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| Name | Class |
|---|---|
| Alberta Innovates Health Solutions | OTHER |
| Glenrose Hospital Foundation | UNKNOWN |
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After a stroke, many people have trouble using their arms and hands. This can make daily tasks-like eating, dressing, or writing-very hard. In Alberta, especially in small towns and rural areas, many stroke survivors go home from the hospital without being referred to rehabilitation. As a result, they miss out on therapy that could help them get better.
This project will test a new way to bring rehabilitation directly into people's homes using telerehabilitation. We will work with 200 stroke survivors across Alberta who did not get regular outpatient rehab. Participants will use the clinically validated Tenzr system-a set of fun, game-like exercises with wearable sensors. Therapists will check in and guide them remotely.
When participants are enrolled in the study, they will be randomized (1:1) into two groups. The Immediate group will receive 8 weeks of home-based telerehabilitation using the Tenzr platform immediately after baseline, while the Delayed group will receive 8 weeks of observation (usual care) followed by 8 weeks of the same telerehabilitation intervention. Everyone in the study will be tested at the baseline, 8 weeks, and 16 weeks. At 16 weeks, we will also interview them to gather their feedback on the telerehabilitation. We want to learn if this program helps people improve arm and hand movement, if it's easy to use, and if people like it. We also want to see if it could be offered more widely across Alberta in the future.
The goal is to give more people access to stroke rehabilitation, no matter where they live.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Immediate Group | Active Comparator | The Immediate group will receive 8 weeks of home-based telerehabilitation using the Tenzr platform immediately after baseline clinical assessments. |
|
| Delayed Group | Active Comparator | Delayed group will receive 8 weeks of observation (usual care) following the baseline clinical assessment; followed by 8 weeks of the same telerehabilitation intervention. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard of Care (SOC) | Other | 8 weeks of standard of care for patients discharged from hospital without referrals to outpatient rehabilitation. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Upper Extremity Fugl-Meyer Assessment for Upper Extremity (FM-UE) | The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with post-stroke hemiplegia. We will be obtaining and reporting the Upper Extremity subscore. It is a score without units. | Baseline, 8 weeks and 16 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Nine-hole Peg Test (NHPT) (sec) | The NHPT requires participants to repeatedly place and then remove nine pegs into nine holes, one at a time, as quickly as possible. | Baseline, 8 weeks, 16 weeks |
| Change in Box and Blocks Test (number of blocks) |
| Measure | Description | Time Frame |
|---|---|---|
| System Usability Scale (Tech eval) | The system usability scale (SUS) is a simple, ten-item attitude Likert scale giving a global view of subjective assessments of usability. | At completion of Tenzr-supported rehab phase (either 8 or 16 weeks dependent on randomization). |
| Client Satisfaction Questionnaire (CSQ-8) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jessica M D'Amico, Scientific Program Lead and Assistant Professor, PhD | Contact | 780-203-9478 | damico1@ualberta.ca | |
| Yoshino Okuma, BScRN, MSc | Contact | yokuma@ualberta.ca |
| Name | Affiliation | Role |
|---|---|---|
| Jessica M D'Amico, PhD | University of Alberta and Alberta Health Services | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Glenrose Rehabilitation Hospital | Recruiting | Edmonton | Alberta | T5G 0B7 | Canada |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| D000069350 | Telerehabilitation |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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This project will employ a randomized, delayed-start controlled crossover design within a hybrid Type I effectiveness-implementation trial framework. Two hundred individuals with post-stroke upper extremity impairment, who have not been referred to outpatient rehabilitation, will be randomized (1:1) into two groups. The Immediate group will receive 8 weeks of home-based telerehabilitation using the Tenzr platform immediately after baseline, while the Delayed group will receive 8 weeks of observation (usual care) followed by 8 weeks of the same telerehabilitation intervention. All participants will be assessed at baseline, 8 weeks, and 16 weeks.
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| Telerehabilitation with Tenzr | Other | 8 weeks of telerehabilitation at home supported by a remote therapist utilizing the Tenzr application. |
|
The Box and Block Test (BBT) measures unilateral gross manual dexterity. It is a quick, simple and inexpensive test. It can be used with a wide range of populations, including clients with stroke. |
| Baseline, 8 weeks, 16 weeks |
| Change in Stroke Impact Scale Score | The Stroke Impact Scale (SIS) is a patient-reported outcome measure that evaluates the biopsychosocial aspects of life after stroke. No units. | Baseline, 8 weeks, 16 weeks |
| Change in PROMIS Upper Extremity Short Form | PROMISĀ® stands for Patient Reported Outcomes Measurement Information System, which is a system of highly reliable, precise measures of patient-reported health status for physical, mental, and social well-being. PROMISĀ® tools measure what patients are able to do and how they feel by asking a number of questions. The PROMIS v1. 2 UE item bank is a useful clinical assessment tool with good psychometric properties that can be implemented in clinical settings and is focused on upper extremity items. | Baseline, 8 weeks, 16 weeks |
The Client Satisfaction Questionnaire (CSQ-8) is one of a limited number of standardised satisfaction measures that have been used widely. |
| At completion of trial (16 weeks) |
| Participant adherence (%, rate of planned sessions completed) | Using the Tenzr application we will report the rate of completed sessions by recording the # rehab sessions completed by the participants using the application versus the planned # rehab sessions and expressed as a percentage. | Collected continuously using the Tenzr application during the telerehabilitation phase of the trial (either baseline-8week block or 8week-16week block dependent on randomization). |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D017216 | Telemedicine |
| D003695 | Delivery of Health Care |
| D010346 | Patient Care Management |