ABSTRACT
PURPOSE: To investigate the usability and effectiveness of standardized circuit class group training (CCT) compared to individualized goal-directed group training (GDT) in subacute stroke survivors. MATERIALS AND METHODS: This study consists of three parts. Part 1 involved a pragmatic, non-randomized controlled trial with subacute participants and their therapists, who participated in four weeks either CCT or GDT. Superiority of the intervention was defined as significantly larger improvement on the Motor Activity Log for patients and lower workload for therapists. In Part 2, six additional workstations were developed for CCT. Part 3 replicated the study of Part 1 with the expanded CCT. RESULTS: Part 1 showed no difference in effectiveness between training methods. CCT did not match the rehabilitation goals of the patient sufficiently, however mental workload seemed lower for therapists. An expansion of CCT could improve the match between the patient's goals and the training (Part 2). Results of Part 3 showed again no difference in effectiveness between methods. CCT was however perceived as less engaging compared to GDT, but mental load for therapists remained lower. CONCLUSIONS: A standardized training could reduce the mental workload for therapists, but patients seemed less engaged. A combination of both might be most beneficial.Trial registration: Dutch Trial Register: NL8844 and NL9471IMPLICATIONS FOR REHABILITATIONProviding a standardized training program after stroke reduces therapists' mental workload.Individualized goal-directed group training results in the best achievement of rehabilitation goals.A combination of standardized and individual training would use best of both intervention modalities.Patients should be involved in the co-creation developing process of training programs.
ABSTRACT
PURPOSE: Patients in the chronic phase after stroke often lack the possibility to intensively train their upper limb function. Assistive devices can be a solution to training intensively at home. This qualitative study investigated stroke survivors' experiences regarding training using the hoMEcare aRm rehabiLItatioN (MERLIN) system, an assistive device and telecare platform. We investigated patients' perspectives regarding the home-based training with the MERLIN system, on the International Classification of Functioning, Disability and Health (ICF) domains and the facilitators and barriers of the MERLIN system. METHODS: Eleven patients in the chronic phase of stroke who completed the MERLIN trial took part in semi-structured interviews. Interviews were analysed using the framework method. RESULTS: Participants were in general positive about the device and the training. Several experienced positive effects on ICF body functions, such as joint range of motion and self-confidence. Some experienced improvements in activities, but not on participation level. Home training had advantages: flexibility in training time and duration and no need to travel. The major barriers were technical hard- and software issues and ergonomic complaints. A list of recommendations regarding assistive devices and home-based rehabilitation was created. CONCLUSIONS: Homebased training using an assistive device was well received by stroke patients to train their upper limb function. Future device developers should take patients' feedback into account to overcome the barriers related to the introduction of new assistive devices at home. Our recommendations may be the first step to implementing patients' perspectives during the early stages of device development. Implications for rehabilitationTraining at home was a well-received and convenient solution to improve the upper limb functionBarriers regarding hard- and software and device ergonomics need to be addressed in future assistive devicesRecommendations are provided for more successful implementation of assistive devices and home-based telerehabilitation programs.
