Electronic Capturing of Activities During REhabilitation for Upper Limb After Stroke

This is a prospective observational cohort study to determine the feasibility of accurate, complete, and timely real-time electronic capturing of upper limb motor intervention sessions during usual care.

In clinical trials accurate reporting of usual care for people with stroke is scarce, thus understanding the control group compared to the experimental group is poor.

The unit of measure is the therapy sessions, where a clinician is providing usual care to a patient. The observed sessions will occur across two Austin Health settings. Setting A: Acute at Austin Hospital, and Setting B: Subacute at Royal Talbot Rehabilitation Centre or the Heidelberg Repatriation Hospital.

For each session, patient characteristics, the multiple dimensions of dose, and the content of usual care motor upper limb interventions will be electronically captured in REDCap. The observed sessions will be video recorded and a second rater will review the session for dose data accuracy. Secondary to determining feasibility, the dose and content data from observed sessions will be analysed to investigate the association of context factors such as setting and upper limb impairment severity.

As such, this study aims to answer the following research questions:

• Is it feasible for clinicians to electronically capture accurate, complete, and timely upper limb motor intervention session dose during usual care of stroke patients?
• Is there an association between dose and content of upper limb intervention sessions and the contextual factors of stroke patients?

Group 1: Stroke patients

Inclusion criteria

• Adults (≥18 years) with a new, first or consecutive stroke, confirmed on CT or MRI.
• Motor upper limb impairment defined by a Shoulder Abduction and Finger Extension (SAFE) score of 0 through 9.
• Able to consent for themselves.
• Likely to receive at least one upper limb intervention session as determined by the treating clinical team.

Exclusion criteria

• Existing co-morbidities that limit upper limb function and usual care treatment provided as determined by the treating clinical team e.g., neural or orthopeadic
• Receiving palliative care or have a limited life expectancy
• Deemed unable or unnecessary to participate in upper limb intervention by the treating clinical team
• Treating Occupational Therapist and local allied health assistant declined to participate in the research preventing recording of usual care data
• Unable to follow basic instructions in English

Group 2: Clinicians

Inclusion criteria

• Occupational therapist or allied health assistant working with the stroke population in an acute or subacute settings within Austin Health.
• At least four months of clinical experience

Exclusion criteria

• Clinicians expected to move into another clinical area within one month.