Background: Most acute stroke patients with disabilities do not receive recommended rehabilitation following\ndischarge to the community. Functional and social barriers are common reasons for non-adherence to post-discharge\nrehabilitation. Home rehabilitation is an alternative to centre-based rehabilitation but is costlier. Tele-rehabilitation is a\npossible solution, allowing for remote supervision of rehabilitation and eliminating access barriers. The objective\nof the Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial is to determine if a novel telerehabilitation\nintervention for the first three months after stroke admission improves functional recovery\ncompared to usual care.\nMethods/design: This is a single blind (evaluator blinded), parallel, two-arm randomised controlled trial study\ndesign involving 100 recent stroke patients. The inclusion criteria are age �40 years, having caregiver support\nand recent stroke defined as stroke diagnosis within 4 weeks. Consenting participants will be randomized with\nvarying block size of 4 or 6 assuming a 1:1 treatment allocation with the participating centre as the stratification\nfactor. The baseline assessment will be done within 4 weeks of stroke onset, followed by follow-up assessments\nat 3 and 6 months. The tele-rehabilitation intervention lasts for 3 months and includes exercise 5-days-a-week\nusing an iPad-based system that allows recording of daily exercise with video and sensor data and weekly\nvideo-conferencing with tele-therapists after data review. Those allocated to the control group will receive usual\ncare. The primary outcome measure is improvement in life task�s social activity participation at three months\nas measured by the disability component of the Jette Late Life Functional and Disability Instrument (LLFDI).\nSecondary outcome variables consist of gait speed (Timed 5-Meter Walk Test) and endurance (Two-Minute Walk\ntest), performance of basic activities of daily living (Shah-modified Barthel Index), balance confidence (Activities-\nSpecific Balance Confidence Scale), patient self-reported health-related quality-of-life [Euro-QOL (EQ-5D)], health\nservice utilization (Singapore Stroke Study Health Service Utilization Form) and caregiver reported stress (Zarit\nCaregiver Burden Inventory).
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