RecruitingACTRN12619000229178

CardiacRehabPlus: Innovation to improve outcomes for TIA and cardiac rehabilitation patients

Is the CardiacRehabPlus model feasible for transient ischaemic attack/minor stroke and cardiac rehabilitation patients in addressing balance and gait deficits?

Sponsor

National Ageing Research Institute

Enrollment

35 participants

Start Date

Jul 15, 2019

Study Type

Interventional

Conditions

Stroke Transient Ischaemic Attack (TIA)

Summary

Transient ischemic attack and minor stroke (TIA/mS) are common cerebrovascular events affecting tens of thousands of Australians. People with TIA/mS usually receive minimal, if any, rehabilitation despite high risk of further stroke, and in many, mild balance and gait problems. Also, people who have had a cardiac event are offered cardiac rehabilitation but do not necessarily have their balance assessed. This project addresses these two substantial gaps. People with TIA/mS will receive rehabilitation through existing cardiac rehabilitation services and the people with cardiac conditions who are participating in cardiac rehabilitation programs will be assessed for balance and gait dysfunction. If deficits are identified, balance and agility exercises will be provided.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Plain Language Summary

Simplified for easier understanding

A transient ischaemic attack (TIA), often called a "mini-stroke," is a brief episode where blood flow to part of the brain is temporarily blocked. While symptoms usually resolve quickly, the risk of a full stroke is significantly elevated afterward. Despite this, most people who experience a TIA receive little to no rehabilitation — even though many have subtle balance and walking difficulties that go unnoticed. The CardiacRehabPlus program addresses two gaps at once. First, it provides TIA and minor stroke patients with access to structured rehabilitation through existing cardiac rehabilitation services. Second, it screens people already attending cardiac rehabilitation for hidden balance and gait problems — and offers targeted exercises if any are found. This study has two streams. You may be eligible for the TIA/minor stroke stream if you have had a confirmed TIA or minor stroke within the last 12 weeks, have minimal lasting disability, and can walk independently. You may be eligible for the cardiac stream if you have been diagnosed with a cardiac condition and have recently started the cardiac rehabilitation program at St Vincent's Hospital Melbourne. All participants must be 18 or older and able to communicate in English.

This is a simplified summary. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

All participants will receive the standard 8 week cardiac rehabilitation program of physical activity and education delivered by cardiac rehab staff. Each weekly session consists of 30 minutes strength exercise, such as bicep curls or squats, and 30 minutes aerobic exercise, such as walking on a treadmill or riding an exercise bike. Intensity is monitored using the Borg RPE scale targeting a range of 12-14. Standard education modules include cardiac risk factor modification, stress management and mindfulness, medications and management, importance of physical exercise, blood sugar levels, healthy eating and food label reading. To encourage compliance participants receive a phone call should they not attend two sessions in a row. Graduation from the program only occurs once a participant attends eight sessions. The Plus component of the CardiacRehabPlus (CR+) program will comprise of additional balance and gait assessment performed by research staff for Transient Ischaemic Attack/minor stroke (TIA/mS) and cardiac cohorts at baseline and on completion of the program. For the TIA/minor stroke cohort, CR+ will also be additional education modules tailored to the TIA/mS cohort. Balance and agility exercises will be included in the program. The additional balance and agility exercise will be provided by research physiotherapists and will be based on the OtagoPlus program, which has been shown to be effective in improving mild balance/gait dysfunction. Between group sessions, participants will be encouraged to do a home exercise program five days per week (approximately 20–30 min each time). For the cardiac event cohort who consent be involved in the provision of balance and gait exercises, will receive in addition to the standard 8 week cardiac rehabilitation, an extra session per week for 8 weeks in parallel with the standard cardiac rehabilitation. The extra balance and agility exercise program will be 60 mins consisting of 30-40 mins of exercise with opportunities for rests – 5 min warm up, 30 minutes balance, agility and strength, 5 min cool down) with a maximum of 4 participants per session. Between group sessions, participants will be encouraged to do a home exercise program three days per week (approximately 20–30 min each time). For both cohorts, exercises will be selected by the intervention physiotherapist from the kits of the exercises from the Otago Exercise Program and/or the Visual Health Information—Health Promotion Resources Balance and Vestibular exercise kit. Examples of the exercises included tandem walks, tandem stances, figure 8 walking, backwards walking. Exercises will be prescribed based on assessment findings and clinical judgement so participants perform at moderate intensity that challenged participants' balance. Participants will be provided with an exercise diary and these will be checked weekly to assist adherence to the home program.