Study Protocol for a Pilot Randomized Controlled Trial of Task-Specific Self-Rehabilitation Training (TASSRET) for Improving Functional Mobility in Community-Dwelling Stroke Survivors in a Low-Resource Setting

Stroke is a major cause of acquired adult neurological disability worldwide, with its incidence showing a concerning upward trend in low- and middle-income countries (LMICs) over the past decade. This rise in stroke cases implies a growing burden of post-stroke disability, where functional limitations affect many survivors long-term. Approximately one-third of first-time stroke survivors may experience physical disabilities lasting five years or more, adversely impacting their community integration and quality of life. In community settings, particularly in LMICs, access to therapy and rehabilitation services is severely limited compared to hospital environments.

A recent systematic review highlighted the scarcity of high-quality, evidence-based research on rehabilitation strategies to improve functional mobility after stroke in LMICs, especially interventions that can be self-administered. Much of the existing evidence for home-based, self-administered post-stroke rehabilitation, including that based on best-practice guidelines, comes from studies in high-income countries (HICs). These models are often unsuitable for LMICs due to feasibility and affordability issues.

Another systematic review of 62 studies demonstrated that exercise-based and brain training interventions can enhance functional outcomes in LMICs post-stroke. Although techniques promoting neuroplasticity exist, task-specific training (TST) shows promise for improving outcomes in these settings. However, research on TST protocols in LMICs is limited by small sample sizes, lack of self-administration features, inadequate descriptions of exercise parameters like type, intensity, and frequency, and a focus on non-community-based settings.

To address these gaps, two formats of a task-specific self-rehabilitation training program (TASSRET-video and TASSRET-manual) were developed for use in developing countries. This protocol outlines a pilot randomized controlled trial (RCT) to investigate their effectiveness in enhancing functional mobility among community-dwelling stroke survivors.

Ethical approval was obtained from the Bayero University Kano Health Research Ethics Committee (NHREC/BUK-HREC/06/12/119/5). Permissions will be sought from community leaders, and recruitment will occur through health centers. Written consent will be obtained from all eligible participants before enrollment, in line with ethical standards.