Stroke Patients' Outpatient Rehabilitation Therapy (SPORT)

Summary

Background: Stroke is the leading cause of long-term disability in Singapore, and studies have found that intensive specialized stroke rehabilitation can improve post-stroke functional outcomes for a substantial proportion of stroke patients. However, despite the benefits associated with adherence to prescribed rehabilitation, the uptake rate of outpatient rehabilitation services (ORS) in Singapore is only 33%.

According to local longitudinal studies, the financial burden of out-of-pocket service costs and the inconvenient transportation from home to rehabilitation centres are important barriers to access to ORS.

Objective: To examine the effect and cost-effectiveness of providing incentives for ORS to improve the uptake of ORS compared to usual care (control) with no incentives

Hypothesis: An evidence-based program to test the effectiveness of providing incentives to alleviate the financial burden as well as inconvenience of transportation for ORS will improve the uptake of and adherence to ORS among stroke patients.

Methodology: This study is an individual-based randomized controlled trial (RCT) of 300 stroke patients recruited from Singapore General Hospital (SGH) and Changi General Hospital (CGH). They will be randomized to one of three study arms (education only, free transportation, and free services and transportation) and interviewed at the time of recruitment and four months after the enrolment in the study. Participants' health conditions, socioeconomic situation, health \& medical services utilization, stroke-related disability measures, quality of life, and reasons for uptake/rejection/withdraw from the services will be collected during both baseline and the 4th month assessments.

Significance: As the first study in Singapore to test innovative ways to increase the stroke ORS uptake rates, it will provide evidence for future policy changes in financing outpatient rehabilitation and other long-term care services in Singapore. It will also provide important empirical parameter estimates for Systems Dynamics modelling of the demand and supply of ORS in Singapore.

Conditions

• Stroke
• Incentives
• Stroke Rehabilitation

Interventions

BEHAVIORAL

Transportation incentives

Free transportation only for the first 3 months post-discharge.

BEHAVIORAL

Transportation and rehabilitation services incentives

Free transportation and rehabilitation services 3 months post-discharge.

Sponsors & Collaborators

• Ministry of Health, Singapore

  collaborator OTHER_GOV

• Duke-NUS Graduate Medical School

  collaborator OTHER

• Changi General Hospital

  collaborator OTHER

• Singapore General Hospital

  collaborator OTHER

• National University of Singapore

  lead OTHER

Principal Investigators

• David B Matchar, MD · Duke-NUS Graduate Medical School

• Sherry Young, MD · Changi General Hospital

• Deidre A De Silva, MD · Singapore General Hospital

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

55 Years

Max Age

100 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2017-05-26

Primary Completion

2019-11-30

Completion

2019-11-30

Countries

• Singapore

Study Locations