An Investigation in Online Neuropilates Classes in Chronic Stroke Patients: A Pilot Randomised Feasibility Study'

Stroke survivors often demonstrate balance and mobility deficits and low physical activity levels. They experience barriers to physical exercise including embarrassment, low self-efficacy and a shortage of tailored community exercise programmes. Access to physical activity programmes for stroke survivors could be improved by providing tailored, online programmes, although little is known about the safety and feasibility of online exercise classes for stroke survivors. One such programme of exercise which has received little attention in the literature is neuropilates. Neuropilates is the practice of a modified pilates programme in those with neurological conditions, is theorised to have beneficial effects on strength, balance and proprioception in stroke survivors. No randomised controlled trial has previously been conducted to investigate online, remotely supervised neuropilates exercise classes in the stroke survivors.

The proposed randomised controlled feasibility study will begin to address some of the afore mentioned gaps in the literature base and determine whether the intervention should be recommended for efficacy testing in line with the standards set for feasibility trials by Bowen et al, 2009. The aim of the study is to conduct a randomised controlled feasibility study to examine the feasibility and clinical outcomes on stroke survivors of a live, online, once weekly, six-week neuropilates exercise class when compared to two control groups. The first control group will be participating in a live, online, once weekly, supervised, six-week generalised exercise class. The second control group will be given a home exercise programme to carry out unsupervised.

Research Design and Methods:

Study Design The design of the trial is a single (assessor) blinded, randomised controlled feasibility study. Due to the nature of the intervention, neither the instructing therapist nor the participant can be blinded to group allocation. An independent assessor, who is blinded to the treatment assignment, will perform all clinical outcome assessments. Participants were asked not to discuss their allocation with their assessors on post assessment. Participants will undergo stratified random sampling, following an initial phone screening conversation. The sampling frame will be 20 - 25 potential participants. The age of the participants and functional status will be the strata considered during this randomisation process to ensure a representative sample in each group with factors that could influence outcome accounted for. In terms of functional ability, higher functionally independent participants will be considered to be those who can walk without an assistive device and lower functionally independent participants will be those who need an assistive device to walk. There will then be four strata from which random sampling will extract from; 1) Less than 65 years, lower functioning, 2) Greater than 65 years, lower functioning, 3) Less than 65 years, higher functioning, 4) Greater than 65 years, higher functioning. Participants from stratum 1 will be divided into intervention and control groups by the following method; all names will be placed into envelopes, shuffled and divided as evenly as possible into intervention and control groups by an independent researcher. This process will be repeated for the rest of the strata. This should result in an even, random spread from each stratum across all groups.

Study Setting: