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StrokeREUSENCT03522519

Predicting Real World Physical Activity and Upper Limb Use After Stroke

An observational study of Stroke, run by University of Zurich at 1 site in Switzerland.

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

Poststroke recovery mainly takes place within the first weeks to months and about 95% of the patients reach their maximum recovery 3 months after stroke onset. Poststroke rehabilitation is initiated as early as possible and aims to reduce functional consequences of stroke, allowing patients to integrate into the… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stroke
What is being tested?
Real world performance of physical activity and arm use
How many people
98 participants
Where
1 siteSwitzerland
Study dates
1 Sep 2018to 31 Mar 2021
Phase
Observational
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

Study population: Admitted to hospital

Who may be able to join

  • First-ever ischemic or hemorrhagic stroke, confirmed by MRI-DWI and/or CT (recurrent strokes are allowed when already included in this study after a first-ever stroke)
  • Paresis or paralysis of the arm and/ or leg
  • Living independently before stroke (mRS >2)
  • Age 18 years or older
  • Written informed consent of the patient or its legal representative after participants' information

Who cannot join

  • Contra-indications on ethical grounds (vulnerable persons)
  • Neurological or other diseases affecting upper limb use and/ or physical activity before stroke
  • Known or suspected non-compliance, drug or alcohol abuse

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • University Hospital Zurich

    Zurich, 8091

Other trials in Switzerland

About this study

Official title: Profiling and Predicting the Natural Course of Real World Physical Activity and Upper Limb Use After Stroke

Poststroke recovery mainly takes place within the first weeks to months and about 95% of the patients reach their maximum recovery 3 months after stroke onset. Poststroke rehabilitation is initiated as early as possible and aims to reduce functional consequences of stroke, allowing patients to integrate into the community. However, up to 75% of the patients remain disabled in the long term. Strikingly, about 20 to 30% of the patients show functional decline (i.e., learned-nonuse) in the long term - most often after having finished their intensive rehabilitation period - and even stroke survivors who have little or no residual disability are less physically active when compared to their age-matched peers.

Poststroke outcomes can be well predicted early after stroke. However, the deficits early after stroke and the outcomes are measured by standardized clinical tests performed in the laboratory. The drawback of these tests is that they provide information about the best possible abilities of the patients, as they are encouraged by therapists in testing situations. This so called "capacity" does not necessarily reflect what patients do in daily life situations (i.e., "performance" or "real world use").

Read more

With the growing interest in the patients' performance, various assessments that objectively measure activities in daily life situations have been developed in the last few years. These devices capture movement in daily life situations in a sensitive and objective way. An additional benefit is that they are less hampered by floor or ceiling effects when compared to clinical laboratory measurements (i.e., clinimetrics). Nevertheless, outcome of real world performance is hardly ever used in clinical trials aiming to determine the effectiveness of stroke rehabilitation interventions. Actually, until today, the natural course of performance remains largely unknown, as are predictors for this course. It is also unknown to which extend patients' subjective reporting of performance matches objectively measured performance. Finally, although it is believed that there is a threshold for, for example, real life use of the paretic arm and further improvement, there is no evidence as to what this threshold is in terms of clinical laboratory measurements.

The present prospective longitudinal cohort study fills in the gap regarding knowledge about the profile and predictability of two performance outcomes during the first year poststroke: engagement in physical activities and the use of the paretic upper limb. In addition, it will provide insight in how physical activity engagement and upper limb use measured by daily life assessments relate to standard clinical laboratory assessments. This knowledge is a prerequisite for the identification of patients' phenotypes and a first essential step towards the development of tailored (i.e., precision medicine), innovative rehabilitation interventions which enhance performance in terms of physical activities or upper limb use in daily life. The ultimate goal is to reduce poststroke disability and associated costs.

RE-USE is a prospective longitudinal observational cohort study of 120 first-ever stroke patients, who will be assessed 3, 10, 28, 90 and 365 days after stroke onset, as well as at discharge of the rehabilitation center.

Conditions
Stroke
Being tested
Real world performance of physical activity and arm use
Keywords
Physical Activity, Upper Extremity, Movement Sensors, Prognosis, Observational Cohort Study
Medical subject headings
Stroke, Motor Activity

What participants receive

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

  • Real world performance of physical activity and arm useBehavioural

    Patients will be assessed by using movement sensors and standard clinical assessments

Study groups in NCT03522519
Study groupRoleWhat they receive
Assessment of real world performanceNot described
Receives: Behavioral: Real world performance of physical activity and arm use

What is being measured

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

  1. Daily life assessment of physical activity engagement and upper limb use

    Real world performance, measured with movement sensors (number)

    Measured: 90 days after stroke onset

Secondary outcomes (21)
  1. Neurological impairments

    National Institutes of Health Stroke Scale (0-42 points, lower scores being better)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  2. Upper limb motor function

    Fugl-Meyer Assessment (0-66 points, higher scores being better)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  3. Motor function

    Motricity Index (0-200 points, higher scores being better)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  4. Trunk ability

    Trunk Control Test (0-100 points, higher scores being better)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  5. Sitting and standing balance

    Berg Balance Scale (0-56 points, higher scores being better)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  6. Walking ability (independence)

    Functional Ambulation Categories (0-5 points, higher scores being better)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  7. Gait speed and cadence (time)

    Ten-Meter Walk Test

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  8. Upper limb capacity

    Action Research Arm Test (0-56 points, higher scores being better)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  9. Upper limb capacity dexterity

    Box and Block Test (number of blocks)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  10. Global disability

    Modified Rankin Scale (0-6 points, lower scores being better)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  11. Fatigue

    Fatigue Severity Scale (9-63 point, lower scores being better)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  12. Cognition

    Montreal Cognitive Assessment(0-30 points, higher scores being better)

    Measured: 3 and 90 days after stroke onset

  13. Neglect

    Apples Test (number)

    Measured: 3 and 90 days after stroke onset

  14. Patient-reported physical activity

    International Physical Activity Questionnaire (3 levels higher levels are better)

    Measured: 90 and 365 days after stroke onset

  15. Patient-reported daily life upper limb use

    Motor Activity Log - 14 item version (0-5 points, higher scores being better)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  16. Patient-reported changes

    Global Rating of Perceived Changes (1-7 points, higher scores being better; 1-10 points, lower scores being better)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  17. Concomitant movement therapy

    Intensity of therapy based on charts (minutes)

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  18. Serious Events and non-serious infections or cardiovascular events

    Serious Events (1. death; 2. life-threatening illness or injury; 3. in-patient or prolonged hospitalisation; 4. medical or surgical intervention to prevent life threatening illness; 5. led to fetal distress, death or a congenital abnormality or birth defect) and non-serious infections or cardiovascular events

    Measured: 3, 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  19. Daily life assessment of physical activity engagement and upper limb use

    Real world performance, measured with movement sensors (number)

    Measured: 3, 10, 28 (expected rehabilitation discharge) and 365 days after stroke onset

  20. Levels of anxiety and depression

    Hospital Anxiety and Depression Scale (0-42 points, higher scores indicate greater levels of anxiety or depression)

    Measured: 10, 28, 90 (expected rehabilitation discharge) and 365 days after stroke onset

  21. Health care costs and loss of income

    Health care costs and loss of income in relation to the stroke (CHF)

    Measured: 365 days after stroke onset

Timeline

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

  1. First posted11 May 2018
  2. Study start1 Sep 2018
  3. Primary completion31 Mar 2021
  4. Study completion31 Mar 2021

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
98 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03522519
Sponsor's protocol ID
2017-01070
Other IDs
2017
Acronym
REUSE
Status last verified
Nov 2021
First submitted
16 Apr 2018
Last updated
29 Nov 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bailey RR, Klaesner JW, Lang CE. Quantifying Real-World Upper-Limb Activity in Nondisabled Adults and Adults With Chronic Stroke. Neurorehabil Neural Repair. 2015 Nov-Dec;29(10):969-78. doi: 10.1177/1545968315583720. Epub 2015 Apr 20.

    PubMed 25896988
  • Han CE, Arbib MA, Schweighofer N. Stroke rehabilitation reaches a threshold. PLoS Comput Biol. 2008 Aug 22;4(8):e1000133. doi: 10.1371/journal.pcbi.1000133.

    PubMed 18769588
  • Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995 May;76(5):406-12. doi: 10.1016/s0003-9993(95)80568-0.

    PubMed 7741609
  • Kwakkel G, Veerbeek JM, van Wegen EE, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015 Feb;14(2):224-34. doi: 10.1016/S1474-4422(14)70160-7.

    PubMed 25772900
  • Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011 May 14;377(9778):1693-702. doi: 10.1016/S0140-6736(11)60325-5.

    PubMed 21571152
  • Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA; American Heart Association Council on Cardiovascular Nursing and the Stroke Council. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010 Oct;41(10):2402-48. doi: 10.1161/STR.0b013e3181e7512b. Epub 2010 Sep 2. No abstract available.

    PubMed 20813995
  • Stewart JC, Cramer SC. Patient-reported measures provide unique insights into motor function after stroke. Stroke. 2013 Apr;44(4):1111-6. doi: 10.1161/STROKEAHA.111.674671. Epub 2013 Feb 19.

    PubMed 23422082
  • Stinear CM, Byblow WD. Letter by Stinear and Byblow regarding article, "patient-reported measures provide unique insights into motor function after stroke". Stroke. 2013 Jul;44(7):e79. doi: 10.1161/STROKEAHA.113.001689. Epub 2013 Jun 4. No abstract available.

    PubMed 23735958
  • Taub E, Uswatte G, Mark VW, Morris DM. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys. 2006 Sep;42(3):241-56.

    PubMed 17039223
  • Wolfe CD, Crichton SL, Heuschmann PU, McKevitt CJ, Toschke AM, Grieve AP, Rudd AG. Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register. PLoS Med. 2011 May;8(5):e1001033. doi: 10.1371/journal.pmed.1001033. Epub 2011 May 17.

    PubMed 21610863
  • Noorkoiv M, Rodgers H, Price CI. Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies. J Neuroeng Rehabil. 2014 Oct 9;11:144. doi: 10.1186/1743-0003-11-144.

    PubMed 25297823
  • Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One. 2014 Feb 4;9(2):e87987. doi: 10.1371/journal.pone.0087987. eCollection 2014.

    PubMed 24505342
  • Pohl J, Verheyden G, Held JPO, Luft AR, Easthope Awai C, Veerbeek JM. Construct validity and responsiveness of clinical upper limb measures and sensor-based arm use within the first year after stroke: a longitudinal cohort study. J Neuroeng Rehabil. 2025 Jan 29;22(1):14. doi: 10.1186/s12984-024-01512-9.

    PubMed 39881332

Questions about this trial

What is this clinical trial studying?

An observational study of Stroke, run by University of Zurich at 1 site in Switzerland.

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 5 inclusion and 3 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 29 Nov 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 Switzerland. 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?

Daily life assessment of physical activity engagement and upper limb use (time frame: 90 days after stroke onset). 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 NCT03522519, which also lists 13 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 29 Nov 2021.

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