TelerehabilitationTelerehabilitation With Aims to Improve Lower Extremity Recovery Post-Stroke (TRAIL-RCT)

TRAIL is a 4-week progressive exercise and self-management intervention for lower extremity recovery delivered by a trained registered physical therapist, in a 2:1 participant-to-therapist ratio. Each participant grouping will receive two telerehabilitation sessions (60-90 minutes) each week for 4 weeks (total 8-12 hours).

The EDUCATION control arm is a 4-week education program focusing on stroke knowledge and risk factors. It will be delivered by health professionals who have experience working with individuals with stroke, knowledge of chronic disease self-management (e.g. physical or occupational therapists, nurses, kinesiologists), and who have completed study-specific training on the EDUCATION program

Participants will receive video conferencing sessions with the same schedule and 2:1 participant-to-coach ratio as TRAIL. Each participant grouping will receive two educational telerehabilitation sessions (60-90 minutes) each week for 4 weeks (total 8-12 hours).

Each week has a specific focus for lower extremity rehabilitation:

Week 1) Building a base: 8 exercises, 10-15 repetitions x 2-3 sets

Week 2) Increasing repetitions: 8 exercises, 15-20 repetitions x 3 sets

Week 3) Building exercise tolerance:10 exercises, 15-20 repetitions x 3 sets

Week 4) Maximizing repetitions: 10 exercises, 30 seconds as many reps as possible x 2 sets

At the end of the second exercise session each week, the therapist and participants work collaboratively to develop an independent exercise action plan to be completed before the first session of the next week. The self-managed plans includes exercises selected from TRAIL, agreed upon by the participant and therapist, that are safe to perform without therapist oversight. The aims of the exercise action plan are to: i) Add exercise volume without using program resources (e.g., therapist time); and ii) Build capacity for self-management for long-term health and well-being after TRAIL has ended.

EDUCATION has a specific focus on:

Week 1) What is stroke (e.g., gaining an understanding of the function of the brain, types of stroke and how stroke affects physical function) and introduction to self-management;

Week 2) What is self-management;

Week 3) Self-management for post-stroke complications (e.g., activities of daily living);

Week 4) Self-management for secondary prevention (e.g., blood pressure, diet, medication, stress management).

Education therapists will be provided with lesson plans and manuals to be circulated with the participants, and will facilitate the educational session through interactive Powerpoint presentations. In addition, participants will be asked to complete 30-60 minutes of educational homework, which will be discussed at the commencement of the following session.