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      Home-based tele-rehabilitation presents comparable positive impact on self-reported functional outcomes as usual care: The Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) randomised controlled trial

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          Abstract

          Introduction

          The aim of this research was to evaluate the impact of a novel tele-rehabilitation system on self-reported functional outcomes compared to usual care during the first three months after stroke.

          Methods

          A parallel, two-arm, evaluator-blinded, randomised controlled trial was conducted. Adults aged ≥40 years who had suffered a stroke within four weeks of the start of the study were recruited from the general community. The intervention group received access to a novel tele-rehabilitation system and programme for three months. The primary outcome measures utilised were the frequency and limitation total scores of the Late-Life Function and Disability Instrument (LLFDI) at three months.

          Results

          A total of 124 individuals were recruited. The mean differences in the LLDFI frequency and limitation total scores at three months comparing the intervention and control groups were –3.30 (95% confidence interval (CI) –7.81 to 1.21) and –6.90 (95% CI –15.02 to 1.22), respectively. Adjusting for the respective baseline covariates and baseline Barthel Index also showed no significant difference between interventions in the LLFDI outcomes.

          Discussion

          The intervention and control groups self-reported similar improvements in functional outcomes. Tele-rehabilitation may be a viable option to provide post-stroke rehabilitation services in Singapore while reducing barriers to continue rehabilitation conventionally after discharge from hospital and encouraging more participation.

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          Most cited references28

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          EuroQol - a new facility for the measurement of health-related quality of life

          (1990)
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            Is Open Access

            Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects☆

            Objectives This study aims to (1) elucidate whether the Hawthorne effect exists, (2) explore under what conditions, and (3) estimate the size of any such effect. Study Design and Setting This systematic review summarizes and evaluates the strength of available evidence on the Hawthorne effect. An inclusive definition of any form of research artifact on behavior using this label, and without cointerventions, was adopted. Results Nineteen purposively designed studies were included, providing quantitative data on the size of the effect in eight randomized controlled trials, five quasiexperimental studies, and six observational evaluations of reporting on one's behavior by answering questions or being directly observed and being aware of being studied. Although all but one study was undertaken within health sciences, study methods, contexts, and findings were highly heterogeneous. Most studies reported some evidence of an effect, although significant biases are judged likely because of the complexity of the evaluation object. Conclusion Consequences of research participation for behaviors being investigated do exist, although little can be securely known about the conditions under which they operate, their mechanisms of effects, or their magnitudes. New concepts are needed to guide empirical studies.
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              Stroke rehabilitation.

              Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                Journal of Telemedicine and Telecare
                J Telemed Telecare
                SAGE Publications
                1357-633X
                1758-1109
                May 2021
                August 28 2019
                May 2021
                : 27
                : 4
                : 231-238
                Affiliations
                [1 ]National University of Singapore, Saw Swee Hock School of Public Health, Singapore
                [2 ]Department of Electrical and Computer Engineering, National University of Singapore, Singapore
                [3 ]Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
                [4 ]Department of Neurology, National Neuroscience Institute, Singapore
                [5 ]Department of Surgery, Duke University Medical Center, USA
                [6 ]Department of Rehabilitation Medicine, National University Hospital, Singapore
                [7 ]Physical Medicine and Rehabilitation Service, Durham Veterans Affairs Medical Center, USA
                [8 ]Department of Medicine, Duke University Medical Center, USA
                Article
                10.1177/1357633X19868905
                31462136
                a8668403-f296-4c5a-848d-c08044413113
                © 2021

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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