Description of the CARE4STROKE programme: A caregiver-mediated exercises intervention with e-health support for stroke patients

BackgroundIntensity of practice and task and context specificity are key factors for improving functional outcome in stroke survivors. Novel methods are needed to augment intensity of practice with minimal use of resources and costs. Caregiver-mediated exercises (CMEs) focused on mobility, in which a caregiver acts as an exercise coach and can increase the intensity of practice. There is preliminary evidence that CME can improve functional outcome, reduce length of stay, and allow early supported discharge, without an increase in caregiver burden. In the CARE4STROKE programme (C4S), CME therapy and e-health support are combined to promote a smoother transition from the inpatient setting to the home environment, with active rehabilitation continuing in the community. The objective of this paper is to describe the content of the C4S intervention in detail and explain implementation of this intervention in practice using the Template for Intervention Description and Replication checklist. MethodsContent, timing and intensity of the programme, participant screening and selection, and intervention procedures were described using the Template for Intervention Description and Replication checklist. Mobility exercises and use of a video application on tablet/smartphone are explained. The role of the caregiver as provider of the intervention is illustrated. DiscussionC4S prescribes an additional exercise dose of 1,200min and may be a promising novel and effective method to augment the pallet of therapeutic options for stroke rehabilitation. Important aspects for successful implementation are availability and suitability of a caregiver. Suggestions for additional use of e-health technology are described. Implications for physiotherapy practiceThe presented description of C4S gives physical therapists practical guidelines to facilitate implementation of the CME intervention.