Background To intensify practice to influence neuroplasticity to optimize UL recovery
after stroke, it is important to empower people with stroke to perform self-directed UL
therapy outside therapy. However, it has been found that increasing UL practice is often
challenging with high level of inactivity found in people with stroke during
rehabilitation. Traditionally, self-directed program has been delivered via hard copy
manuals. Hardcopy manuals are often cumbersome and difficult to retrieve and handle,
especially for those with moderate/severe UL impairment. Hence a more accessible format
of exercise/activities instructions is needed. There is lack of reminders for people with
stroke to keep up to prescribed exercise regime. This may affect adherence as some may
not remember the prescribed practice sessions. Without immediate feedback of UL movement
performed during self-practice, people with stroke may continue with compensatory
movement performance without correction. This may in turns hinder UL recovery.
The aim of this study is to overcome these challenges by developing an AI-powered
interactive smartphone application called AMPLIFY app that enables prescription and
progression of exercises/functional activities, while offering immediate feedback on UL
movement performed, real-time logging and monitoring of adherence through virtual
platform. The inherent interactive nature of app offers features to engage and remind
people with stroke to use their paretic UL. This app offers remote monitoring and
supervision by therapists without need for actual therapists' physical presence. As the
AMPLIFY app is a newly developed AI-powered interactive smartphone application, it is
important to investigate the app's feasibility, usefulness in improving users'
experience, effect on adherence, UL use, recovery and cost-effectiveness.
Aim:
To Investigate:
Feasibility of AMPLIFY app in completing self-directed UL therapy programme
Usefulness of AMPLIFY app in improving the users' experience in self-directed UL
therapy programme performance
Effectiveness of AMPLIFY app in increasing adherence in self-directed UL therapy
programme performance
Effectiveness of AMPLIFY app in increasing UL use, confidence and improving recovery
after stroke
Cost-effectiveness of AMPLIFY app in reducing the need for clinical review in
self-directed UL therapy programme performance
Methods:
The study is a prospective randomized controlled trial (RCT) to compare the
implementation of AMPLIFY programme in two modes of delivery- smartphone app versus
hardcopy manuals to investigate the aims mentioned above.
People with stroke who fit into the inclusion and exclusion criteria will be invited to
participate in the study via informed consent by the research assistant (RA)/ study team
members. Once the informed consent has been given by the participants, the participants
will undergo the pre-intervention assessment. After the pre-intervention assessment, the
participants will be randomised either to the experimental group (AMPLIFY programme via
the smartphone app) or control group (AMPLIFY programme via the hardcopy manuals). The
intervention of experimental and control arms are described below. Both groups
essentially undergo the same AMPLIFY programme but via different modes. Time points of
assessment: pre-intervention, post-intervention and post-3months intervention
assessments.
Experimental arm Assigned intervention The AMPLIFY Programme will be delivered via
smartphone application with two levels. Level 1 is catered for people with stroke with
Action Research Arm Test (ARAT) score <34, while Level 2 is catered for people with
stroke with ARAT score >=34. Level 1 consists of six warm up exercises, six strengthening
exercises and ten functional activities. Level 2 consists of three warm up exercises,
four strengthening exercises, nine hand coordination and dexterity exercises, and ten
functional activities. Five to six exercises (including at least one functional activity)
will be prescribed to the stroke participants for each session to be performed
independently or with the help of caregiver. Stroke participants are to performed the
exercises/functional activities three sessions per day (i.e. morning, afternoon, evening)
and for six days per week. In addition, the stroke participants are to use their paretic
UL to perform the functional activities prescribed to them whenever needed throughout the
day. The AMPLIFY programme will last for four weeks. If the stroke participants are
discharged before the AMPLIFY programme ends, the participants will continue with the
programme at home with the reviews being performed by the therapists via
tele-rehabilitation. Frequency of reviews for the experimental group will be as follows:
Week1 (2x); Week2 (1x); Week3 (x0); Week4 (x1).
Control arm Assigned intervention The AMPLIFY Programme consists of two booklets (Booklet
1 and Booklet 2). Booklet 1 is catered for people with stroke with ARAT score <34, while
Booklet 2 is catered for people with stroke with ARAT score >=34. Booklet 1 consists of
six warm up exercises, six strengthening exercises and ten functional activities. Booklet
2 consists of three warm up exercises, four strengthening exercises, nine hand
coordination and dexterity exercises, and ten functional activities. Five to six
exercises (including at least one functional activity) will be prescribed to the stroke
participants for each session to be performed independently or with the help of
caregiver. Stroke participants are to performed the exercises/functional activities three
sessions per day (i.e. morning, afternoon, evening) and for six days per week. In
addition, the stroke participants are to use their paretic UL to perform the functional
activities prescribed to them whenever needed throughout the day. The AMPLIFY programme
will last for four weeks. If the stroke participants are discharged before the AMPLIFY
programme ends, the participants will continue with the programme at home with the
reviews being performed by the therapists via tele-rehabilitation. Frequency of reviews
for the control group will be as follows: Week1 (3x); Week2 (2x); Week3 (x1); Week4 (x1).