Assessing the feasibility of using an online monitored Graded Repetitive Arm Supplementary Programme (GRASP) for home-based chronic stroke survivors

Introduction: GRASP is a self-administered rehabilitation intervention designed to improve upper limb performance in the stroke-affected arm. Recent feasibility studies indicate that GRASP can be successfully implemented in the home, with chronic stroke survivors, using minimal professional supervision via remote monitoring. This study evaluates the feasibility of delivering and monitoring a home-based GRASP programme, online, via weekly videoconferencing, to individual participants, over 8 weeks.
Method: A mixed method, repeated measures, feasibility study was conducted. Participants were assessed at 3 successive time intervals: (Baseline; 8-weeks and 3-months). Carers were given a supporter’s manual and the instructor conducted weekly monitoring sessions via Zoom with the participant to check/adapt exercises and set weekly ADL goals.
Results: Recruitment/retention: 13 participants, mean age 56.5 (S.D = 11.4) years, consented to participate and 2 withdrew. Effectiveness: There were significant improvements in primary outcomes measures between baseline and post-test for the Action Research Arm Test - ARAT (Mean difference = 6.06(6.02); p=.007) and Box and Block Score (Mean difference =3.3(2.11); p<.001) as well secondary measures of Quality of Life (SS-QoL) (p=.005) and Self-Efficacy (SSEQ) (p =.005). Adherence: Participants’ adherence was high, confirmed with average attendance of weekly videoconferences and reported practice times. Efficacy and acceptability: An interview examining the participant’s experience showed that using video-conferencing over 8 weeks was acceptable and improved confidence and daily use of the paretic arm.
Conclusion: There is the potential for Online-GRASP to be successfully implemented in the home and monitored by charity organisations, using volunteers or peer stroke survivors as instructors.