Stroke is a leading cause of disability in Australia. In 2020, a Deloitte Access Economics study, commissioned by the Stroke Foundation, estimated the national economic impact of stroke that year was $6.2 billion in direct financial costs and a further $26.0 billion in lost wellbeing and premature mortality. Some 445,000 stroke survivors – and their families – were dealing daily with the emotional cost. And the number is growing. More people are surviving stroke. The challenge is to maximise their recovery – and quality of life – through rehabilitation.
JCU has secured Townsville a place in a national stroke rehabilitation trial – the first of its kind in the world. The North Queensland city is the only regional centre in Australia participating in the $993,000 study, which is testing a new approach to restoring communication and hand and arm function in stroke survivors.
Townsville University Hospital (TUH), JCU and Alliance Rehabilitation have joined forces to deliver the trial in regional Queensland, where it aims to recruit participants from Townsville and Cairns. A total of 160 stroke survivors Australia-wide will take part in the study, funded by the Medical Research Future Fund.
“Our participation will help give a voice to regional and rural areas in terms of research and what our communities need,” said JCU Senior Lecturer in Physiotherapy, Dr Moira Smith, the Townsville coordinator of the trial.
Ready access to stroke rehabilitation can be challenging in rural and regional areas. The UPper limb and Language Impairment and Functional Training (UPLIFT) trial, which commenced in April 2023, is testing a new rehabilitation model via both in-clinic and telehealth at-home delivery. JCU has previously pioneered telehealth for cancer care and diabetes management.
Regaining the ability to walk is often the main priority, as it allows stroke survivors to leave hospital sooner. But one in six stroke survivors experience long-term problems with both arm movement and communication, which affect many aspects of daily life, including dressing, eating and communicating with others.
Both arm movement and communication share common pathways in the brain – which may explain why many people use hand gestures while talking or to convey other messages through sign language.
The UPLIFT project aims to establish whether combining communication therapy with arm and hand therapy, delivered through high intensity training regimes, achieves better results than standard approaches.
At present, depending on accessibility to rehab services, a stroke survivor does well to undertake an hour-long training session twice a week at an outpatient therapy clinic, and practise prescribed exercises at home, independently or with the assistance of family members.
UPLIFT is upping the ante. Participants will be randomly assigned to undertake either two or four hours of training per day, five days a week, for four weeks, under the guidance of a physiotherapist, occupational therapist, and speech pathologist.
Those with mild to moderate disability may receive telerehabilitation training at home, via video calls, while participants with more severe impairment will attend the Alliance Rehabilitation centre in Townsville.
The trial is open to Townsville and Cairns residents who have recently suffered their first stroke – between three and 24 months prior to joining the trial – and now have difficulty with arm movement and communication. (Cairns participants offered in-clinic training must be able to relocate to Townsville for the duration of the trial.)
“This post-acute period is when the potential for recovery is greatest and people are more likely to tolerate this intensity of training,” said UPLIFT JCU Principal Investigator, Associate Professor, Rehabilitation, Ruth Barker.
At AITHM, JCU and TUH therapists will conduct a baseline assessment of each participant, before they commence the trial, to gauge their current level of upper limb and communication skills. The participants will be re-assessed again at the end of their four-week training period.
The assessments will be “blinded”, i.e., the assessors will not know which particular UPLIFT training regime – number of hours and training location – a participant undertakes with their Alliance Rehabilitation therapists.
The baseline assessment may be confronting for some participants, acknowledged Dr Smith. “It highlights the difficulties that they have. But it also highlights their abilities,” she added. “It gives us a starting point for their rehabilitation journey, including the goals they wish to achieve, that therapists can work towards with them.”
To ensure standardised delivery of training and other components of the trial Australia-wide, all participating therapists have undergone pre-trial training through the University of Melbourne, where trial initiator and Coordinating Principal Investigator, Associate Professor Kate Hayward, is based. A physiotherapist, she completed her Honours degree at JCU in 2008, with a study on upper limb recovery after stroke, supervised by A/Professor Barker.
UPLIFT’s Townsville project partners, all seasoned rehabilitation researchers and/or therapists, have welcomed the opportunity to contribute to the trial, which will run until March 2025. They are keen to provide a regional perspective on stroke rehabilitation – and demonstrate the capacity of the region to pull its weight in any future national trials.
Most importantly, we want stroke survivors in our region to have the opportunity to participate in this national trial because we know that access to clinical trials can improve outcomes,” said A/Professor Dr Barker.
Furthermore, “As a regional site, we would love to see the trial results used to guide service development and planning to ensure regional Australians have access to exceptional, evidence-based stroke rehabilitation care,” said Claire Hession, one of the TUH researchers who will recruit and assess trial participants.
Alliance Rehabilitation CEO, Andrea van Grinsven, added, “We feel incredibly privileged to have this opportunity to contribute right here on our doorstep. We are excited for the opportunity this presents for both our clinicians and local participants.”