Description of the CARE4STROKE programme: A caregiver-mediated exercises intervention with e-health support for stroke patients

Background: Intensity of practice and task and context specificity are key factors
for improving functional outcome in stroke survivors. Novel methods are needed to
augment intensity of practice with minimal use of resources and costs. Caregivermediated
exercises (CMEs) focused on mobility, in which a caregiver acts as an exercise
coach and can increase the intensity of practice. There is preliminary evidence
that CME can improve functional outcome, reduce length of stay, and allow early supported
discharge, without an increase in caregiver burden. In the CARE4STROKE
programme (C4S), CME therapy and e‐health support are combined to promote a
smoother transition from the inpatient setting to the home environment, with active
rehabilitation continuing in the community.
The objective of this paper is to describe the content of the C4S intervention in detail
and explain implementation of this intervention in practice using the Template for
Intervention Description and Replication checklist.
Methods: Content, timing and intensity of the programme, participant screening
and selection, and intervention procedures were described using the Template for
Intervention Description and Replication checklist. Mobility exercises and use of a
video application on tablet/smartphone are explained. The role of the caregiver as
provider of the intervention is illustrated.
Discussion: C4S prescribes an additional exercise dose of 1,200 min and may be a promising
novel and effective method to augment the pallet of therapeutic options for stroke
rehabilitation. Important aspects for successful implementation are availability and suitability
of a caregiver. Suggestions for additional use of e‐health technology are described.
Implications for physiotherapy practice: The presented description of C4S gives
physical therapists practical guidelines to facilitate implementation of the CME
intervention.