O'Neil Jennifer, Egan Mary, Marshall Shawn, Bilodeau Martin, Pelletier Luc, Sveistrup Heidi
School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Bruyère Research Institute, Ottawa, ON, Canada.
JMIR Res Protoc. 2019 Oct 9;8(10):e14867. doi: 10.2196/14867.
Traumatic brain injury (TBI) may impact an individual physically, cognitively, socially, and emotionally. Poor balance, reduced mobility, and low daily physical activity often will require ongoing physical rehabilitation intervention. However, face-to-face specialized physiotherapy is not always accessible for individuals living in rural settings.
We will answer four questions: (1) What is the feasibility of a remotely supervised, home-based, intensive exercise intervention with survivors of moderate and severe TBI? (2) Does the frequency of remote supervision have an impact on the feasibility of completing a home-based intensive exercise program? (3) Does the frequency of remote supervision impact balance, functional mobility, and physical activity? (4) What is the lived experience of remote supervision for both survivors and caregivers?
Four participants will complete two intensive, 4-week (five days per week) home-based exercise interventions remotely supervised via synchronous videoconference. Each exercise intervention will have a goal of 160 to 300 repetitions or 60 minutes of tailored exercises to promote neuroplasticity and be defined as an intensive home-based exercise intervention. An alternating single-subject design will allow for the comparison between two frequencies of remote supervision, once weekly and five times weekly. Daily repeated outcome measures, pre- and postintervention outcome measures, and 1-month follow-up outcome measures will be collected to explore the effect on feasibility and physical variables. Daily outcome measures include step count and Five Times Sit-to-Stand test. Pre-post measures include assessment of quiet stance and the Community Balance and Mobility Scale. A semistructured interview will be completed at the end of each intervention segment to document the lived experience of both survivors and their study partners. Finally, five questionnaires will be used to understand the overall experience: the Mayo-Portland Adaptability Inventory-4 Participation Index, Satisfaction With Life Scale, Fall Efficacy Scale-International, Interpersonal Behavior Questionnaire, and System Usability Scale. Data will be analyzed following traditional single-subject methods of analysis.
Ethics approval was received from both the Bruyère Research Institute and University of Ottawa review boards in March 2019. Recruitment is underway.
The proposed intervention is complex in nature due to the involvement of multiple technology sources and the inclusion of a complex dyad (survivors and caregivers) in a community setting. This type of research is timely given that alternative methods of physical intervention delivery are needed to facilitate gains in balance, mobility, physical activity among TBI survivors with limited access to clinical care, and the quality of the patients' experience.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14867.
创伤性脑损伤（TBI）可能会对个体的身体、认知、社交和情感方面产生影响。平衡能力差、行动能力下降以及日常身体活动量低通常需要持续的物理康复干预。然而，对于生活在农村地区的人来说，面对面的专业物理治疗并不总是能够获得。
我们将回答四个问题：（1）对中度和重度TBI幸存者进行远程监督的家庭强化运动干预的可行性如何？（2）远程监督的频率是否会对完成家庭强化运动计划的可行性产生影响？（3）远程监督的频率是否会影响平衡能力、功能性移动能力和身体活动？（4）幸存者和护理人员对远程监督的实际体验如何？
四名参与者将通过同步视频会议接受远程监督，完成两项为期4周（每周五天）的家庭强化运动干预。每次运动干预的目标是进行160至300次重复或60分钟的定制运动，以促进神经可塑性，并被定义为家庭强化运动干预。交替单受试者设计将允许比较两种远程监督频率，即每周一次和每周五次。将收集每日重复的结果测量、干预前后的结果测量以及1个月随访的结果测量，以探讨对可行性和身体变量的影响。每日结果测量包括步数和五次坐立测试。干预前后的测量包括安静站立评估和社区平衡与移动量表。在每个干预阶段结束时将完成一次半结构化访谈，以记录幸存者及其研究伙伴的实际体验。最后，将使用五份问卷来了解总体体验：梅奥-波特兰适应性量表-4参与指数、生活满意度量表、国际跌倒效能量表、人际行为问卷和系统可用性量表。数据将按照传统的单受试者分析方法进行分析。
2019年3月获得了布鲁耶尔研究所和渥太华大学审查委员会的伦理批准。招募工作正在进行中。
由于涉及多种技术来源，并在社区环境中纳入了复杂的二元组（幸存者和护理人员），因此拟议的干预措施本质上较为复杂。鉴于需要替代的物理干预提供方法，以促进获得有限临床护理的TBI幸存者在平衡、移动能力、身体活动方面的改善以及患者体验的质量，这类研究很及时。
国际注册报告识别码（IRRID）：PRR1-10.2196/14867。
