Feasibility of deploying peer coaches to mentor frontline home health aides and promote mobility among individuals recovering from a stroke: pilot test of a randomized controlled trial.
Feasibility of deploying peer coaches to mentor frontline home health aides and promote mobility among individuals recovering from a stroke: pilot test of a randomized controlled trial.
复制标题
部署同伴教练指导一线家庭健康助理并促进中风康复者活动能力的可行性：一项随机对照试验的初步试验。
DOI：
10.1186/s40814-022-00979-4
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发表时间：
2022-01-31
影响因子：
1.7
通讯作者：
Williams O
中科院分区：
文献类型：
--
作者：
Feldman PH;McDonald MV;Onorato N;Stein J;Williams O
每年约有10万人在中风后接受家庭保健服务。有证据表明，以家庭为基础的中风康复的好处，但很少有人知道资源有效的方法来提高其有效性，也没有人探索利用低成本的家庭健康助手（HHA），以加强重复性任务训练的价值，以家庭为基础的康复的关键组成部分。我们开发并试行了中风家庭健康援助恢复计划（SHARP），该计划部署了经过专门培训的HHA作为“同伴教练”，以指导一线助手，并帮助中风康复者通过更好地坚持重复运动方案来增加他们的活动能力。我们评估了SHARP的可行性，并准备进行一项全面的随机对照试验（RCT）。具体而言，我们检查了（1）招募和随机化程序的实用性，（2）程序的可接受性，（3）干预的保真度，（4）结果测量的性能。这是一项可行性研究，包括一项试点RCT。目标入组为60名接受卒中后家庭健康服务的患者，他们被随机分为SHARP +常规家庭护理组或仅常规护理组。该方案规定了为期30天的干预，计划进行4次家庭教练访视，包括1次联合教练/物理治疗师访视。主要参与者的结果是60天的移动性变化，使用基于性能的定时起身和行走和4米步行步态速度测试。与参与者，教练，物理治疗师和一线助手的访谈提供了可接受性数据。入组数据、访视跟踪报告和录音提供了干预保真度数据。混合方法包括定性数据的主题分析和结构化数据的定量分析，以检查干预的可行性和结果措施的性能。实现60名参与者的招募目标需要修改参与者资格标准，以适应中风后接受家庭护理的个人接受HHA服务的下降。这种修改需要重新设计干预措施。教练和参与者的可接受性很高，但治疗师和一线助手的可接受性较低。干预忠诚度好坏参半：87%的干预参与者接受了所有四次计划的教练访问;然而，没有发生联合教练/治疗师访问。60天随访保留率为78%。然而，只有55%的参与者可以完成基线和随访时基于表现的主要结局移动性评估。审判以目前的形式是不可行的。在进行最终试验之前，需要对项目进行重大重新设计，以解决影响入组、教练/HHA/治疗师协调和实施基于表现的结局指标的问题。ClinicalTrials.gov，NCT 04840407。2021年4月9日登记的追溯
Each year, approximately 100,000 individuals receive home health services after a stroke. Evidence has shown the benefits of home-based stroke rehabilitation, but little is known about resource-efficient ways to enhance its effectiveness, nor has anyone explored the value of leveraging low-cost home health aides (HHAs) to reinforce repetitive task training, a key component of home-based rehabilitation. We developed and piloted a Stroke Homehealth Aide Recovery Program (SHARP) that deployed specially trained HHAs as “peer coaches” to mentor frontline aides and help individuals recovering from stroke increase their mobility through greater adherence to repetitive exercise regimens. We assessed the feasibility of SHARP and its readiness for a full-scale randomized controlled trial (RCT). Specifically, we examined (1) the practicability of recruitment and randomization procedures, (2) program acceptability, (3) intervention fidelity, and (4) the performance of outcome measures. This was a feasibility study including a pilot RCT. Target enrollment was 60 individuals receiving post-stroke home health services, who were randomized to SHARP + usual home care or usual care only. The protocol specified a 30-day intervention with four planned in-home coach visits, including one joint coach/physical therapist visit. The primary participant outcome was 60-day change in mobility, using the performance-based Timed Up and Go and 4-Meter Walk Gait Speed tests. Interviews with participants, coaches, physical therapists, and frontline aides provided acceptability data. Enrollment figures, visit tracking reports, and audio recordings provided intervention fidelity data. Mixed methods included thematic analysis of qualitative data and quantitative analysis of structured data to examine the intervention feasibility and performance of outcome measures. Achieving the 60-participant enrollment target required modifying participant eligibility criteria to accommodate a decline in the receipt of HHA services among individuals receiving home care after a stroke. This modification entailed intervention redesign. Acceptability was high among coaches and participants but lower among therapists and frontline aides. Intervention fidelity was mixed: 87% of intervention participants received all four planned coach visits; however, no joint coach/therapist visits occurred. Sixty-day follow-up retention was 78%. However, baseline and follow-up performance-based primary outcome mobility assessments could be completed for only 55% of participants. The trial was not feasible in its current form. Before progressing to a definitive trial, significant program redesign would be required to address issues affecting enrollment, coach/HHA/therapist coordination, and implementation of performance-based outcome measures. ClinicalTrials.gov, NCT04840407. Retrospectively registered on 9 April 2021