Original Research
An Innovative STRoke Interactive Virtual thErapy (STRIVE) Online Platform for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2020.03.011Get rights and content

Objective

To investigate the STRoke Interactive Virtual thErapy (STRIVE) intervention on upper-extremity clinical outcomes in community-dwelling stroke survivors.

Design

Assessor-blinded randomized controlled trial.

Setting

Study screening and testing was conducted in a university clinic. Participants completed the virtual therapy (VT) intervention in a community-based stroke support group setting.

Participants

Of 124 stroke survivors initially assessed, 60 participants were recruited (time poststroke, 13.4±8.9 y). Participants were allocated to either VT or control group using a block randomization design and were stratified by sex.

Interventions

Participants were randomized to receive 8 weeks of VT or usual care. The intervention consisted of approximately 45 minutes of twice weekly VT training on the Jintronix Rehabilitation System.

Main Outcome Measures

Between-group differences in the Fugl-Meyer Upper Extremity scale and Action Research Arm Test score were joint primary outcomes in this study.

Results

Significant between-group differences for the Fugl-Meyer Upper Extremity scale were seen at the end of the intervention (F1, 1=5.37, P=.02, d=0.41). No significant differences were observed with the Action Research Arm Test. No adverse events were reported.

Conclusions

We demonstrated clinically meaningful improvements in gross upper extremity motor function and use of the affected arm after a VT intervention delivered via a community-based stroke support group setting. This data adds to the contexts in which VT can be used to improve upper limb function. Use of VT in community-based rehabilitation in chronic stroke recovery is supported.

Section snippets

Methods

This was a multi-site, assessor-blinded randomized controlled trial conducted in 2 Australian community centers in Melbourne, Victoria, Australia. A full description of the study protocol is available.14 In brief, stroke survivors were recruited from local stroke support groups in the Melbourne metropolitan area or via advertisement in social or print media platforms.

Upon initial contact via phone or e-mail, the study was explained verbally or in writing. Interested participants were then sent

Demographic and clinical data

Sixty stroke survivors (25 women; age, 61.4±8.7y; time poststroke, 13.4±8.9y) enrolled in the study. Demographic data of participants allocated to the VT and UC groups are provided in table 1. There were 2 dropouts from the VT group (fig 1). The remaining participants randomized to the VT group (n=28) completed all 16 VT sessions. Thirty-nine VT sessions had to be rescheduled for the following reasons: a lack of transport or carer support (n=21), forgot to attend (n=9), unforeseen schedule

Discussion

This community-based study demonstrated quantitative improvements in UE function, as indicated by the FMUE, after the VT program compared with UC in stroke survivors. The improvement in the FMUE exceeded the range of improvement indicated as being clinically meaningful (FMUE, 4.25-7.25).15,17 This improvement is consistent with those noted in a recent Cochrane review, which found a small significant effect (mean difference, 2.85; 95% confidence interval, 1.06-4.65) across 16 trials (n=599) as a

Conclusions

Delivery of VT-based exercise through a community-based stroke support group is feasible, safe, and effective. The approach developed and tested in this study emphasized the remote, online delivery and monitoring of regular, tailored upper limb training. Exercise adherence was excellent and, in the absence of any adverse events because of the intervention, we can be confident a VT program can be safely tolerated in stroke survivors with mild-to-moderate UE impairment. Without observable changes

Suppliers

  • a.

    Jintronix Rehabilitation System; Jintronix.

  • b.

    Microsoft Xbox Kinect camera; Microsoft Corporation.

Acknowledgment

We thank Jessica Freeman, MSc, for assisting in data collection.

References (32)

  • B.R. Ballester et al.

    Domiciliary VR-based therapy for functional recovery and cortical reorganization: randomized controlled trial in participants at the chronic stage post stroke

    JMIR Serious Games

    (2017)
  • K.E. Laver et al.

    Virtual reality for stroke rehabilitation

    Cochrane Database Syst Rev

    (2017)
  • S.C. Cramer et al.

    Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after stroke: a randomized clinical trial

    JAMA Neurol

    (2019 Jun 24)
  • J. Wingham et al.

    Participant and caregiver experience of the Nintendo Wii Sports after stroke: qualitative study of the trial of Wii in stroke (TWIST)

    Clin Rehabil

    (2015)
  • G.N. Lewis et al.

    Virtual reality games for rehabilitation of people with stroke: perspectives from the users

    Disabil Rehabil Assist Technol

    (2011)
  • L. Lanyon et al.

    Exploring participant perspectives of community aphasia group participation: from “I know where I belong now” to “some people didn’t really fit in”

    Aphasiology

    (2018)
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    Supported by the Heart Foundation (grant no. 101350). W.-P.T. was supported by an Alfred Deakin Postdoctoral Research Fellowship.

    Disclosure: M.M. received personal fees from Silverline Research. The other authors have nothing to disclose.

    Clinical Trial Registration No.: ACTRN12617000745347.

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