A technology enriched approach to increasing rehabilitation dose after stroke: clinical feasibility study

Objective: To assess the feasibility of a multi-technology, group-based, approach to increasing rehabilitation dose early after stroke.
Methods: Mixed methods design reporting recruitment, dropout, safety, dose and acceptability.
Setting: Acute Hospital Stroke Unit
Participants: Sixty stroke patients, 9.0 median (IQR 12.8) days after stroke, referred for rehabilitation, without contraindications to light exercise.
Intervention: Personalised rehabilitation delivered in supervised groups, using a multi-technology rehabilitation gym, in addition to usual care.
Main measures: Feasibility was based on achieving recruitment rates over 3.2 per month, dropout rates below 6%, absence of suspected unexpected serious adverse reactions and shoulder pain prevalence below 60%. Acceptability was derived from interviews with the clinical team. Dose (rehabilitation time) was recorded manually. Function was measured with the modified Rivermead Mobility Index and Therapy Outcome Measure.
Results: Feasibility was satisfactory with high recruitment rates (6 per month), low dropout (2%), no suspected unexpected serious adverse reactions and low prevalence (19%) of shoulder pain. Thematic analysis of interview data indicated the clinical team (n=9) found the intervention acceptable and identified organisational constraints to higher doses. Participants attended an average of 9.1 (1-32) sessions during their hospital stay (23.0 days, SD 19.7), with sessions lasting 52 minutes (SD 15.7), on average. The modified Rivermead Mobility Index and Therapy Outcome Measure increased by 17.9 (SD 8.6) and 5.7 points (SD 2.4), respectively.
Conclusions: Strong feasibility findings support future trials of multi-technology, group-based rehabilitation. This novel approach is an encouraging step toward achieving recommended doses of rehabilitation after stroke but needs further investigation.