AzTrials
AzTrials

Stroke RehabilitationTelestrokeNCT04440215

Optimizing Patient Adherence to Stroke Rehabilitation Treatment

A study testing Telerehabilitation and team meetings and team care plans in people with Stroke Rehabilitation and Telerehabilitation, run by Université de Sherbrooke at 6 sites in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

Stroke impacts nearly 400,000 Canadians annually. Three quarters of stroke survivors will live with minor to severe impairments or disabilities; which require rehabilitation care. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Telerehabilitation and team meetings and team care plans
Could I receive a placebo?
No, everyone receives an active treatment
How many people
330 participants
Where
6 sitesCanada
Study dates
10 Jul 2020to 1 Dec 2024
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

  • Have had stroke event (haemorrhagic or ischemic)
  • Are considered to be safe for home discharge by the acute/ in-patient care team (i.e. mild to moderate Functional Independence Measure score)
  • Have a relative or informal caregiver who is present in the home should physical rehabilitation treatments are required;
  • Can speak French or English.

Who cannot join

  • Having severe cognitive decline prior to the stroke event

Trial locations and contacts

6 sites in 1 country.

Isabelle Gaboury, PhD contact

514-452-9078

isabelle.gaboury@usherbrooke.ca

Francois Bordeleau, MSc contact

514-550-0601

francois.bordeleau@usherbrooke.ca

6 sites in 1 country

Canada6 sites, 6 recruiting
  • Centre de réadaptation en déficience physique - Installation Châteauguay

    Châteauguay, Quebec, J6J 4G7

    Diane Aspirot, diane.aspirot.cisssmo16@ssss.gouv.qc.ca

    Recruiting
  • Centre de réadaptation en déficience physique - Installation Granby

    Granby, Quebec, J2G 5L9

    Nadine Morin, 450-777-4641 ext. 300, nadine.morin.cisssmo16@ssss.gouv.qc.ca

    Recruiting
  • Centre de réadaptation en déficiences physique - Installation Saint-Hubert

    Longueuil, Quebec, J3Y 3N7

    Christine Mills, (450) 676-7447 ext. 2272, christine.mills.cisssmo16@ssss.gouv.qc.ca

    Recruiting
  • Centre de réadaptation en déficience physique - Installation Longueuil

    Longueuil, Quebec, J4J 1T2

    Sophie Laniel, (450) 676-7447 ext. 2279, sophie.laniel.cisssmo16@ssss.gouv.qc.ca

    Recruiting
  • Centre de réadaptation en déficience physique - Installation Saint-Hyacinthe

    Saint-Hyacinthe, Quebec, J2T 1N2

    Nadine Morin, 450-774-5003 ext. 2246, nadine.morin.cisssmo16@ssss.gouv.qc.ca

    Recruiting
  • Centre de réadaptation en déficience physique - Installation Vaudreuil-Dorion

    Vaudreuil-Dorion, Quebec, J7V 7E4

    Diane Aspirot, diane.aspirot.cisssmo16@ssss.gouv.qc.ca

    Recruiting

Other trials in Canada

About this study

Official title: Optimizing Patient Adherence to Stroke Rehabilitation Treatment: a Telerehabilitation Trial

Stroke impacts nearly 400,000 Canadians annually. Three quarters of stroke survivors will live with minor to severe impairments or disabilities; which require rehabilitation care. Strong evidence supports beginning rehabilitation as soon as the patient's medical status has stabilized and continuing following discharge from acute care. Access to optimal services is hampered, however, by travel distances to access rehabilitation, the lack of opportunities for structured and formal interprofessional communication among service providers, and failures to engage the patient and family members in a structured decision making process. Moreover, adherence to rehabilitation treatments has been shown to be suboptimal. Many patients refuse their outpatient rehabilitation treatments outright or decrease the duration and/or frequency of their treatments over time.

The aim of this proposed mixed methods pragmatic clinical trial is to evaluate an intervention that provides patients who have experienced stroke the opportunity to return home safely after their acute hospital stay, to encourage patient (and family) engagement in their rehabilitation care, and to overcome challenges of access to patient-centered interprofessional rehabilitation care.

Read more

The proposed intervention will entail 220 patients (and family) to receive rehabilitation care through remote, live treatment sessions with an interdisciplinary group of clinicians (called telerehabilitation) versus standard of care (n = 110 patients). Five rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to engage the patient/family. Grounded in findings gathered through a Canadian Institute of Health Research (CIHR) funded pilot study, the primary study objective is to evaluate process, clinical outcomes and costs of telerehabilitation in comparison with usual care. Through qualitative interviews with patients and family as well as clinicians, a second objective of this pragmatic, controlled trial is to explore and describe contextual factors (both personal and environmental) that will help the delivery of care, and improve patient's outcomes while fully using technology to deliver stroke rehabilitation care.

This study represents a unique, highly relevant opportunity to minimize both knowledge and practice gaps, while producing robust, indepth data on the factors related to the effectiveness of telerehabilitation.

Read the detailed description

Stroke impacts nearly 400,000 Canadians annually. Three quarters of stroke survivors will live with minor to severe impairments or disabilities; which require rehabilitation care representing >$3.6 billion in Canadian healthcare expenditure every year. Strong evidence supports beginning rehabilitation as soon as the patient's medical status has stabilized and continuing following discharge from acute care, ideally in the patient's community. Access to optimal services is hampered, however, by travel distances to access rehabilitation, the lack of opportunities for structured and formal interprofessional communication among service providers, and failures to engage the patient and family members in a structured decision making process. Even when travel is not a barrier, adherence to rehabilitation treatments has been shown to be suboptimal. Many patients refuse their outpatient rehabilitation treatments outright or decrease the duration and/or frequency of their treatments over time.

The aim of this proposed mixed methods pragmatic clinical trial is to evaluate an intervention that provides patients who have experienced stroke the opportunity to return home safely after their acute hospital stay, to encourage patient (and family) engagement in their rehabilitation care, and to overcome challenges of access to patient-centered interprofessional rehabilitation care.

The proposed intervention will entail 220 patients (and family) to receive rehabilitation care through remote, live treatment sessions with an interdisciplinary group of clinicians (called telerehabilitation) versus standard of care (n = 110 patients). Five rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to engage the patient/family. Grounded in findings gathered through a CIHR funded pilot study, the primary study objective is to evaluate process, clinical outcomes and costs of telerehabilitation in comparison with usual care. Through qualitative interviews with patients and family as well as clinicians, a second objective of this pragmatic, controlled trial is to explore and describe contextual factors (both personal and environmental) that will help the delivery of care, and improve patient's outcomes while fully using technology to deliver stroke rehabilitation care.

This application has been developed by an interdisciplinary team of researchers, local healthcare providers from each region involved, two patient partners who have experienced stroke, provincial network stakeholders, and decision makers, all engaged in the successful implementation of stroke guidelines and jurisdictional strategic plans. A panel of Canadian health system knowledge users rounds out the team, to enhance the proposed intervention, to communicate the relevance and anticipated use of the findings within their province, and to foster adaptation of improved stroke care elsewhere. Finally, the study has been endorsed by several knowledge users from the Quebec Ministry of Health as well as the Quebec Heart and Stroke Foundation. Considering contrasts between rehabilitation practices and the Canadian Stroke recommendations and the lack of relevant, robust data, this study represents a unique, highly relevant opportunity to minimize both knowledge and practice gaps, while producing robust, indepth data on the factors related to the effectiveness of telerehabilitation.

Being tested
Telerehabilitation and team meetings and team care plans, Usual care
Keywords
Rehabilitation, Stroke, Adherence, Home, Telerehabilitation, Interprofessional shared decision making
Medical subject headings
Stroke

What participants receive

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

  • Telerehabilitation and team meetings and team care plansOther

    A mix of home or rehabilitation center visits and telerehabilitation will be planned by the rehabilitation team for a maximum of 16 weeks. Moreover, for each participant enrolled, a multidisciplinary meeting will be organised. The patient/family will participate in the meeting and the decision making process using the telerehabilitation platform. The team will generate an interprofessional individualized treatment plan, aiming for an interprofessional shared decision making process.

  • Usual careOther

    Rehabilitation teams will be instructed to provide care as they have been doing previously. Currently, this translates into no telerehabilitation, and interdisciplinary meetings not systematically organized and/or not involving a complete team of professionals.

Study groups in NCT04440215
Study groupRoleWhat they receive
ControlOtherUsual rehabilitation care (no telerehabilitation, interdisciplinary meetings not systematically organized and/or not involving a complete team of professionals)
Receives: Other: Usual care
TelerehabilitationExperimentalA mix of home or rehabilitation center visits, telerehabilitation and interprofessional shared decision making process.
Receives: Other: Telerehabilitation and team meetings and team care plans

What is being measured

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

  1. Patient adherence to stroke rehabilitation plan (Patient journal)

    Time spent (in minutes) doing any stroke rehabilitation exercises (online + offline). This includes (but is not limited to) physical, writing and speech therapy, and mental health-related exercises recommended by the rehabilitation professional.

    Measured: Through intervention completion (up to 12 weeks)

  2. Change in patient adherence to stroke rehabilitation plan

    StREAM questionnaire which is a 12-item questionnaire coted on a 4-point Likert scale which measure patients' adherence to a rehabilitation program.

    Measured: Change from baseline and 4-, 6-, 12-week post-recruitment

  3. Patient adherence to stroke rehabilitation plan (Professional perception)

    Health care professional perception of the participants' adherence to the rehabilitation program, evaluated on a 10-point scale.

    Measured: Through intervention completion (up to 12 weeks)

Secondary outcomes (12)
  1. Sociodemographic questionnaire

    Home questionnaire including information about sex, age, clinical information about stroke

    Measured: At recruitment (baseline)

  2. Change in functional recovery and independence

    The modified 5-level Functional Independence Measure (FIM; 18 items) will be used. This measurement tool explores an individual's physical, psychological and social function. The tool is used to assess a patient's level of disability as well as change in patient status in response to rehabilitation or medical intervention. A lower score reflects greater disability.

    Measured: Change from baseline and 12-week post-recruitment

  3. Change in reintegration into normal social activities

    The Reintegration to Normal Living Index (RNLI; 11 items) will be used to assess the degree to which the participants perceived their normal social activities have been impacted by the stroke event. A higher score indicates more difficulty to reintegrate normal living.

    Measured: Change from baseline and 12-week post-recruitment

  4. Change in depression state

    The Beck Depression Inventory (Beck; 21 items) will be used to measure the severity of depression. The inventory is composed of items relating to depressive symptoms. A higher score indicates higher depression state.

    Measured: Change from baseline and 12-week post-recruitment

  5. Use of healthcare services

    This outcome, defined as expenses related to services and long-term complications, including hospitalization and physician visits is measured with 3 different tools: 1) Section A - Use of healthcare services (16 items) of the questionnaire developed by the Institut National de Santé Publique du Québec (INSPQ), 2) information collected daily by the participant in a calendar and 3) Health administrative provincial data on use of public health services received.

    Measured: within 12 week and 6 month post recruitment

  6. Adverse events

    Presence of adverse events related to rehabilitation (pain, dizziness, fatigue, number of falls)

    Measured: Through intervention completion (up to 12 weeks)

  7. Perception of interprofessional care shared decision making (Patient POV)

    The Collaboration and Satisfaction About Care Decision tool (9 items) will be used. This questionnaire will be completed by the health care professionals involved in the study.

    Measured: 12 weeks after recruitment

  8. Perception of interprofessional care shared decision making (Clinical team POV)

    The Assessment of Interprofessional Team Collaboration Scale, short version (AITCS; 23 items) will be used. This questionnaire will be completed by the health care professionals involved in the study.

    Measured: Through study completion (up to 5 years)

  9. Statistics related to the telerehabilitation platform use

    Home questionnaire on telerehabilitation platform utilisation (who, when, duration).

    Measured: Through intervention period (up to 3 years)

  10. Presence of intervention plan in the patient file

    A "Yes" or "No" answer to the presence of an intervention plan in the patient file

    Measured: 12 weeks after recruitment

  11. Specific shared decision making (SDM) behaviours during decision-making (Questionnaire)

    A composite questionnaire (SURE, 4 questions; Assumed role for decision-making, 1 question; CollaboRATE, 3 questions; Quality in decision-making, 6 questions) will be used to assess the extent to which practitioners involve patients in decision making processes. Patients will be given this questionnaire following the meeting to establish their rehabilitation plan.

    Measured: At the start of the rehabilitation period

  12. Specific shared decision making (SDM) behaviours during decision-making (Interviews)

    A randomized sample of 60 patients will be selected (50% control, 50% intervention). The meetings to establish their treatment plan will be recorded and analyzed using qualitative methods, in order to document the dynamics of the decision-making process. This qualitative section of the study will help enrich and contextualize the quantitative data collected for the other outcomes.

    Measured: At the start of the rehabilitation period

Timeline

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

  1. First posted19 Jun 2020
  2. Study start10 Jul 2020
  3. Primary completion1 Dec 2023 (estimated)
  4. Study completion1 Dec 2024 (estimated)

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
Health services research
Allocation
Non-randomised
Intervention model
Sequential
Model description
An interrupted time series design. It consists of observing the same dependent variable over time, with a break in the series of observations corresponding to the introduction of an intervention.
Masking
None (open label)
Enrolment
330 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04440215
Sponsor's protocol ID
MP-04-2020-519
Acronym
Telestroke
Status last verified
Jul 2021
First submitted
12 Jun 2020
Last updated
21 Jul 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Gaboury I, Tousignant M, Corriveau H, Menear M, Le Dorze G, Rochefort C, Vachon B, Rochette A, Gosselin S, Michaud F, Bollen J, Dean S. Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial. JMIR Res Protoc. 2021 Oct 28;10(10):e32134. doi: 10.2196/32134.

    PubMed 34709196

Questions about this trial

What is this clinical trial studying?

A study testing Telerehabilitation and team meetings and team care plans in people with Stroke Rehabilitation and Telerehabilitation, run by Université de Sherbrooke at 6 sites 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 4 inclusion and 1 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: status not confirmed, as of the sponsor's last update on 21 Jul 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites 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?

Results are not available in the source record.

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

Contact Isabelle Gaboury, PhD (514-452-9078, isabelle.gaboury@usherbrooke.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Patient adherence to stroke rehabilitation plan (Patient journal) (time frame: Through intervention completion (up to 12 weeks)). The study lists 3 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 NCT04440215, which also lists 1 linked publication.

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 21 Jul 2021.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in