EVERLAP: Early VERsus Later Augmented Physiotherapy compared with usual upper limb physiotherapy: an exploratory RCT of arm function after stroke.

Up to 80% of acute stroke patients have impairments of the upper limb (UL: arm and hand), which often persists, affecting daily activities, participation, mood and carer burden.  Evidence indicates that improving function after stroke requires task-specific, repetitive training - although more research is needed on UL physiotherapy (PT) specifically.  One of the key questions in providing UL physiotherapy after stroke is when best to start (i.e. within the first few weeks, when patients recover most; or after the first few months, when patients tend to be more settled and most hospital care has finished).  Another key question is how much extra support and  UL physiotherapy to provide.

Study intervention - early: Augmented UL PT: strategies primarily aimed at improving functional activity of the affected upper limb, provided within 3 weeks after stroke, comprising 27 extra hours over 6 weeks; 6 days per week, 45 minutes per day, divided depending on individual tolerance (e.g. 15 minutes 3 times per day).  To enhance self-management, research physiotherapists will provide either a workbook, Mobile phone app or DVD. This intervention will be provided in addition to usual UL physiotherapy.

Although currently not routinely used by therapists, reminders for patients to activate their upper limb may be an important adjunct to upper limb physiotherapy. For this reason, an arm activity reminder app has been designed to remind stroke patients to carry out their exercises. 

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Study duration: 36 months.

Chief Investigator:  Prof Frederike van Wijck

Co-Investigator: Prof Lynne Baillie

Project Researchers: Dr Nicholas Micallef, Dr Stephen Uzor

Funder: The Chartered Society of Physiotherapychartered-society-of-physiotherapy1