Efficacy and Sustainability of a CarePartner-Integrated Telerehabilitation Program for Persons with Stroke - Project Summary/Abstract: Our long-term goal is to optimize stroke recovery by developing family-centered rehabilitation interventions that support continued and progressive functional improvements in the stroke survivor - without increasing caregiver burden. Stroke is a leading cause of long-term disability, with the majority of stroke survivors reporting prolonged difficulty using their affected upper extremity. Contrary to expectations, upper extremity functional capacity improvement is not always reflected in stroke survivor activity performance in daily life. Family carepartners play a key role in stroke survivor recovery and perseverance in practicing upper extremity activities. However, carepartners often feel unprepared, experience high strain, and reduced quality of life. To address this gap, we developed our theory-based family-centered intervention, Carepartner and Collaborative Integrated Therapy (CARE-CITE), that uses well-established autonomy- supportive strategies (characterized by empathy, choice, problem-solving, and reduced use of controlling language) to engage carepartners during stroke survivor in-home rehabilitation activities. To positively motivate stroke survivors to persist in upper extremity task practice, the carepartners learn how to create an autonomy- supportive environment through instructional web-based modules that feature exemplary videos of family scenarios practicing in-home rehabilitation activities. In virtual therapist-guided home training sessions, the dyad and therapist-co-creates a tailored and progressive exercise program that integrates meaningful upper extremity practice into daily activities of living. Across three preliminary studies, we have demonstrated good recruitment, adherence, and safety, with strong content validity, high carepartner satisfaction, and low study burden. Promising data for improvements in chronic and sub-acute stroke survivors showed clinically meaningful improvements in upper extremity functional capacity and activity performance assessments, as well as social participation. Carepartners showed reduced strain and family conflict with improved quality of life. The goals of this R01 are to use a fully virtual, two-group randomized clinical trial (n=110 dyads) to test the efficacy of CARE-CITE at two months and sustainability of improvements at 6 months compared to an attention control group. The specific aims are to determine the effects of CARE-CITE on stroke survivor upper extremity functional capacity (Aim 1), upper extremity daily activity performance (accelerometry and patient- reported measures), and social participation (Aim 2). Additionally, we will evaluate the effects on carepartner strain, conflict around stroke recovery, and quality of life (Aim3). Aligned with the NIH Research Plan on Rehabilitation, the impact of this work is the development of innovative family-level interventions to improve both stroke survivor and carepartner outcomes. Upon the successful study completion, our next goal will be to translate this clinically feasible CARE-CITE intervention into current stroke systems of care; and to expand its application for use in other disability-related conditions broadening public health impact.
