Summary:
High doses of intensive rehabilitation therapy can improve functional outcomes after stroke, but most patients do not receive such therapy for reasons that can include limited access, difficulty traveling, and low motivation. Telehealth might be an effective means to improve patient outcomes after stroke by vastly increasing therapy doses and access, and by boosting motivation through use of games plus regular videoconferences with a licensed occupational therapist (OT) or physical therapist (PT). Several prior studies support the efficacy of telehealth, including a prior phase 2 StrokeNet trial (JAMA Neurol 2019;76:1079-1087). The TR-2 trial is a controlled, assessor-blind, randomized, phase III superiority trial that will recruit 202 patients with UE motor deficits 4±1 months after stroke onset and randomize them to [1] 6 weeks of intensive daily arm motor telerehabilitation (TR) in addition to usual care vs. [2] usual care alone, and then follow them for 8 months (i.e., until they are 12 months after stroke onset). The TR therapy consists of 36 70-minute therapy sessions provided in the home via telehealth; half are supervised by a therapist and half are completely patient autonomous. Patients in the usual care group will be offered TR after the 12-month point. This trial will be open to English-speaking and to Spanish-speaking patients.
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