CClinicalTrials.gg
CompletedNCT03460587Updated Dec 17, 2020Results posted

Long-term Telerehabilitation for Patients With Stroke

An interventional study of Telerehabilitation in Stroke, Cerebrovascular Disorders and Brain Diseases, sponsored by University of California, Irvine. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-12-17.

Sponsored by University of California, Irvine · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
13
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

The aim of the current protocol is to study 40 patients, each for 12 weeks, to address hypotheses related to the ability of a telerehabilitation system to (a) improve motor status and disability, (b) collect various forms of patient data from the home, (c) improve risk factor knowledge and control, and (d) assess patient compliance with home-based telerehabilitation.

Patients who have returned to their home after stroke will be provided with a telehealth system and be asked to use it 6 days/week for 12 weeks, during which time subjects will use this system for daily rehabilitation therapy, assessments, and education--all on one platform.

Read the detailed description

Stroke is perennially one of the leading causes of human disability. Stroke is truly a chronic disease, with survivors living for years or decades after the event. Increasing evidence describes years of steady decline in several health measures for stroke survivors. Many factors contribute to this, including further strokes, uncontrolled risk factors, development of late complications of stroke, and limited access to rehabilitation therapy.

New approaches are needed that address the many needs of stroke survivors, efficiently and in aggregate. Emerging telehealth technologies have high potential to address this major unmet need, but substantial innovation will be needed. The long-term goal is to establish a telehealth platform to treat chronic stroke.

A telehealth system will be delivered to enrollee's home. Patients will be asked to interact with their system daily (at least 6 days/wk) for 12 weeks. For 3 times per week, during the first 2 weeks, and then 1 time per week thereafter, a study therapist or research assistant in the lab will use the telehealth system to have a videoconference with the subject, to answer questions, provide feedback, review progress, and make any changes needed in the therapy plan. Study personnel will monitor usage statistics and performance measures for all systems.

A key strategy is to measure in parallel, patient behaviors in three categories of health issues central to chronic stroke: (1) medical management issues including risk factor knowledge and control, (2) disability issues including motor function, and (3) psychological issues including depression and anxiety.

02

Conditions studied

  • Stroke
  • Cerebrovascular Disorders
  • Brain Diseases
  • Central Nervous System Diseases
  • Nervous System Diseases
  • Vascular Diseases
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Age ≥18 years at the time of randomization
  2. Stroke that is radiologically verified, due to ischemia or to intracerebral hemorrhage or subarachnoid hemorrhage, and with any time of stroke onset prior to randomization
  3. Arm motor Fugl Meyer score of 28-66; if Arm motor Fugl Meyer score> 59, must also have Box \& Blocks on affected side >25% lower
  4. Box \& Block Test score with affected arm is at least 3 blocks in 60 seconds at the first visit
  5. Informed consent signed by the subject
  6. Behavioral contract signed by the subject

Exclusion criteria

Exclusion Criteria:

  1. A major, active, coexistent neurological or psychiatric disease, including alcoholism or dementia
  2. A diagnosis (apart from the index stroke) that substantially affects paretic arm function
  3. A major medical disorder that substantially reduces the likelihood that a subject will be able to comply with all study procedures
  4. Severe depression, defined as Geriatric Depression Scale Score >11
  5. Significant cognitive impairment, defined as Montreal Cognitive Assessment score \< 22; note that this exclusion criteria can be waived at the discretion of the study PI, e.g., for aphasia
  6. Deficits in communication that interfere with reasonable study participation
  7. Lacking visual acuity, with or without corrective lens, of 20/40 or better in at least one eye
  8. Life expectancy \< 6 months
  9. Receipt of Botox to arms, legs, or trunk in the preceding 6 months, or expectation that Botox will be administered to the arm, leg, or trunk prior to completion of participation in this study
  10. Unable to successfully perform all 3 of the rehabilitation exercise test examples
  11. Unable or unwilling to perform study procedures/therapy, or expectation of non-compliance with study procedures/therapy, or expectation that subject will be unable to participate in study visits
  12. Concurrent enrollment in another investigational study
  13. Non-English speaking, such that subject does not speak sufficient English to comply with study procedures
  14. Expectation that subject will not have a single domicile address during the 12 weeks of therapy, within 75 miles of the central study site
  15. Note that the presence of wireless home internet connectivity is not an exclusion criterion, but preference may be given to enrollees who do have wireless home internet connectivity because this will enable testing of study hypotheses.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
13 participants (actual)

Study arms

  • Experimental
    Home-based Telerehabilitation

    Home-based Telerehabilitation

    Device: Telerehabilitation

Interventions

  • DeviceTelerehabilitation

    The Telerehabilitation system will deliver rehabilitation treatment sessions via an in-home internet-connected computer. A major component of the system is the use of games to promote therapeutically relevant movements. The subject will perform daily assigned home-based telerehabilitation games and exercises and 5 minutes of stroke education, all guided by the telerehabilitation system.During some of the sessions, therapists will initiate a videoconference with the subject's telerehabilitation system to discuss progress, issues, and revise treatment plans as needed.

05

What researchers measure

Primary outcomes

  1. Fugl-Meyer Arm Motor Scale

    measure of arm impairment, scores range from 0 to 66 with higher numbers reflecting less arm impairment

    Time frame: 90 days

Secondary outcomes

  1. Fugl-Meyer Leg Motor Scale

    measure of leg impairment, scores range from 0 to 34 with higher numbers reflecting less leg impairment

    Time frame: 90 days

06

Results

Posted Dec 17, 2020

Participant flow

Participant flow — Overall Study
MilestoneHome-based Telerehabilitation
Started13
Completed13
Not completed0

Outcome measures

PrimaryFugl-Meyer Arm Motor Scale

measure of arm impairment, scores range from 0 to 66 with higher numbers reflecting less arm impairment

Time frame:
90 days
Reported as:
Median · units on a scale
Fugl-Meyer Arm Motor Scale
units on a scaleHome-based Telerehabilitation
Fugl-Meyer Arm Motor Scale59 (52.5 to 61.5)
SecondaryFugl-Meyer Leg Motor Scale

measure of leg impairment, scores range from 0 to 34 with higher numbers reflecting less leg impairment

Time frame:
90 days
Reported as:
Median · units on a scale
Fugl-Meyer Leg Motor Scale
units on a scaleHome-based Telerehabilitation
Fugl-Meyer Leg Motor Scale28 (27 to 30.5)

Adverse events

Collected over From enrollment to 90 days later. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Home-based Telerehabilitation0/13 (0%)0/13 (0%)0/13 (0%)

Baseline characteristics

All patients who signed informed consent.

Age, Continuous
Age, Continuous(years)Home-based Telerehabilitation
Median61 (52 to 65.5)
Sex: Female, Male
Sex: Female, Male(Participants)Home-based Telerehabilitation
Female4
Male9
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Home-based Telerehabilitation
Hispanic or Latino1
Not Hispanic or Latino12
Unknown or Not Reported0
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Home-based Telerehabilitation
American Indian or Alaska Native0
Asian3
Native Hawaiian or Other Pacific Islander0
Black or African American1
White9
More than one race0
Unknown or Not Reported0
Region of Enrollment
Region of Enrollment(participants)Home-based Telerehabilitation
United States13
Time post-stroke
Time post-stroke(days)Home-based Telerehabilitation
Median129 (52 to 486)
Arm motor Fugl-Meyer score
Arm motor Fugl-Meyer score(units on a scale)Home-based Telerehabilitation
Median46 (42 to 57)
Leg motor Fugl-Meyer score
Leg motor Fugl-Meyer score(units on a scale)Home-based Telerehabilitation
Median28 (23.5 to 29)
07

Study locations

1 site
  • University of California, Irvine
    Irvine, California 92697, United States
08

References and documents

Publications

  • Dodakian L, McKenzie AL, Le V, See J, Pearson-Fuhrhop K, Burke Quinlan E, Zhou RJ, Augsberger R, Tran XA, Friedman N, Reinkensmeyer DJ, Cramer SC. A Home-Based Telerehabilitation Program for Patients With Stroke. Neurorehabil Neural Repair. 2017 Oct-Nov;31(10-11):923-933. doi: 10.1177/1545968317733818. Epub 2017 Oct 26. PubMed 29072556 ↗
  • Cramer SC, Sur M, Dobkin BH, O'Brien C, Sanger TD, Trojanowski JQ, Rumsey JM, Hicks R, Cameron J, Chen D, Chen WG, Cohen LG, deCharms C, Duffy CJ, Eden GF, Fetz EE, Filart R, Freund M, Grant SJ, Haber S, Kalivas PW, Kolb B, Kramer AF, Lynch M, Mayberg HS, McQuillen PS, Nitkin R, Pascual-Leone A, Reuter-Lorenz P, Schiff N, Sharma A, Shekim L, Stryker M, Sullivan EV, Vinogradov S. Harnessing neuroplasticity for clinical applications. Brain. 2011 Jun;134(Pt 6):1591-609. doi: 10.1093/brain/awr039. Epub 2011 Apr 10. PubMed 21482550 ↗
  • Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet. 1999 Jul 17;354(9174):191-6. doi: 10.1016/S0140-6736(98)09477-X. PubMed 10421300 ↗
  • Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, Zhou RJ, Raefsky SM, Nguyen T, Vanderschelden B, Wong G, Bandak D, Nazarzai L, Dhand A, Scacchi W, Heckhausen J. A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Front Neurol. 2021 Feb 3;11:611453. doi: 10.3389/fneur.2020.611453. eCollection 2020. PubMed 33613417 ↗

Study documents

  • Study protocol · Nov 22, 2020
  • Statistical analysis plan · Nov 22, 2020

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03460587
Lead sponsor
University of California, Irvine
Responsible party
Steven C. Cramer, MD (Professor of Neurology, University of California, Irvine) — Principal investigator
First posted
Mar 9, 2018
Start date
Aug 29, 2018
Primary completion
Mar 31, 2019
Completion
Mar 31, 2019
Results posted
Dec 17, 2020
Last update
Dec 17, 2020

Study contacts

Steven Cramer, MD
principal investigator · UC Irvine

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Jun 2020. You cannot join it, but the record below documents what was studied.

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