Personalised community based telerehabilitation post stroke to increase rehabilitation time and improve motor recovery (PRACTISE): study protocol for a randomised controlled feasibility trial

Abstract

Abstract Introduction Stroke is the second leading non-communicable cause of death and third leading cause of death and disability worldwide with prevalence expected to rise 120% between 2015 and 2035. The first 6 months after stroke is the optimum time for neuroplasticity and a critical period for rehabilitation. UK national clinical guidelines recommend stroke survivors should receive at least 3 h/day of multidisciplinary rehabilitation at least 5 days/week. Workforce shortages and service variability make achieving this standard consistently challenging. Goal setting, telerehabilitation, and self-management strategies are advocated, yet their combined use in community-based rehabilitation has not been tested. This study aims to conduct a randomised feasibility-controlled trial with embedded process evaluation to assess the feasibility of delivering a 16-week, personalised, home-based physiotherapy, prior to progression to a full-scale trial. Methods and analysis This trial will recruit 60 participants with moderate post-stroke disability across Scotland. Participants will be randomised to the PRACTISE intervention or control (usual physiotherapy). PRACTISE (Personalised community-based telerehabilitation post stroke to increase rehabilitation time and improve motor recovery) is a 16-week, personalised physiotherapy programme involving goal setting, supported self-management and exercise via an online video-based platform. PRACTISE consists of five home-based physiotherapy sessions and four online/telephone sessions with participants encouraged to engage in a personalised exercise programme up to five times/week for up to 3 h/day. Both groups will receive other usual stroke care. Feasibility outcomes will include recruitment, retention, and completion rates. A process evaluation will assess acceptability and implementation factors. Clinical outcomes, recorded at weeks 0, 8, 16, and 24 by a blinded assessor, include the Canadian Occupational Performance Measure (primary outcome) and measures of limb function, fatigue, quality of life, functional ability, treatment burden, falls, self-efficacy, caregiver strain, and healthcare resource use (secondary outcomes). Exercise dosage and adherence will be monitored via exercise diaries. Discussion Intensive post-stroke rehabilitation is recommended but challenging to achieve. PRACTISE combines goal setting, self-management, and online exercise prescription to support stroke survivors to achieve recommended rehabilitation doses. This study will examine the feasibility, acceptability, and mechanisms of the intervention to inform potential refinement and progression to a full-scale trial. Trial registration Prospectively registered at https://clinicaltrials.gov . (NCT06871878).