LifeCIT Development and pilot evaluation of a web-supported programme of Constraint Induced Therapy following stroke (LifeCIT) Meagher C 1, Conlon A 2, Hughes AM 1, Pollet S 1, Yardley L 2, Burridge, JH 1 1 Faculty of Health Sciences, University of Southampton, UK 2 Faculty of Social and Human Sciences, University of Southampton, UK Constraint Induced Therapy (CIT) is an evidence based intensive intervention which has not been widely implemented in UK stroke rehabilitation practice. A team at the University of Southampton has developed a website authoring tool (‘LifeGuide’). LifeGuide allows researchers and therapists to create web based interventions for online healthcare therapy support. We are currently using LifeGuide to develop a web supported CIT system (‘LifeCIT’) for upper limb post- stroke rehabilitation. 1)STAGE 1: To use qualitative methodologies, with patients, carers and therapists in order to develop a web-based programme for CIT. 2)STAGE 2: Conduct a pilot study of LifeCIT to: a) assess the effects of the intervention on: upper limb function and quality of life b) estimate the effect size of the intervention compared with usual care c) establish adherence to LifeCIT. d) carry out a preliminary evaluation of the relative economic costs and benefits of this method of providing rehabilitation following stroke. STAGE 1 To identify and implement the necessary components of this web-based intervention, qualitative “think aloud studies” were carried out with a purposive sample of 4 chronic stroke patients. Data collection and analysis has been concurrent with intervention development, allowing immediate modification and re-testing of intervention components as potential improvements have been identified. We anticipate to recruit 12 acute stroke patients in early 2012 and their carers/therapists to take part in further ‘think aloud’ studies. STAGE 2 A pragmatic, randomised controlled, single blinded pilot study of the feasibility, acceptability and clinical effectiveness of this intervention compared to usual care will be conducted with acute stroke patients across 6 NHS Trusts. Participants will receive either three weeks of LifeCIT or usual care. Interim Results: Stage 1 (Development) The need for explicit instructions to navigate the website emerged, as well as a system design with limited choice and self-evident navigation. Data analysis revealed that computer games and activities would be motivational if they had an addictive challenging nature, with a user centred approach. To enable comparison with the EXCITE trial (Wolf et al. 2006) the same primary outcome measure will be used: The Motor Activity Log. Changes in upper limb activity will be compared across the groups. Data will be collected at baseline, after the trial period and at a six month follow up. The findings of the initial qualitative interviews have led to an alteration of the LifeCIT system design, which automatically directs users through the website, rather than having user led navigation. Computer games are currently being developed to be included in LifeCIT. 12 Further interviews will be conducted, allowing for re-testing of intervention components as they are designed. Flow Chart Chronic Stroke patient Interviews LifeCIT system design Acute stroke patient interviews LifeCIT system design Pilot RCT Implementation of Analysis into LifeCIT Design Background Objectives Method Conclusions Future work: Results of Stage 2 (RCT) References: Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Journal of the American Medical Association 2006; 296(17):