Telerehabilitation for Patients with Stroke

描述(申请人提供)：中风是致残的主要原因，鉴于存活率的提高，中风的负担正在增加。因此，中风后的康复治疗仍然是一个主要的全国性问题，每年的成本高达数十亿美元。虽然增加强度和持续时间的康复治疗与改善患者结果密切相关，但许多患者由于成本和可及性等问题而得不到这一点。需要以最有效的方式提供中风康复的方法。远程医疗解决方案可能有助于解决这些问题。本研究采用单盲、随机、非劣势的研究设计，旨在确定远程康复治疗与门诊治疗是否具有相同的疗效。主要终点是治疗后手臂运动状态从基线到1个月的变化。一项初步研究发现，telerehab在增加患者对中风预防和风险因素控制的知识方面做得很好。目前的研究将证实这一结果，并将确定这些知识的进步是否延伸到与中风患者结局相关的两个硬终点的现实世界改善：体重和血压控制。由于许多治疗形式的依从性往往是有限的，因此将测试与受试者之间依从性差异有关的假设。该计划的长期目标是开发一个在家庭中提供远程康复的综合系统，利用经济合理的方法增加获得高强度治疗的机会，从而改善患者的预后。目前的提议是朝着这个方向迈出的重要一步。

DESCRIPTION (provided by applicant): Stroke is a major cause of disability, and the burden of stroke is increasing given increasing survival rates. Rehabilitation therapy after stroke therefore remains a major national concern, with an annual cost of several billion dollars. While rehabilitation therapy of increased intensity and duration have been firmly linked with improved patient outcomes, many patients do not receive this due to issues such as cost and access. Methods are needed to deliver stroke rehabilitation in a maximally efficient manner. A telehealth solution might be useful to address these issues. This study aims to determine if telerehabilitation is comparably efficacious with outpatient clinic therapy, using a single-blind, randomized, non-inferiority study design. The primary endpoint is the change in arm motor status from baseline to 1 month post-therapy. A pilot study found that telerehab performed well at increasing patient knowledge on stroke prevention and risk factor control. The current study will confirm this result and will determine whether these gains in knowledge extend to real world improvement in two hard endpoints relevant to stroke patient outcomes: body weight and blood pressure control. Because compliance with many forms of therapy is often limited, hypotheses related to inter-subject differences in compliance will be tested. The long-term goal of this program is to develop a comprehensive system for delivery of telerehabilitation in the home that increases access to high intensity therapy using an economically sound approach, and thereby improves patient outcomes. The current proposal is a major step in this direction.