Improving Post-acute Stroke Follow-up Care by Adopting Telecare Consultations in a Nurse-led Clinic

Improving Post-acute Stroke Follow-up Care by Adopting Telecare Consultations in a Nurse-led Clinic During COVID-19 and Beyond: A Hybrid Type 2 Implementation-effectiveness Randomized Trial

Since 2017, Hong Kong has provided post-acute stroke services in clinics operated by stroke advanced practice nurses (APNs). Currently, the applicability of the clinics has been further limited by the emergence of the coronavirus (COVID-19) pandemic due to restrictions on visits to the clinics and tightened social distancing requirements. Telecare consultations may be a viable option for contributing more flexible, interactive, and cost-efficient care models to support stroke survivors over the longer run. The present study takes advantage of this opportunity by utilizing implementation science to simultaneously implement and evaluate a telecare model of care in a nurse-led post-acute stroke clinic.

Study Overview

• Status: Recruiting
• Conditions: Stroke
• Intervention / Treatment: Procedure: Telecare consultation; Procedure: Usual face-to-face consultation

• Study Type: Interventional
• Enrollment (Estimated): 196
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Arkers Wong, Ph.D.; Phone Number: 85234003805; Email: arkers.wong@polyu.edu.hk

Study Locations

• Hong Kong
  • Kowloon, Hong Kong
    • Recruiting
    • Queen Elizabeth Hospital
    • Contact: Wai Yan Kwok; Phone Number: 85235067349; Email: bkwyv02@ha.org.hk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• confirmed diagnosis of stroke within 1 month before enrolment, will be discharged home within a week, aged 18 or above, cognitively competent with a score equal to or greater than 22 in the Montreal Cognitive Assessment Hong Kong version, own a smartphone

Exclusion Criteria:

• have unaccompanied hearing or vision loss, cannot be reached by phone, bedbound, have no Internet connection at home, participating in other clinical trials at the same time, require physical contact, i.e. wound dressing

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; Participants will receive three tertiary stroke care consultations provided by stroke nurses via telecare in 3 months.	Procedure: Telecare consultation; Using Zoom to communicate with patients
Placebo Comparator: Control group; Participants will receive three usual face-to-face consultations provided by stroke nurses in 3 months	Procedure: Usual face-to-face consultation; Face-to-face communication with patients

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chang in Degree of disability after stroke	Simplified modified Rankin scale will be used to measure the degree of disability for stroke patients. The scale has three questions to identify whether the patient has a score from 0 to 5, with higher scores representing higher degree of disability.	baseline, three months when the program is completed, three months after the program is completed.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of the recurrence of stroke	The percentage of participants who re-admitted to hospital because of recurrent stroke	baseline, three months when the program is completed, three months after the program is completed.
Change of Quality of life, which measures an individual perception oftheir position in life. It includes physical and mental health.	Quality of life will be measured using the Hong Kong version of EuroQol 5-dimension. The scale has five subdomains, which include mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. Since the scale has 5 items, each digit in the five digit codes refers to the status of each dimension, ranging from 1 for no problem, to 5 for sever problem. A higher scores indicate better quality of life.	baseline, three months when the program is completed, three months after the program is completed.
Change of Post-stroke depression	Post-stroke depression will be measured using the Chinese version of the Geriatric Depression scale. This scale has a minimum score of 0 and a maximum score of 15. Lower scores represent lower depression level.	baseline, three months when the program is completed, three months after the program is completed.
Change of Medication adherence	Medication adherence will be determined using the Adherence to Refills and Medications Scale. The scale produces an overall adherence score of 10-40, with lower scores indicating better adherence.	baseline, three months when the program is completed, three months after the program is completed.
Change of Social participation	Social participation will be measured using the 11-item Reintegration to Normal Living index. This scale is used to measure whether the patient has participated in several social activities before and after occurrence of stroke. The scale yields total score from 0-22, with higher scores indicating poorer social participation.	baseline, three months when the program is completed, three months after the program is completed.
Number of attendances at a general practitioners' office, emergency department, hospital, and general out-patient clinic	To measure the utilization of healthcare services by stroke patient before and after the intervention	baseline, three months when the program is completed, three months after the program is completed.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost effectiveness of the program	Cost and quality-adjusted life years will be collected at baseline, three months when the program is completed, and three months after the program is completed. Incremental cost-effectiveness ratios between the groups will be calculated by dividing the difference in cost by the difference in quality-adjusted life years.	baseline, three months when the program is completed, three months after the program is completed.

Collaborators and Investigators

• Sponsor: The Hong Kong Polytechnic University
• Collaborators: The Queen Elizabeth Hospital
• Investigators: Principal Investigator: Arkers Wong, Ph.D., The Hong Kong Polytechnic University

Publications and helpful links

General Publications

• Wong AKC, Kwok VWY, Wong FKY, Tong DWK, Yuen BMK, Fong CS, Chan ST, Li WC, Zhou S, Lee AYL. Improving post-acute stroke follow-up care by adopting telecare consultations in a nurse-led clinic: Study protocol of a hybrid implementation-effectiveness trial. J Adv Nurs. 2024 Mar;80(3):1222-1231. doi: 10.1111/jan.15960. Epub 2023 Nov 10.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2022
• Primary Completion (Estimated): October 30, 2025
• Study Completion (Estimated): December 30, 2025

Study Registration Dates

• First Submitted: December 7, 2021
• First Submitted That Met QC Criteria: January 5, 2022
• First Posted (Actual): January 10, 2022

Study Record Updates

• Last Update Posted (Estimated): September 10, 2025
• Last Update Submitted That Met QC Criteria: September 8, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: stroke; telecare consultation
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: A0036516

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No