Delivering an intensive exercise programme through a technology enriched rehabilitation gym for the recovery of function in people with chronic stroke: A feasibility study (Preprint)

BACKGROUND Rehabilitation improves post-stroke recovery, with greater effect for many when applied intensively within enriched environments. The failure of healthcare providers to achieve minimum recommendations for rehabilitation motivated the development of a technology enriched rehabilitation gym (TERG) that enables individuals, under supervision, to perform high intensity, self-managed, exercises safely in an enriched environment. OBJECTIVE This study aimed to assess feasibility of the TERG approach and gather preliminary evidence of effect for future research. METHODS This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment an 8-week exercise programme, using the TERG (e.g. virtual reality treadmills, power assisted equipment, balance trainers and upper limb training systems), was structured in partnership with participants. Feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from mean change in standard outcome measures. RESULTS Seventy individuals registered interest, the first 50 were invited for assessment, 39 attended and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (aged 60.4 ±13.3 years, 39.0 ± 29.2 months post-stroke, 17 males, 10 with aphasia) were recruited to a feasibility study with 25 completing. Participants attended an average of 18.7±6.2 sessions with a 82% attendance rate. Reasons for non-attendance related to personal life, illness, weather, care and transport. Nineteen adverse events were reported; muscle/joint pain, fatigue, dizziness and viral illness, all resolved within a week. Participants found the TERG programme to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. CONCLUSIONS This study assessed feasibility of a holistic, technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation programme delivered through a TERG is feasible, in terms of recruitment, retention, adherence and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population INTERNATIONAL REGISTERED REPORT RR2-doi.org/10.3389/fresc.2021.820929