***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: OBJECTIVES To assess multiple psychometric characteristics of a new stroke outcome measure , the Stroke Impact Scale ( SIS ) , using Rasch analysis , and to identify and remove misfitting items from the 8 domains that comprise the SIS . DESIGN Secondary analysis of 3-month outcomes for the Glycine Antagonist in Neuroprotection ( GAIN ) Americas r and omized stroke trial . SETTING A multicenter r and omized trial performed in 132 centers in the United States and Canada . PARTICIPANTS A total of 696 individuals with stroke who were community-dwelling and independent prior to acute stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Rasch analysis was performed using WINSTEPS , version 3.31 , to evaluate 4 psychometric characteristics of the SIS : ( 1 ) unidimensionality or fit ( the extent to which items measure a single construct ) , ( 2 ) targeting ( the extent to which the items are of appropriate difficulty for the sample ) , ( 3 ) item difficulty ( the ordering of items from least to most difficult to perform ) , and ( 4 ) separation ( the extent to which the items distinguish distinct levels of functioning within the sample ) . RESULTS ( 1 ) Within each domain , most of the items measured a single construct . Only 3 items misfit the constructs and were deleted ( " add and subtract numbers , " " get up from a chair , " " feel emotionally connected " ) and 2 items ( " h and le money , " " manage money " ) misfit the combined physical domain . These items were deleted to create SIS , version 3.0 . ( 2 ) Overall , the items are well targeted to the sample . The physical and participation domains have a wide range of items that capture difficulties that most individuals with stroke experience in physical and role functions , while the memory , emotion , and communication domains include items that capture limitations in the most impaired patients . ( 3 ) The order of items from less to more difficult was clinical ly meaningful . ( 4 ) The individual physical domains differentiated at least 3 ( high , average , low ) levels of functioning and the composite physical domain differentiated more than 4 levels of functioning . However , because difficulties with communication , memory , and emotion were not as frequently reported and difficulties with h and function were more frequently reported , these domains only differentiated 2 ( high , low ) to 3 ( high , average , low ) strata of patients . Time from stroke onset to administration of the SIS had little effect on item functioning . CONCLUSION Rasch analysis further established the validity of the SIS . The domains are unidimensional , the items have an excellent range of difficulty , and the domain scores differentiated patients into multiple strata . The activities of daily living/instrumental activities of daily living , mobility , strength , composite physical , and participation domains have the most robust psychometric characteristics . The composite physical domain is most able to discriminate difficulty in function in individuals after stroke , while the communication , memory , and emotion domain items only capture limitations in function in the more impaired groups of patients Background and Purpose — This study compared the psychometric properties of 3 clinical balance measures , the  Berg Balance Scale ( BBS ) , the Balance subscale of the Fugl-Meyer test ( FM-B ) , and the Postural Assessment Scale for Stroke Patients ( PASS ) , in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset . Methods — One hundred twenty-three stroke patients were followed up prospect ively with the 3 balance measures 14 , 30 , 90 , and 180 days after stroke onset ( DAS ) . Reliability ( interrater reliability and internal consistency ) and validity ( concurrent validity , convergent validity , and predictive validity ) of each measure were examined . A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity . Results — The FM-B and BBS showed a significant floor or ceiling effect at some DAS points , whereas the PASS did not show these effects . The BBS , FM-B , and PASS all had good reliability and validity for patients at different recovery stages after stroke . The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but , as expected , only a low level of responsiveness at 90 to 180 DAS . The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset , 14 to 30 DAS . Conclusions — All 3 measures tested showed very acceptable levels of reliability , validity , and responsiveness for both clinicians and research ers . The PASS showed slightly better psychometric characteristics than the other 2 measures OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions UNLABELLED Several studies showed that Constraint-Induced Movement Therapy ( CIMT ) leads to a lasting improvement of upper extremity function in chronic stroke patients . The original technique includes an intensive 2-week program with 6 hours of daily physiotherapy . Due to high expenses it is difficult to implement this concept in outpatient care . PURPOSE The objective of this study was to evaluate the effects of a 4-week homebased CIMT program among chronic stroke patients and to compare them with a 2-week CIMT program , based on the original technique . METHODS Seven adults with chronic stroke completed a newly developed variant of CIMT  , performed at patients ' homes ( group1 , CIMThome ) , supervised by an instructed family member , constraint of unaffected h and for a target of 60 % of waking hours . The intervention was analysed with pre- , post-treatment and 6-month follow-up measurements . Effects on improvement in upper extremity function were compared with patients treated according to the original protocol ( group2 , CIMTclassic ) , supervised by a physiotherapist , constraint of unaffected h and for a target of 90 % of waking hours . RESULTS Patients from both groups showed almost identical improvement of their motor function according to scores on the Wolf Motor Function Test ( WMFT ) and the Motor Activity Log ( MAL ) immediately after the treatment period as well as at follow-up after 6 months . CONCLUSIONS Our study suggests that CIMThome is not only feasible but also as effective as CIMTclassic . This finding should be replicated in a larger prospect i ve r and omized trial to perform a non-inferiority analysis Background and Purpose — This proof-of-concept trial investigated the effects of an 8-week program of  caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden . Methods — Sixty-three hospitalized stroke patients ( mean age 68.7 , 64 % female ) were r and omly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care . Primary outcome was the Stroke Impact Scale mobility domain . Secondary outcomes included length of stay , other Stroke Impact Scale domains , readmissions , motor impairment , strength , walking ability , balance , mobility , ( extended ) activities of daily living , psychosocial functioning , self-efficacy , quality of life , and fatigue . Additionally , caregiver ’s self-reported fatigue , symptoms of anxiety , self-efficacy , and strain were assessed . Assessment s were completed at baseline and at 8 and 12 weeks . Results — Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility ( P=0.6 ) ; however , carers reported less fatigue ( 4.6 , confidence interval [ CI ] 95 % 0.3–8.8 ; P=0.04 ) and higher self-efficacy ( −3.3 , CI 95 % −5.7 to −0.9 ; P=0.01 ) at week 12 . Per- protocol analysis , examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility ( −9.8 , CI 95 % −20.1 to 0.4 ; P=0.06 ) , significantly improved extended activities of daily living scores at week 8 ( −3.6 , CI 95 % −6.3 to −0.8 ; P=0.01 ) and week 12 ( 3.0 , CI 95 % −5.8 to −0.3 ; P=0.03 ) , a 9-day shorter length of stay ( P=0.046 ) , and fewer readmissions over 12 months ( P<0.05 ) . Conclusions — Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice , result ing in improved patient-extended activities of daily living , reduced length of stay with fewer readmissions post stroke , and reduced levels of caregiver fatigue with increased feelings of self-efficacy . The current findings justify a larger definite phase III r and omized controlled trial . Clinical Trial Registration — URL : http://www.anzctr.org.au . Unique identifier : ACTRN12613000779774 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 and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 1 
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There is very low- to moderate- quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation .
Future high- quality research should determine whether CME interventions are (cost-)effective