Telerehabilitation for Patients with Stroke

描述（由申请人提供）：中风是导致残疾的主要原因，随着生存率的提高，中风的负担正在增加。因此，中风后的康复治疗仍然是国家关注的主要问题，每年花费数十亿美元。虽然增加康复治疗的强度和持续时间与改善患者预后密切相关，但由于费用和获取等问题，许多患者没有接受这种治疗。需要以最有效的方式提供中风康复的方法。远程保健解决方案可能有助于解决这些问题。本研究采用单盲、随机、非劣效性研究设计，旨在确定远程康复是否与门诊治疗具有可比性。主要终点是治疗后1个月手臂运动状态从基线的变化。一项初步研究发现，远程治疗在提高患者对中风预防和风险因素控制的认识方面表现良好。目前的研究将证实这一结果，并将确定这些知识的收获是否延伸到现实世界中与中风患者结局相关的两个硬终点的改善：体重和血压控制。由于对多种形式的治疗的依从性通常是有限的，因此将测试与依从性的主体间差异有关的假设。该项目的长期目标是开发一个全面的家庭远程康复系统，以经济合理的方式增加高强度治疗的可及性，从而改善患者的治疗效果。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.