Kari Dunning

BACKGROUND Mindfulness has potential to improve lives after stroke but survivors experience barriers (e.g. transportation) to attend face-to-face programs. Only two virtual mindfulness programs have been explored for stroke survivors, but they included the diagnosis of traumatic brain injury and only persons with high levels of chronic fatigue, not representative of the general population of persons with stroke. OBJECTIVE The aims of this study were to: 1) investigate the effect of a virtual mindfulness program for stroke survivors on the primary outcomes of acceptance, stress and self-compassion and secondary outcomes including fatigue, depression, anxiety, and sleep; 2) explore the stroke survivor experience to better understand the effectiveness of the mindfulness program. METHODS This was a mixed methods study involving eight stroke survivors with a mean age of 55.3 years (range 41-66) and mean time post stroke of 48.6 months (range 7 to 94). Primary outcomes measured before (PRE), after the program (POST), and two months later (POST2) included the Illness Cognition Questionnaire (ICQ), the Acceptance of Illness Questionnaire (AIQ), the Perceived Stress Scale (PSS), and the Self-compassion Scale (SCS). Secondary outcomes included Frieberg Mindfulness Inventory (FMI), Mental Fatigue Scale (MFS), Patient-Reported Outcomes Measurement Information System (PROMIS®)-Short Form (depression, anxiety, fatigue, sleep disturbance). A paired t-test was conducted to compare PRE, POST and POST2 outcomes. Qualitative data was collected via a semi structured interview with each participant after the program. RESULTS Significant improvements were observed from PRE to POST for PSS (P=.03) and the SCS (P=.003), with continued improvements demonstrated at POST2. Although acceptance showed an improved trend from PRE to POST to POST2, only the ICQ helplessness scale was close to being significant (P=.05). Several secondary outcomes improved significantly from PRE to POST2 including FMI (P=0.003) and the PROMIS subscales of fatigue (P=.04) and sleep (P=.03). The qualitative findings supported the quantitative results and provided a deeper understanding of the impact on participants. CONCLUSIONS These results demonstrate how a virtual mindfulness program adapted for stroke may benefit survivors including decreasing stress and increasing self-compassion. Although changes in acceptance were not significant, a trend of improvement from PRE to POST to POST2 was observed and worthy of further investigation. Significant improvements were also observed for secondary outcomes of fatigue and sleep. Virtual mindfulness programs offer a feasible and promising approach to help survivors move forward with life after stroke. Due to small sample size, results should be interpreted appropriately and further research is recommended. CLINICALTRIAL No registration

Background: Stroke is a leading cause of serious, long-term disability and has a sudden onset. Upon discharge to the home setting, families are thrust into providing care, often without sufficient training from health care providers. Aligned with current patient and caregiver guidelines, the Telehealth Assessment and Skill-Building Kit (TASK III) is a nurse-led intervention designed to empower caregivers to address their own needs and those of the survivor using innovative skill-building strategies. Objective: This study aims to test the short-term (immediately after the intervention at 8 wk) and long-term (12, 24, and 52 wk) efficacy of the TASK III intervention, compared with an information, support, and referral (ISR) group, to improve caregiver life changes (ie, changes in physical health, physical functioning, emotional well-being, and general health) as a result of providing care. Methods: A randomized controlled clinical trial design will be used with baseline data collection from 296 family caregivers by telephone after the stroke survivor is discharged home. Caregivers randomly assigned to the ISR group (n=148, 50%) will receive information from the American Heart Association about stroke family caregiving. Caregivers randomly assigned to the TASK III group (n=148, 50%) will receive a TASK III resource guide and information from the American Heart Association. Both groups will receive 8 weekly calls from a nurse, with a booster call a month later. Outcomes will be assessed by blinded data collectors at 8, 12, 24, and 52 weeks. The primary outcome (at 8 wk) is caregiver life changes measured by the Bakas Caregiving Outcomes Scale. Secondary outcomes are depressive symptoms; other symptoms (eg, stress, fatigue, sleep, pain, and shortness of breath); unhealthy days; diet; exercise; and self-reported health care use. Mediators are task difficulty, threat appraisal, and self-efficacy. Program evaluation outcomes (satisfaction and technology ratings) will also be analyzed. Results: The trial was registered on March 10, 2022. Enrollment and random assignment of the first participant was on November 30, 2022, with an anticipated completion of recruitment by November 30, 2025. Completion of the primary end point data analysis is anticipated by August 31, 2026, with results expected to be reported on ClinicalTrials.gov by April 1, 2027. As of October 9, 2024, a total of 198 (66.9% of the proposed total sample of 296) family caregivers have been enrolled and randomly assigned to the TASK III group (n=98, 49.5%) or the ISR group (n=100, 50.5%). The last update was performed on January 25, 2024. Conclusions: If the TASK III intervention is shown to be efficacious in the proposed randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care, providing a tremendous public health impact. Trial Registration: ClinicalTrials.gov NCT05304078; https://clinicaltrials.gov/study/NCT05304078 International Registered Report Identifier (IRRID): DERR1-10.2196/67219

BACKGROUND Stroke is a leading cause of serious, long-term disability and has a sudden onset. Upon discharge to the home setting, families are thrust into providing care, often without sufficient training from health care providers. Aligned with current patient and caregiver guidelines, the Telehealth Assessment and Skill-Building Kit (TASK III) is a nurse-led intervention designed to empower caregivers to address their own needs and those of the survivor using innovative skill-building strategies. OBJECTIVE This study aims to test the short-term (immediately after the intervention at 8 wk) and long-term (12, 24, and 52 wk) efficacy of the TASK III intervention, compared with an information, support, and referral (ISR) group, to improve caregiver life changes (ie, changes in physical health, physical functioning, emotional well-being, and general health) as a result of providing care. METHODS A randomized controlled clinical trial design will be used with baseline data collection from 296 family caregivers by telephone after the stroke survivor is discharged home. Caregivers randomly assigned to the ISR group (n=148, 50%) will receive information from the American Heart Association about stroke family caregiving. Caregivers randomly assigned to the TASK III group (n=148, 50%) will receive a TASK III resource guide and information from the American Heart Association. Both groups will receive 8 weekly calls from a nurse, with a booster call a month later. Outcomes will be assessed by blinded data collectors at 8, 12, 24, and 52 weeks. The primary outcome (at 8 wk) is caregiver life changes measured by the Bakas Caregiving Outcomes Scale. Secondary outcomes are depressive symptoms; other symptoms (eg, stress, fatigue, sleep, pain, and shortness of breath); unhealthy days; diet; exercise; and self-reported health care use. Mediators are task difficulty, threat appraisal, and self-efficacy. Program evaluation outcomes (satisfaction and technology ratings) will also be analyzed. RESULTS The trial was registered on March 10, 2022. Enrollment and random assignment of the first participant was on November 30, 2022, with an anticipated completion of recruitment by November 30, 2025. Completion of the primary end point data analysis is anticipated by August 31, 2026, with results expected to be reported on ClinicalTrials.gov by April 1, 2027. As of October 9, 2024, a total of 198 (66.9% of the proposed total sample of 296) family caregivers have been enrolled and randomly assigned to the TASK III group (n=98, 49.5%) or the ISR group (n=100, 50.5%). The last update was performed on January 25, 2024. CONCLUSIONS If the TASK III intervention is shown to be efficacious in the proposed randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care, providing a tremendous public health impact. CLINICALTRIAL ClinicalTrials.gov NCT05304078; https://clinicaltrials.gov/study/NCT05304078 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/67219

Family caregivers exhibit a wide variety of needs and concerns while providing care to stroke survivors after discharge to the home setting. We report the results of two related studies utilizing a multimethod design in which stroke family caregivers (N = 12; N = 10) were interviewed using open‐ended questions, followed by written caregiver ratings regarding the types of telehealth technologies they preferred for the telephone assessment and skill‐building kit (TASK III). Qualitative data were analyzed using content analysis procedures with a provisional “start list” of codes in a matrix template based on the types of telehealth technologies in the rating forms. Descriptive statistics were used to analyze ratings with response scales ranging from 1 = strongly disagree to 5 = strongly agree. Average ratings for the telehealth technologies for the TASK III resource guide were obtained for the mailed hard copy binder (M = 3.58–4.13; SD = 0.35–1.00), an interactive website (https://www.task3web.com/; M = 3.86–4.17; SD = .72–1.07), an eBook (M = 3.17–3.67; SD = 0.84–1.17), and a USB drive (M = 3.75–4.00; SD = .82–.96). Average ratings for the telehealth technologies for the TASK III calls with the nurse were obtained for the use of a telephone (M = 4.36–5.00; SD = 0.00–0.89), FaceTime on an iOS device (e.g., iPhone or iPad; M = 3.73–4.40; SD = 0.79–0.98), or online videoconferencing (M = 3.17–3.50; SD = 0.82–1.47). Qualitative data revealed a wide variety of preferences for each type of telehealth technology, with advantages and disadvantages of each. The findings underscored the importance of offering multiple telehealth technology options to stroke family caregivers. Future studies are recommended that employ randomized control trial methodology to test theoretically‐based interventions that are based on stroke family caregiver preferences for telehealth technologies.

Background and Objectives: High-intensity interval training (HIIT) is a promising strategy for improving gait and fitness after stroke, but optimal parameters remain unknown. We tested the effects of short vs long interval type and over-ground vs treadmill mode on training intensity. Methods: Using a repeated measures design, 10 participants with chronic hemiparesis performed 12 HIIT sessions over 4 weeks, alternating between short and long-interval HIIT sessions. Both protocols included 10 minutes of over-ground HIIT, 20 minutes of treadmill HIIT and another 10 minutes over-ground. Short-interval HIIT involved 30 second bursts at maximum safe speed and 30–60 second rest periods. Long-interval HIIT involved 4-minute bursts at ~90% of peak heart rate (HR_peak) and 3-minute recovery periods at ~70% HR_peak. Results: Compared with long-interval HIIT, short-interval HIIT had significantly faster mean overground speeds (0.75 vs 0.67 m/s) and treadmill speeds (0.90 vs 0.51 m/s), with similar mean treadmill HR (82.9 vs 81.8%HR_peak) and session perceived exertion (16.3 vs 16.3), but lower overground HR (78.4 vs 81.1%HR_peak) and session step counts (1481 vs 1672). For short-interval HIIT, training speeds and HR were significantly higher on the treadmill vs. overground. For long-interval HIIT, the treadmill elicited HR similar to overground training at significantly slower speeds. Conclusions: Both short and long-interval HIIT elicit high intensities but emphasize different dosing parameters. From these preliminary findings and previous studies, we hypothesize that overground and treadmill short-interval HIIT could be optimal for improving gait speed and overground long-interval HIIT could be optimal for improving gait endurance.