Description of the CARE4STROKE programme: A caregiver‐mediated exercises intervention with e‐health support for stroke patients

Abstract

BackgroundIntensity of practice and task and context specificity are key factors for improving functional outcome in stroke survivors. Novel methods are needed to augment intensity of practice with minimal use of resources and costs. Caregiver‐mediated exercises (CMEs) focused on mobility, in which a caregiver acts as an exercise coach and can increase the intensity of practice. There is preliminary evidence that CME can improve functional outcome, reduce length of stay, and allow early supported discharge, without an increase in caregiver burden. In the CARE4STROKE programme (C4S), CME therapy and e‐health support are combined to promote a smoother transition from the inpatient setting to the home environment, with active rehabilitation continuing in the community.The objective of this paper is to describe the content of the C4S intervention in detail and explain implementation of this intervention in practice using the Template for Intervention Description and Replication checklist.MethodsContent, timing and intensity of the programme, participant screening and selection, and intervention procedures were described using the Template for Intervention Description and Replication checklist. Mobility exercises and use of a video application on tablet/smartphone are explained. The role of the caregiver as provider of the intervention is illustrated.DiscussionC4S prescribes an additional exercise dose of 1,200 min and may be a promising novel and effective method to augment the pallet of therapeutic options for stroke rehabilitation. Important aspects for successful implementation are availability and suitability of a caregiver. Suggestions for additional use of e‐health technology are described.Implications for physiotherapy practiceThe presented description of C4S gives physical therapists practical guidelines to facilitate implementation of the CME intervention.

mHealth Intervention Applications for Adults Living With the Effects of Stroke: A Scoping Review

“… Both the SHEMA intervention and traditional stroke health education can improve patients’ knowledge of stroke risk factors, but the SHEMA was not superior to traditional stroke health education. Vloothius et al 41 N=7 ∗ Qualitative Netherlands CARE4STROKE Exercise/physical activity/functional mobility To explore how people living with stroke and caregivers managed exercises together. Different role dynamics are at play in caregiver-mediated exercises, and it is important to be aware of possible effects on the strain of patient or caregiver.…”

Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): A randomized controlled trial

“…The content of the CARE4STROKE program is reported in accordance with the TIDieR guidelines [19, 20] and has been published elsewhere in more detail. [21] Briefly, the program consisted of 8 weeks of exercise therapy, executed with a caregiver, in addition to usual care following the current guidelines in the Netherlands. [2] The exercise program was composed by a trained physical therapist during weekly sessions.…”

Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study

“…On the other hand, informal caregivers often lack knowledge and support and they need more education on how they can provide support with exercise and physical activity [22,23]. Many studies have revealed a need for practical support for stroke survivors and their informal caregivers to help them engage in home-based exercise [10], and recent studies have suggested support could be provided by technical applications [24][25][26][27].…”

“…Technical applications can offer a variety of repetitive and challenging functional tasks [29,31] that can encourage plasticity of the brain and enhance motor learning. Stroke survivors are generally willing to use technical applications to assist with home-based exercise [32][33][34] and many studies have investigated different technical approaches [24,30,35,36]. Virtual reality has been defined as a user-computer interface with real-time simulation and has been shown to increase activity significantly more than conventional therapy [31,37].…”