DOI: 10.12688/f1000research.186129.1 ISSN: 2046-1402

Effectiveness and Cost-effectiveness of Home-Based Occupational Therapy with Activity Monitoring for Daily Functioning of People Post-Stroke: Protocol for a Partially Randomised Usual Care Stepped-Wedge Trial

Sanne Pellegrom, Margriet Pol, Ton Satink, Margo van Hartingsveldt, Johanna Maria van Dongen, Gerben ter Riet, Bianca Buurman, Maud Graff
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Background Transitioning from a geriatric rehabilitation centre or hospital to home is challenging for persons post-stroke, as they must increase their ability to perform daily activities and self-manage their lives. Moreover, persons post-stroke exhibit more sedentary behaviour at home than during rehabilitation, which is detrimental to their health. The Occupational Therapy at Home E-Rehabilitation (OTHER) intervention aims to increase daily activities and self-management in persons post-stroke. OTHER involves in-person (online) coaching using information from activity monitoring. Here, we describe the design of a study investigating the (cost-)effectiveness of OTHER on the recovery of daily activities among older persons after stroke and evaluate its implementation process. Methods A partially randomised stepped-wedge cluster trial was conducted in nine geriatric rehabilitation centres and two hospitals. Data collection is complete, with 116 of the intended 171 participants enrolled. Post-stroke participants (aged ≥60 years) starting (inpatient) rehabilitation to return home were included. The intervention group receives the OTHER intervention by an occupational therapist, starting at the institute and continuing at home, consisting of activity monitoring and coaching to support performing daily activities and increasing self-management. The control group received care as usual. The primary outcome was the Canadian Occupational Performance Measure performance score, which measures perceived daily functioning at 6 months. A process evaluation assessed the implementation process of the OTHER intervention during the research period. In total, 116 participants had been enrolled. Discussion This trial investigated the effect of activity monitoring combined with home-based occupational therapy coaching for persons post-stroke. With this study, we aim to provide insight into the effectiveness and cost-effectiveness of the OTHER intervention compared to care as usual for persons post-stroke, and describe the process of implementation, which includes home-based geriatric rehabilitation. Registration This trial is registered in ClinicalTrials.gov (NCT05855226; https://clinicaltrials.gov/study/NCT05855226). The trial was registered on 13 March 2023. The study started on 13 March 2023 and was completed on 20 March 2026. This protocol has been previously published as a preprint at MEDRXIV. 1

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