Effect of Individualized Coaching at Home on Quality of Life in Subacute Stroke Patients.

Background: Stroke causes psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Physical activity (PA) in stroke recovery is beneficial. The benefits of PA on quality of life after stroke are less documented. The aim of the study was to evaluate the effect of a home-based PA incentive program at home in post-stroke patients in the subacute phase on quality of life. Methods: This is a prospective, randomized, single-blind, and monocentric clinical trial. Eighty-three patients were randomly assigned to either an experimental group (EG; n = 42) or to a control group (CG; n = 41). The experimental group followed a home-based PA incentive program for 6 months. Three incentive methods were used: daily monitoring with an accelerometer, weekly telephone calls, and home visits every three weeks. Patients were evaluated before intervention (T0) and after intervention (T1) at 6 months. The control group was a non-intervention group receiving usual care. The outcome was the quality of life with the EuroQol EQ-5D-5L evaluated at baseline and 6 months post-intervention. Results: The mean age was 62.2 years ± 13.6 with a post-stroke time of 77.9 ± 45.1 days. The mean values of the utility index (EQ-5D-5L) in the control group and experimental group at T1 were 0.721 ± 0.207 and 0.808 ± 0.193, respectively (p = 0.02). Discussion: Our study shows a significant difference in the Global QOL index (EQ-5D-5L) between the two groups of subacute stroke patients after 6 months of the individualized coaching program, which combined home visits and weekly telephone calls.

Influence of daily physical activity on fine motor skills of adults around a Fitts task.

INTRODUCTION: Achieving our daily tasks depends on the speed-accuracy conflict. Physical activity plays a role in the development of our motor skills. However, the relationship between physical activity level (PAL) and fine motor skills remains largely unexplored.

Compliance with Upper Limb Home-Based Exergaming Interventions for Stroke Patients: A Narrative Review.

BACKGROUND: Telerehabilitation and follow-up techniques have been developed in recent years to assess the effectiveness of diverse intervention programmes that include exergaming technologies. For patients with upper limb impairment after stroke, motion-gaming technologies can provide effective and amusing training. Beyond efficiency, professionals must analyse patient compliance with the system for self-use at home, because patients may or may not independently perform the exercises prescribed by the therapist. Questions on the sustainable use of this type of home exercise also arise. OBJECTIVE: This review examines user compliance with exercise programmes, measured according to the training rate (percentage of prescribed sessions and minutes completed) and completion rate (number of drop-outs and discontinued interventions) reported or calculable according to the data collected. RESULTS AND DISCUSSION: Rates of compliance with training were relatively high. No group effect on compliance was found. Drop-out and discontinued intervention rates were either due to external causes or directly related to the technologies. Some studies have reported the use of supervision, most of them through home visits and remote support. Few studies performed long-term follow-up, which could provide information to help broaden practices. This narrative review considers how this field of research may evolve in the future.

Measured and Perceived Effects of Upper Limb Home-Based Exergaming Interventions on Activity after Stroke: A Systematic Review and Meta-Analysis.

After discharge from the hospital to home, stroke patients may experience weakness and reduced movement in their hemiparetic arms that limits their ability to perform daily activities. Therapists can use exercise games (exergames) to maintain functional abilities and daily use of the arm at home. A systematic review and meta-analysis was conducted to determine the efficiency of upper limb home-based rehabilitation, using exergaming on activity abilities in stroke. Randomized controlled trials were reviewed in the CENTRAL, MEDLINE, CINAHL, EMBASE, and SCOPUS online databases. Clinical measures of observation and self-reporting were studied in post-intervention and follow-up. Nine studies were included in this systematic review (535 participants). The Physiotherapy Evidence Database (PEDro) score was 6.6/10 (SD 1.0, range 5-8), indicating good quality. This systematic review and meta-analysis showed that upper limb home-based exergaming interventions were no more effective in terms of activity than conventional therapy after stroke, according to the observational and subjective assessments in post-intervention and follow-up. Using this same approach, future studies should focus on evaluating home-based exergames through subgroup analysis to be able to propose recommendations.

Bringing rehabilitation home with an e-health platform to treat stroke patients: study protocol of a randomized clinical trial (RGS@home).

BACKGROUND: There is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering AI-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action. METHODS: The RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke ≥ 30 days). The trial will end in July 2023. DISCUSSION: We predict an improvement in the patients' recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals. TRIAL REGISTRATION: C linicalTrials.gov NCT04620707. Registered on November 3, 2020.

Influence of training protocols on text input speed on a computer in individuals with cervical spinal cord injury: a randomised controlled trial.

STUDY DESIGN: Randomised controlled trial. OBJECTIVES: To evaluate the impact of two different word prediction software (WPS) training protocols on text input speed (TIS) in people with tetraplegia and to determine which was the most effective. SETTING: Rehabilitation department, Garches, France. METHODS: Participants with neurological levels between C6 and C8 were allocated to one of three different groups. The REHAB group underwent training with an occupational therapist. The SELF group carried out a standardised home self-training with a written training guide. The CONTROL group had no training. Participants were assessed at day 15 (D15) and day 30 (D30). The primary outcome was a copying task with and without WPS (WITH and WITHOUT). RESULTS: Forty-two participants (mean age ± SD of 39.8 ± 12) were included and 38 completed the study. At D30, the mean (95% confidence interval) difference in TIS between the CONTROL and SELF groups was 3.8 [-1.7 to 9.4] characters per minute (cpm) (p = 0.23), between the REHAB and SELF groups was 12.9 [7.4 to 18.4] cpm (p < 0.001), and between the REHAB and CONTROL groups was 9.1 [3.5 to 14.6] cpm (p < 0.001). CONCLUSIONS: The results of this study showed that occupational therapist-supervised training improved TIS but word prediction software did not increase TIS. These results suggest that supervised training should be provided to all individuals who are prescribed with devices and systems to facilitate computer access in order to increase their TIS.