Staying connected: Personalising stroke recovery and rehabilitation through new technologies for people with stroke living at home

Three participant groups are provided with interventions: 1. People with stroke 2. Therapists (occupational therapists and physiotherapists) 3. Therapy Buddies (people nominated by Stroke participants to assist them with therapy in the home environment under the direction of the Therapists) Participant Group 1 (People with stroke) Will participate in the study for a 12 month period, during which they will receive 2 periods of therapy (each period consisting of 10 sessions of approximately 1 hour over 6 weeks) of evidence-based upper limb therapy that is tailored to their identified goals. Dates of sessions and attendance will be recorded in the Individual Therapy Record, completed by the Therapist. Selection of therapy will be based on the developed MYPLAN approach. The MYPLAN approach involves the individual with stroke self-selecting real-world activities that they would like to improve their performance of. These activities form their identified goals. A n app-based publicly available algorithm (VIATHERAPY) is used to guide the therapist and the individual with stroke to an established evidence-based therapy that is best suited to achieve their identified goals, based on their clinical assessment findings combined with analysis of their current performance of these activities. Therapy options are based upon current best-practice evidence and clinical guidelines, and comprise: Mirror Therapy; Motor Imagery; SENSe Therapy; modified Constraint Induced Movement Therapy; Strength Training; Task Specific Training; and use of electrical stimulation to muscle groups (e-STIM). Therapy will be primarily delivered remotely via telehealth to the participant with stroke or in an environment of their choice. Any equipment that may be required for the selected therapy will be provided to the Participant with Stroke by the research team. In addition, participants in Group 1 (stroke survivors) will be stratified into one of two subgroups that are allocated based on entry into the study, i.e. the first 75 participants (1-75) will be in one subgroup, while the second 75 participants (76-150) will be in the other subgroup. Participants 1-75 will receive 2 therapy blocks during their 12 month involvement in the study at time periods that enable a spread of periods across the timeframe of the study for the subgroup. Participants 76-150 will receive 2 therapy blocks during their 12 involvement in the study as determined by the Growing Self-Organizing Maps (an Artificial Intelligence approach developed for predictive models of recovery) prediction algorithm. Participant Group 2 (Therapists) Occupational therapists and physiotherapists will be involved in an implementation intervention and will receive training in the MYPLAN approach and therapy selection algorithm (using the Via Therapy App that they will download to their phone to generate therapy options, and then using a paper-based document to select the therapy from this generated list of options). In addition, therapists will receive training in 8 established upper limb therapies (e.g. motor imagery, strength training, task specific training) that are evidence based and recommended in clinical guidelines. Training will be delivered using interactive workshops delivered online by trained clinical researchers and involving multimedia resources. Therapist training will commence on the Therapists entry into the study, and will be completed prior to the therapist commencing with their first participant with stroke.There will be 8 modules covered across the workshops that will vary in length between 2 and 6 hours, dependent on the content that is involved for training of the various therapies. The participants who are therapists will also receive supervision and mentoring throughout their involvement. The knowledge and skill of therapists will be measured before, during and after delivery of therapy and during the up-skilling process. Confidence and ability to deliver therapy remotely will be evaluated, and will include assessment of treatment fidelity. Treatment fidelity will include assessment by Therapy Trainers and video observation and analysis. Participant Group 3 (Therapy Buddies) Participants with stroke (Group 1) on entering into the study have the opportunity to nominate a person of their choice (Therapy Buddy) to assist them with the performing of any tasks required during the therapy sessions, under the direction of the Therapist. Therapy Buddies may also assist in practice sessions outside of the therapy sessions at the agreement of the Therapy Buddy and the Participant with Stroke for the amount of time and frequency determined by Therapy Buddy and Participant with Stroke. Therapy Buddies, if used, will be surveyed regarding their experiences in assisting with therapy in the study, and perceived benefit of therapy to the stroke survivor.