Feasibility of a Physiotherapy Programme, with Integrated TelerehabIlitation to Increase Rehabilitation Time and Improve Motor Function

The main aim of the Canadian Occupational Performance Measure is to identify occupational performance problems, concerns and issues of participants (wants to do, needs to do or is expected to do, but can't do, doesn't do or isn't satisfied with the way they do it). Through a discussion, participant identifies up to five problems they face in self-care, productivity and leisure. They then prioritise the activities and rate their current level of performance and satisfaction with each. The COPM is generally a reliable, valid, and acceptable tool for researchers with satisfactory test-retest reliability specifically in stroke. COPM results will be given to physiotherapist of intervention participant. This will allow discussion between the participant and physiotherapist to agree specific, and meaningful goals using the G-AP framework.

The Action Research Arm Test is a 19-item physical measure to assess upper extremity performance (coordination, dexterity and functioning) in stroke recovery. It comprises 4 sub-tests (grasp, grip, pinch, and gross arm movement). Within each sub-test, assessments are arranged in order of decreasing difficulty, with the most difficult task examined first, followed by the least difficult task. Item scored on a four-point scale from 0 (can do no part of the test) to 3 (performs the test normally).

Motricity Index assesses motor impairment and muscle strength of the upper and lower limbs and involves three upper limb activities; shoulder abduction, elbow flexion and pinch grip and three lower limbs; hip extension, knee extension and ankle dorsiflexion.

Timed up and go test assesses mobility, balance, walking ability, and fall risk. The participant stands from a chair, walks 3 metres at a comfortable pace, turns around, walks back to the chair and sits down. The time to complete the test is recorded and walking aids are used as required. The test will be conducted three times with the average score being calculated and used as the final measure.

The Barthel Index is a patient reported outcome and measures the extent to which somebody can function independently and has mobility in their activities of daily living. Activities of daily living measured include feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. Each activity is scored out of 10, with a maximum of score 100.

The Stroke Specific Quality of Life questionnaire consists of 49 items each assessed on a 5-point scale. The domains covered include mobility, energy, work and productivity, mood, self-care, language, thinking and personality. Scores range from 49 to 245 with higher scores associated with higher quality of life.

EQ-5D-5L evaluates health-related quality of life with one question for each of the five dimensions mobility, self- care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The Eq-5D-5L also comprises a visual analogues scale that records the participants self-rated health on a vertical visual analogue scale where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'.

Fatigue Severity Scale is 9-item scale, that is self reported by participants. The scale measures the severity of fatigue and its effect on a person's life against 9 statements. Each item is scored on a scale of 1 (strongly disagree) -7 (strongly agree). Scores range from 9 to 63 with higher scores indicating more severe fatigue.

Stroke Self Efficacy Questionnaire is a self-report scale of self-efficacy post stroke that demonstrates good internal consistency and criterion validity. It is a 13-item patient reported outcome where participants rate their confidence with stated tasks from 0 not at all confident to 10 very confident. The SSEQ total score can potentially range from 0 to 130 with higher scores indicating higher levels of self-efficacy.

The Patient Experience of Treatment and Self-Management was developed to measure treatment burden in people with multi-morbidity and/or complex self-management regimens. However, it omits stroke-specific burdens. Therefore, the Patient Experience of Treatment and Self-Management after Stroke (PETS-STROKE) PETS-STROKE is a 34-item patient reported measure that captures the workload of healthcare and impact on wellbeing experienced by the stroke survivor.

The number of falls since the previous assessment will be self-reported, with a fall defined as 'an unexpected event in which the participant comes to rest on the ground, floor or lower'. As the intended outcome of the intervention is to increase functional activity this may increase risk of falls.

Caregiver strain index This is a self report written questionnaire across 13-items which assesses the level of stress experienced by informal caregivers, answered with - Yes (2), Sometimes (1) or No (0). The maximum score is 26.

Care delivered by physiotherapists, occupational therapists and speech and language therapists, for both CONTROL and INTERVENTION groups will be recorded by the therapist using a short checklist. This will include, date of appointment, duration of appointment, who the appointment was with (e.g., physiotherapist, speech and Language), and content via a checklist of usual care interventions. This will be completed for each therapy appointment

Exercise diaries will be completed by participants either in the Giraffe platform (intervention) or paper (control). This information will be used to determine the weekly dose of exercise from which dose/response will be calculated for the clinical outcomes.

Data from screening, recruitment and follow-up logs will be used to generate realistic estimates of eligibility, recruitment, consent and follow-up rates, reasons for drop-out and adverse events. Outcome measure completion and missing data will also be recorded.

To understand fidelity of PRACTISE, 20 audio recordings of PRACTISE sessions between a physiotherapist and a participant will be made. This will include 5 on session-1 (week 1), 5 on session-5 (week 4), 5 on session-6 (week 6) and 5 on session-9 (week 16). Physiotherapists will record these sessions via a Dictaphone. Equal representation will be sought across site locations.

Interviews will be conducted to assess fidelity, acceptability and adherence of the study. Interviews will be conducted with:

• individuals who have had experienced a stroke,
• carer or significant others and
• treating physiotherapist.

Interviews will be conducted after the 16-week intervention period for individuals who have experienced a stroke and for carers or significant others. Therapist interviews will be conducted when their involvement in the study is complete.

The economic analysis will focus on the feasibility and acceptability of collecting healthcare resource use and Quality of Life data required to conduct a full economic evaluation in a future trial. Item completion rates will be presented to assess data completeness. Data on the delivery of the PRACTISE intervention and usual care will be recorded by health care professionals during appointments with individuals who have experienced a stroke (described in dose response measure). Participants will be asked to record the aspects of their care in a record book on a weekly or as required basis during the 16-week period. This will include unplanned or urgent healthcare contacts in the last week, indicating who they saw, how, how many times, and if it was related to their stroke. The purchasing of any medication directly related to the stroke, purchase of exercise equipment to complete rehabilitation and digital devices used for tele-rehabiliton.