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Trial registered on ANZCTR
Registration number
ACTRN12610000096055
Ethics application status
Approved
Date submitted
22/01/2010
Date registered
1/02/2010
Date last updated
18/12/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Circuit class therapy for rehabilitation after stroke. A pragmatic randomised controlled trial (CIRCIT).
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Scientific title
Is circuit class therapy more effective than usual care over 5 days or usual care over 7 days a week in improving six minute walk test performance in stroke survivors receiving inpatient rehabilitation after stroke?
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Secondary ID [1]
1346
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None
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Universal Trial Number (UTN)
U1111-1113-4627
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Trial acronym
CIRCIT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Stroke
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Condition category
Condition code
Stroke
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0
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Ischaemic
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Stroke
256819
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0
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Haemorrhagic
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Physical Medicine / Rehabilitation
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0
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Physiotherapy
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a 3-armed randomised controlled trial (RCT) to compare two methods of providing an increased amount of physical therapy during stroke rehabilitation to usual care.
Intervention 1 = Circuit class therapy. Participants will receive a target of 3 hours per day (5 days a week) of group circuit class therapy aimed at improving mobility and upper limb function. Circuit class therapy groups will be run with a staff to participant ratio of between 1:4 and 1:6. Participants in this arm of the trial will not receive individual (one-to-one) treatment sessions.
Intervention 2 = 7-day per week therapy. Participants in this arm of the trial will receive usual care physical therapy over 7-days per week. Active therapy time will be capped at 90 minutes per day.
Control arm - usual care (see further description below)
As the trial aims to compare different models of service delivery, the interventions will be provided for the duration of the participants' inpatient stay (average 6 weeks).
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Intervention code [1]
255896
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Rehabilitation
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Comparator / control treatment
Usual care physical therapy. Participants in this arm of the trial will receive usual care physical therapy, 5-days a week, capped at 90 minutes of active therapy time per day. Participants will receive usual care therapy for the duration of their inpatient stay (average 6 weeks).
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Control group
Active
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Outcomes
Primary outcome [1]
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Walking ability (Six minute walk test)
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Assessment method [1]
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Timepoint [1]
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2 and 4 weeks after admission to rehabilitation and at 3 and 6 months post-stroke
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Secondary outcome [1]
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Walking ability (timed 10 metre walk and Functional Ambulation Classification)
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Assessment method [1]
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Timepoint [1]
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2 and 4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [2]
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Ability to perform Activities of Daily Living (Functional Independence Measure)
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Assessment method [2]
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Timepoint [2]
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2 and 4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [3]
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Upper limb function (Wolf Motor Function Test)
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Assessment method [3]
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Timepoint [3]
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2 and 4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [4]
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Stroke Impact Scale (mobility section)
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Assessment method [4]
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Timepoint [4]
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4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [5]
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Quality of life (Assessment of quality of life instrument)
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Assessment method [5]
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Timepoint [5]
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4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [6]
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Participant satisfaction (Hopsat questionnaire)
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Assessment method [6]
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Timepoint [6]
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4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [7]
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Complications (including adverse events). Medical records will be audited to determine the number and nature of all adverse events and new medical conditions experienced while in hospital. These will include (but are not limited to) worsening of stroke symtoms, falls (inlcuding those that do not result in injury), angina, myocardial infarction or chest infections.
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Assessment method [7]
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Timepoint [7]
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4 weeks from start of rehabilitation and 3 and 6 months post-stroke
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Secondary outcome [8]
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Length of hospital stay. This will be taken as the number of days between admission to rehabilitation and discharge from rehabilitation (as documented in the medical records).
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Assessment method [8]
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Timepoint [8]
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at discharge from inpatient rehabilitation
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Secondary outcome [9]
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Resource utilisation. Prospective data will be collected on the amount of therapist time provided to all participants as well as any other related costs such as equipment purchases etc.
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Assessment method [9]
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Timepoint [9]
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During inpatient rehabilitation data will be prospectively collected regarding costs associated with providing the interventions.
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Eligibility
Key inclusion criteria
People admitted to an inpatient rehabilitation facility with a diagnosis of stroke.
A motor Functional Independence Measure (FIM) score of between 38 and 62 points at admission to rehabilitation
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Minimum age
No limit
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
People who required physical assistance from another person to walk prior to their hospital admission.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants will be allocated to groups via a phone-in centralised system off-site to the data collection sites.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated sequence generation, stratified by site.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Nil applicable
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
11/02/2010
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Actual
21/07/2010
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Date of last participant enrolment
Anticipated
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Actual
25/06/2013
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Date of last data collection
Anticipated
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Actual
23/12/2013
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Sample size
Target
282
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Accrual to date
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Final
283
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Council
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Address [1]
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Level 1
16 Marcus Clarke Street
Canberra ACT 2601
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr Susan Hillier
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Address
School of Health Sciences
University of South Australia
PO Box 2471
Adelaide, SA 5001
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Dr Coralie English
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Address [1]
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School of Health Sciences
University of South Australia
PO Box 2471
Adelaide, SA 5001
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Country [1]
251698
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Australia
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Secondary sponsor category [2]
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Individual
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Name [2]
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Professor Maria Crotty
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Address [2]
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Head of Department, Rehabilitation and Aged Care
Flinders University
PO Box 2100
Adelaide SA 5001
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Country [2]
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Australia
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Other collaborator category [1]
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Individual
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Name [1]
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Professor Leonie Segal
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Address [1]
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School of Health Sciences
University of South Australia
PO Box 2471
Adelaide, SA 5001
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Country [1]
1071
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Australia
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Other collaborator category [2]
1072
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Individual
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Name [2]
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Associate Professor Julie Bernhardt
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Address [2]
1072
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National Stroke Research Institute
Neurosciences Building Level 1 Austin Health
300 Waterdale Rd
Heidelberg Heights
VIC 3081
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Country [2]
1072
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Australia
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Other collaborator category [3]
1073
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Individual
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Name [3]
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Professor Adrian Esterman
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Address [3]
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School of Health Sciences
University of South Australia
PO Box 2471
Adelaide, SA 5001
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Country [3]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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University of South Australia Human Research Ethics Committee
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Ethics committee address [1]
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Research and Innovation Services University of South Australia Mawson Lakes Campus Mawson Lakes Boulevard Mawson Lakes SA 5095
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Ethics committee country [1]
258452
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Australia
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Date submitted for ethics approval [1]
258452
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Approval date [1]
258452
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11/01/2010
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Ethics approval number [1]
258452
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P379/09
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Ethics committee name [2]
258453
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Flinders Clinical Research Ethics Committee
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Ethics committee address [2]
258453
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Room 2A221 Flinders Medical Centre Bedford Park SA 5042
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Ethics committee country [2]
258453
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Australia
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Date submitted for ethics approval [2]
258453
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Approval date [2]
258453
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22/12/2010
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Ethics approval number [2]
258453
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1/09/0377
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Summary
Brief summary
Loss of independence is common following stroke, and may lead to reduced quality of life. We will investigate if an increased amount of physical rehabilitation following stroke leads to improvements in walking ability, arm function and independence. Two ways of providing an increased amount of physical rehabilitation will be compared to usual care to find out which leads to improved physical mobility and how they compare economically. The key hypotheses are: 1. Compared to usual care therapy (5 days a week), group circuit class therapy (provided 5 days a week for 3 hours per day) will lead to improvements in walking function and mobility. 2. Compared to usual care therapy (5 days a week) providing physical therapy over 7 days a week will lead to improvements in walking function and mobility. 3. Compared to 7-day a week therapy, group circuit class therapy (5 days a week) will lead to improvements in walking function and mobility. 4. Group circuit class therapy will be more cost-effective than 7-day week therapy.
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Trial website
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Trial related presentations / publications
Van Kessel G, Hiller S and English C (2017) Physiotherapists’ attitudes towards circuit class therapy and 7 day per week therapy is influenced by normative beliefs, past experience and perceived control: a qualitative study Physiotherapy Theory and Practice 33(11): 850-858 https://doi.org/10.1080/09593985.2017.1357152 English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, Bernhardt J, Crotty M, Esterman A, Segal L, Hillier S (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data. Journal of Physiotherapy Vol 62, Issue 3,pp. 124-129. Bennett L, Luker J, English C, Hillier S (2015) Stroke survivors’ perspectives on two novel models of inpatient rehabilitation: seven-day a week individual therapy or five-day a week circuit class therapy. Disability and Rehabilitation Nov 24:1-10 English C, Bernhardt J, Crotty M, Esterman A, Segal L and Hillier S (2015) Circuit class therapy or 7-day week therapy for increasing rehabilitation intensity of therapy after stroke (CIRCIT). A randomised controlled trial. International Journal of Stroke 10: 594-602 DOI:10.1111/ijs.12470 English C, Bernhardt J and Hillier S (2014) Circuit class therapy and 7-day-week therapy increase physiotherapy time, but not patient activity. Early results from the CIRCIT trial. Stroke 45:3002-7. DOI: 10.1161/STROKEAHA.114.006038 English C, Hillier S, Kaur G and Hundertmark L (2014)“Stroke survivors spend more time in active task practice, but similar time in walking practice when physiotherapy is provided in circuit classes versus individual therapy sessions.” Journal of Physiotherapy 60:50-54 http://dx.DOI.org/10.1016/j.jphys.2013.12.006 “Circuit Class Therapy and 7-Day Week Therapy for Increasing Rehabilitation Intensity of Therapy. Results of the CIRCIT Trial” Stroke 2014 Stroke Society of Australasia Annual Scientific Meeting, Hamilton Island July 31-Aug 2nd 2014 English C, Shields N, Brusco N, Taylor N, Watts J, Peiris C, Bernhardt J, Crotty M, Esterman A, Hillier S “Does weekend therapy reduce length of rehabilitation hospital stay for people with stroke? An individual patient data meta-analysis.” World Congress of NeuroRehabilitation Philadelphia, USA May 10-12th 2016 English C, Bernhardt J, Crotty M, Esterman A, Hillier S “Time spent in physiotherapy sessions during sub-acute rehabilitation does not predict recovery of walking ability.” European Stroke Organisation Conference, Glasgow, UK April 17-19 2015 (POSTER) Hillier S, English C, Bernhardt J, Crotty M, Esterman A, Segal L “Circuit class and 7-day week therapy for increasing rehabilitation intensity of therapy after stroke (CIRCIT): Six month follow-up and cost analysis of the CIRCIT RCT 9th World Stroke Congress, Istanbul, Turkey, October 22-25, 2014. International Journal of Stroke 2014 9:22
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Susan Hillier
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Address
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School of Health Sciences, University of South Australia
PO Box 2471
Adelaide, SA 5001
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Country
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Australia
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Phone
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+61 8 83022544
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Susan Hillier
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Address
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School of Health Sciences
University of South Australia
PO Box 2471
Adelaide 5001
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Country
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Australia
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Phone
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+61 8 83022544
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Fax
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+61 8 83022766
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Email
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[email protected]
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Contact person for scientific queries
Name
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Susan Hillier
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Address
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School of Health Sciences
University of South Australia
PO Box 2471
Adelaide 5001
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Country
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Australia
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Phone
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+61 8 83022544
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Fax
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+61 8 83022766
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Circuit class therapy and 7-day-week therapy increase physiotherapy time, but not patient activity: early results from the CIRCIT trial.
2014
https://dx.doi.org/10.1161/STROKEAHA.114.006038
Embase
Circuit class therapy or seven-day week therapy for increasing rehabilitation intensity of therapy after stroke (CIRCIT): A randomized controlled trial.
2015
https://dx.doi.org/10.1111/ijs.12470
N.B. These documents automatically identified may not have been verified by the study sponsor.
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