***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : ( 1 ) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the dem and on therapist re sources . ( 2 ) To explore whether extended mitt use alone may enhance outcome . Design : A combined case-control and r and omized controlled study with pre- and post-treatment measures by blinded observers . Setting : A university hospital rehabilitation department . Participants : Sixteen stroke patients ( nine men and seven women ; mean age 56.7 years ; on average 28.9 months post stroke , five of whom were 6 - 9 months post stroke ) with moderate motor impairments in the contralateral upper limb . Intervention : Constraint-induced therapy ( mitt on the less affected h and 90 % of waking hours for 12 days ) with 2 - 3 patients per therapist and 6 h of group training per day . After the training period , the patients were r and omized either to using the mitt at home every other day for two-week periods for another three months ( in total 21 days ) or to no further treatment . Outcome measures : Modified Motor Assessment Scale , Sollerman H and Function Test , Two-Point Discrimination test and Motor Activity Log . Results : The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale ( 1.44 ( 95 % confidence interval ( 95 % CI ) 0.59 - 2.28 ) points ; P = 0.003 ) and on Sollerman H and Function Test ( 3.81 ( 95 % CI 0.26 - 7.36 ) points ; P = 0.037 ) but showed no sensory change in the Two-Point Discrimination Test ( P = 0.283 ) . The median difference in self-reported motor ability ( Motor Activity Log ) also improved ( P B=0.001 ) . However , no additional effect was seen from wearing a mitt for another three months . Conclusion : Constraint-induced group therapy , allowing several patients per therapist , seems to be a feasible alternative to improve upper limb motor function . The restraint alone , extended in time , did not enhance the treatment effect Background . Targeted physical activity drives functional recovery after stroke . This review aim ed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions . Summary of Review . A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions . Seven studies were included ; six observational and one r and omised controlled trial . People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration . The most common activities practice d in a physiotherapy session were walking , sitting , and st and ing with a mean ( SD ) practice time of 8.7 ( 4.3 ) , 4.5 ( 4.0 ) , and 8.3 ( 2.6 ) minutes , respectively . Conclusion . People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity . In light of dosage studies , practice time may be insufficient to drive optimal motor recovery OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke Abstract Objective : To determine whether attending an aerobic fitness program during  inpatient stroke rehabilitation  is associated with increased participation in physical activity after discharge . Design : This was a prospect i ve cohort study . Patients who received inpatient stroke rehabilitation and were discharged into the community ( n = 61 ; mean age , 65 years ) were recruited . Thirty-five participants attended a st and ardized aerobic fitness program during inpatient rehabilitation , whereas 26 did not . The Physical Activity Scale for Individuals with Physical Disabilities ( PASIPD ) and adherence to the American College of Sports Medicine ( ACSM ) guidelines were assessed up to 6 months after discharge . Results : Participants in the fitness group had PASIPD scores and adherence to ACSM guidelines similar to those of participants in the nonfitness group up to 6 months after discharge . There was no significant correlation between volume of exercise performed during the inpatient program and amount of physical activity after discharge . Conclusion : Participation in an inpatient fitness program did not increase participation in physical activity after discharge in individuals with stroke . A new model of care that encourages patients to pursue physical activity after discharge and reduces the potential barriers to participation should be developed Background Loss of upper limb function affects up to 85 % of acute stroke patients . Recovery of upper limb function requires regular intensive practise of specific upper limb tasks . To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice . Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities . A wrist-worn device has been developed that monitors and provides ‘ live ’ upper limb activity feedback to remind patients to use their stroke arm in daily activities ( The CueS wristb and ) . The aim of this trial is to assess the feasibility of a multi-centre , observer blind , pilot r and omised controlled trial of the CueS wristb and in clinical stroke services . Methods / design This pilot r and omised controlled feasibility trial aims to recruit 60 participants over 15 months from North East Engl and . Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy . Each participant will be r and omised to an intervention or control group . Intervention participants will wear a CueS wristb and ( between 8 am and 8 pm ) providing “ live ” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme ( review ed twice weekly by an occupational/physiotherapist ) . Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘ sham ’ CueS wristb and that monitors upper limb activity but provides no feedback . Outcomes will determine study feasibility in terms of recruitment , retention , adverse events , adherence and collection of descriptive clinical and accelerometer motor performance data at baseline , 4 weeks and 8 weeks . Discussion The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke . The study will establish whether the study protocol can be supported by clinical stroke services , thereby informing the design of a future multi-centre r and omised controlled trial of clinical and cost-effectiveness . Trial registration IS RCT N:82306027 . Registered 12 July 2016 BACKGROUND The loss of normal ambulatory function after stroke , besides causing disability , leads to progressive deconditioning and exposes patients to increased risk of cardiovascular diseases and recurrent stroke . Conventional rehabilitation is mainly limited to the subacute period after stroke . Effective , safe and sustainable interventions for patients and healthcare system , including the long-term , should be identified . AIM To verify the feasibility , safety and preliminary efficacy of an original home-based rehabilitation model compared to a st and ard supervised program in chronic hemiplegic stroke survivors . DESIGN Pilot , two-arm , parallel group , r and omized , controlled clinical trial . SETTING Community-dwelling poststroke patient/Hospital . POPULATION Twelve chronic hemiplegic stroke patients ( age=66.5±11.9 years , males , N.=9 ) . METHODS Participants were r and omly assigned for a 10-week period to a structured home-based exercise program ( N.=6 ) and a st and ard supervised group- setting program ( N.=6 ) . The feasibility outcomes included adherence to interventions , retention rate and safety . Satisfaction was also evaluated by the Client Satisfaction Question naire . Efficacy was assessed by the 6-minute walk test , Timed Up and Go and Stair Climb tests . The impact on Quality -of-life was estimated using the physical activity domain of the Short Form-36 question naire . Operators ' time consuming was also calculated . RESULTS Adherence was 91 % in the home-based exercise group and 92 % in the st and ard supervised group . The retention rate was 100 % , with no adverse events reported and high satisfaction scores for both interventions . 6-minute walk test and physical activity domain significantly increased in both groups ( P=0.03 ) . Timed Up and Go improved in both groups , significantly for the home-based exercise group ( P=0.03 ) while Stair Climb remained stable . Time required to operators to implement the home-based exercise program was 15 hours vs. 30 hours for the st and ard supervised one . CONCLUSIONS In a sample of hemiplegic chronic stroke patients , a structured home-based exercise program was feasible , safe and capable of inducing improvements in functional capacity and Quality -of-life comparable to a conventional supervised rehabilitation program A future larger r and omized controlled trial will be needed to confirm such results . CLINICAL REHABILITATION IMPACT With the limitation of a small sample size , the study suggested that a home-based program for chronic stroke might be an effective alternative to traditional supervised programs with the peculiarity of being sustainable for patients and healthcare system Background Most acute stroke patients with disabilities do not receive recommended rehabilitation following discharge to the community . Functional and social barriers are common reasons for non-adherence to post-discharge rehabilitation . Home rehabilitation is an alternative to centre-based rehabilitation but is costlier . Tele-rehabilitation is a possible solution , allowing for remote supervision of rehabilitation and eliminating access barriers . The objective of the Singapore Tele-technology Aided Rehabilitation in Stroke ( STARS ) trial is to determine if a novel tele-rehabilitation intervention for the first three months after stroke admission improves functional recovery compared to usual care . Methods / design This is a single blind ( evaluator blinded ) , parallel , two-arm r and omised controlled trial study design involving 100 recent stroke patients . The inclusion criteria are age ≥40 years , having caregiver support and recent stroke defined as stroke diagnosis within 4 weeks . Consenting participants will be r and omized with varying block size of 4 or 6 assuming a 1:1 treatment allocation with the participating centre as the stratification factor . The baseline assessment will be done within 4 weeks of stroke onset , followed by follow-up assessment s at 3 and 6 months . The tele-rehabilitation intervention lasts for 3 months and includes exercise 5-days-a-week using an iPad-based system that allows recording of daily exercise with video and sensor data and weekly video-conferencing with tele-therapists after data review . Those allocated to the control group will receive usual care . The primary outcome measure is improvement in life task ’s social activity participation at three months as measured by the disability component of the Jette Late Life Functional and Disability Instrument ( LLFDI ) . Secondary outcome variables consist of gait speed ( Timed 5-Meter Walk Test ) and endurance ( Two-Minute Walk test ) , performance of basic activities of daily living ( Shah-modified Barthel Index ) , balance confidence ( Activities-Specific Balance Confidence Scale ) , patient self-reported health-related quality -of-life [ Euro-QOL ( EQ-5D ) ] , health service utilization ( Singapore Stroke Study Health Service Utilization Form ) and caregiver reported stress ( Zarit Caregiver Burden Inventory ) . Discussion The goal of this trial is to provide evidence on the potential benefit and cost-effectiveness of this novel tele-rehabilitation programme which will guide health care decision-making and potentially improve performance of post-stroke community-based rehabilitation . Trial Registration This trial protocol was registered under Clinical Trials.gov on 18 July 2013 as study title “ The Singapore Tele-technology Aided Rehabilitation in Stroke ( STARS ) Study ” ( ID : The STARS Study , Clinical Trials.gov Identifier : NCT01905917 ) Background The level of physical activity undertaken by stroke survivors living in the community is generally low . The main objectives of the IMPACT trial are to determine , in individuals undergoing rehabilitation after stroke , if 8 weeks of high-intensity treadmill training embedded in self-management education ( i ) results in more physical activity than usual physiotherapy gait training and ( ii ) is more effective at increasing walking ability , cardiorespiratory fitness , self-efficacy , perception of physical activity , participation , and health-related quality of life as well as decreasing cardiovascular risk , and depression , at 8 and 26 weeks . Methods A prospect i ve , two-arm , parallel-group , r and omised trial with concealed allocation 
    Output:
    
Conclusion : There is not a consistent measure of adherence that is currently utilized .
Diaries and logbooks are the most frequently utilized tools