Comparison of Two Rehabilitation Strategies in Patients With Hemiparesis One Year or More After Stroke. Efficacy and Cost After One Year Treatment. A Randomized, Controlled, Multicenter, Single Blind Study
试验速览
- 阶段
- 不适用
- 入组人数
- 124
- 试验地点
- 2
- 主要终点
- Functional motor recovery assessed by a composite endpoint (one for upper limbs and one for lower limbs)
研究概览
简要总结
In the situation of motor limitations that people often experience after stroke, current health systems cannot provide for the daily amount and duration of high intensity muscle stretch and motor training that would be required over protracted periods to involve muscle and brain plasticity. For patients with sufficient cognitive abilities, Guided Self-rehabilitation Contracts allow implementing stretch and training at high intensity and may result in meaningful functional improvement in chronic stages, as long as discipline persists over at least a year span.
This single blind control protocol will evaluate Guided Self-rehabilitation Contracts as against conventional therapy in the community, for a one year duration in persons with chronic hemiparesis after stroke.
详细描述
This single blind controlled multicentre protocol will compare the evolution after a one-year treatment, either using a Guided Self-rehabilitation Contract or conventional therapy in the community. Patients with chronic stroke-induced hemiparesis (over a year post stroke) will be selected to be randomized between the two groups, Conventional or in Guided Self-rehabilitation Contracts.
In Guided Self-rehabilitation Contracts, the therapist acts as a coach, in the sports' sense, providing double guidance:
- Technical, selecting and teaching the required exercises to the patient using infrequent thorough visits, for example every month.
- Psychological, binding with the patient on the contract.
The patient agrees to:
- Perform the prescribed daily stretch postures and rapid alternating movements over the long term.
- Document this work in a written diary.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient with spastic hemiparesis, following a unique stroke episode over a year before enrollment into the study
- •Barefoot walking possible with no assistive device over 10 m
- •Fast barefoot ambulation speed between 0.1 m/sec and 1.3 m/sec
- •Mean Modified FRENCHAY Score between 2 and 8/10
- •Patient having provided a signed consent to participate in this trial
排除标准
- •Multiple stroke episodes, clinically of based on brain imaging
- •No recent (less than 3 months before enrollment) brain imaging (CT scan or MRI) in case of doubt about multiple stroke episodes
- •Concurrent severe condition jeopardizing functional or vital prognosis, or the ability to participate in rehabilitation sessions
- •Cognitive, phasic or behavioral condition impeding verbal communication, active participation to a rehabilitation or self-rehabilitation program, or participation in a research study, according to the investigator's judgment
- •Person having a tutor or benefiting from a law protection order
- •Person not benefiting from French State Health Insurance
结局指标
主要结局
Functional motor recovery assessed by a composite endpoint (one for upper limbs and one for lower limbs)
时间窗: After one year of treatment
1. Fast 10-meter barefoot ambulation speed with no assistive device 2. Active upper limb function using the Modified FRENCHAY scale (10 everyday life activities performed live in front of the investigator and videotaped - videos reviewed later by a blinded investigator).
次要结局
- Speed, step length and cadence over 10 meters at comfortable speed, barefoot and with shoes, with no assistive device(One assessment visit every 6 month for 2 years)
- Speed, step length, cadence and physiological cost index over 2 minutes at maximal speed, with shoes(One assessment visit every 6 month for 2 years)
- Disability Assessment Scale: interview between patient and investigator, assessing the level of disability in 4 domains (dressing, cosmesis, hygiene and pain)(One assessment visit every 6 month for 2 years)
- Barthel Activity of Daily Living (ADL) Index(One assessment visit every 6 month for 2 years)
- Euro-Qol - 5 dimension (EQ-5D)(One assessment visit every 6 month for 2 years)
- Geriatric Depression Scale - 15(One assessment visit every 6 month for 2 years)
- Questionnaire to the patient (or caregiver) evaluating monthly frequency of physical therapy sessions and amount of home aid during the whole study period, that will serve as basis for a cost evaluation from the point of view of medical insurance.(One assessment visit every 6 month for 2 years)
- Estimation of the total cost of care, including medical costs, social expenses, amount of social benefits, from the point of view of the medical insurance and of the state, to include all payors.(One assessment visit every 6 month for 2 years)