12 months

  22. Stroke characteristic

    Date, side and type of stroke

    Measured: Baseline

  23. Stroke characteristic date

    Date of stroke

    Measured: Baseline

  24. Stroke side

    Side of brain in which stroke occured

    Measured: Baseline

  25. Stroke type

    The type of stroke

    Measured: Baseline

  26. Sociodemographic data-age

    Age in years

    Measured: Baseline

  27. Sociodemographic data-sex

    Sex

    Measured: Baseline

  28. Height

    Height in meters

    Measured: Baseline, 3 months, 6 months, and 12 months

  29. Weight

    Weight in Kg

    Measured: Baseline, 3 months, 6 months, and 12 months

  30. Sociodemographic data-employment

    Employment Status

    Measured: Baseline

  31. Education level

    Years of education

    Measured: Baseline

  32. Personal income

    Category of personal income

    Measured: Baseline

  33. Charlson Comorbidity Index

    16-item scale to predict mortality. 8 items are given 1 point each, 8 other receive a score depending on the severity of condition

    Measured: Baseline

  34. Co-intervention type

    Type of co-intervention

    Measured: Monthly (1-12 months)

  35. Co-intervention frequency

    Frequency of co-intervention

    Measured: Monthly (1-12 months)

  36. Caregiver Assistance Scale

    17-item, caregiver self-report Indicates assistance provided to the care recipient in basic and instrumental ADLs and treatment-related activities

    Measured: Baseline, 3 months, 6 months, and 12 months

  37. Rand

    Emotional well-being and Energy/Fatigue Score, 9-item, self-report; Caregiver's perceived emotional status and energy levels over the past 4 weeks.

    Measured: Baseline, 3 months, 6 months, and 12 months

  38. Time per week spent caregiving

    Time in hours

    Measured: Baseline, 3 months, 6 months, and 12 months

  39. Costs report

    Self-reported costs for implementing one 12-week exercise program will be estimated for; healthcare system: salary of physical therapist train and provide consultation to fitness instructors; recreation provider: salary of fitness instructors and program coordinators, marketing, room booking, overhead, and equipment; and program participant: registration fee, transportation, personal health aides, unpaid caregiver's lost salary

    Measured: Bi-weekly (1-3 months)

  40. Intervention fidelity-activity checklist

    TIME Program activities at Recreation Site-Completed by Fitness Instructors

    Measured: Bi-weekly (1-3 months)

  41. Intervention feasibility-attendance sheet

    TIME Program attendance at Recreation Site-Completed by Fitness Instructors

    Measured: Bi-weekly (1-3 months)

  42. PT Evaluation form

    Evaluation conducted by Physical Therapist healthcare partner regarding the adherence to protocol

    Measured: Weekly (1-3 months)

  43. Adverse events

    Adverse events occurring during the TIME exercise program; completed by fitness instructors

    Measured: Weekly (1-3 months)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Apr 2017
  2. Study start2 Feb 2017
  3. Primary completion28 Feb 2019
  4. Study completion30 May 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
A 2-group randomized controlled trial in which participants are assigned to immediate or delayed participation in a community exercise program
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
33 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03122626
Sponsor's protocol ID
G-16-00013979
Status last verified
Jan 2021
First submitted
10 Apr 2017
Last updated
12 Jan 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Aravind G, Bashir K, Cameron JI, Bayley MT, Teasell RW, Howe JA, Tee A, Jaglal SB, Hunter S, Salbach NM. What matters to program partners when implementing a community-based exercise program for people post-stroke? A theory-based qualitative study and cost analysis. Front Rehabil Sci. 2023 Aug 14;4:1064206. doi: 10.3389/fresc.2023.1064206. eCollection 2023.

    PubMed 37645234
  • Aravind G, Bashir K, Cameron JI, Howe JA, Jaglal SB, Bayley MT, Teasell RW, Moineddin R, Zee J, Wodchis WP, Tee A, Hunter S, Salbach NM. Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial. Pilot Feasibility Stud. 2022 Apr 22;8(1):88. doi: 10.1186/s40814-022-01037-9.

    PubMed 35459194

Questions about this trial

What is this clinical trial studying?

A study testing Together in Movement and Exercise (TIME) Program in people with Stroke and Balance, run by University of Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Jan 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Subjective Index of Physical and Social Outcome (SIPSO) (time frame: Change from baseline to 3 months.). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03122626, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jan 2021.

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