Rehabilitation Your Way: A Randomized Trial Comparing 2 Home-Based and Self-Managed Programs After Stroke

Area of Science:

• Neurology
• Rehabilitation Medicine
• Digital Health

Background:

• Limited clinical resources necessitate effective home-based, self-managed stroke rehabilitation strategies.
• This study addresses the need for accessible upper extremity rehabilitation post-stroke.

Purpose of the Study:

• To compare the efficacy of a home-based online self-managed program (Stroke Rehabilitation Online Guide - STRONG) against a paper exercise program (PEP) for improving upper extremity function in stroke survivors.
• To evaluate the impact of STRONG on daily activity participation, movement quality, and self-efficacy.

Main Methods:

• A randomized trial involving 43 stroke participants stratified by motor ability and self-efficacy.
• Intervention: 6-week program of upper extremity exercises, with STRONG incorporating online video games and guided exercises, and PEP using written exercises.
• Outcome Measures: Fugl-Meyer Upper Extremity Assessment, Wolf Motor Function Test, Motor Activity Log, Stroke Motivation Scale, and Self-Efficacy Scale.

Main Results:

• Neither STRONG nor PEP demonstrated superiority in primary outcomes (Fugl-Meyer Upper Extremity Assessment, Wolf Motor Function Test-Timed).
• STRONG participants reported significantly better quality of movement and increased amount of arm and hand use in daily activities.
• Higher self-efficacy was observed in the STRONG group post-intervention, though not sustained at follow-up.

Conclusions:

• Both home-based programs yielded modest motor improvements for stroke survivors.
• The STRONG program, focusing on daily tasks and optional exercises, enhanced daily arm and hand function and adherence.
• Home-based, self-managed rehabilitation incorporating digital tools shows promise for stroke recovery, warranting further investigation in larger trials.