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Trial registered on ANZCTR
Registration number
ACTRN12616000340437
Ethics application status
Approved
Date submitted
11/03/2016
Date registered
16/03/2016
Date last updated
16/03/2016
Type of registration
Retrospectively registered
Titles & IDs
Public title
Efficacy of the Assessment for Rehabilitation tool in improving proportions of patients with stroke assessed for rehabilitation
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Scientific title
Efficacy of the Assessment for Rehabilitation tool in improving proportions of patients with stroke assessed for rehabilitation: A mixed methods cluster randomised trial.
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Secondary ID [1]
288742
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
stroke
297984
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Condition category
Condition code
Physical Medicine / Rehabilitation
298138
298138
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0
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Other physical medicine / rehabilitation
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Stroke
298157
298157
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0
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Haemorrhagic
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Stroke
298158
298158
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0
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Ischaemic
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Multifaceted behaviour change intervention for health professionals working in acute stroke units. All sessions conducted onsite at acute hospitals. Comprised of
1. education sessions: Two education sessions delivered onsite to acute stroke unit team by research physiotherapist (>10 years clinical experience). Both education sessions (duration 30-60 minutes) held within a 1 month period, participants were invited to attend both sessions. Education regarding Assessment for Rehabilitation Tool (rationale for use, how to use) provided. Up to 3 additional education sessions provided if this was nominated as a strategy by participants in the strategy development workshop
2. Printed educational materials: paper copies of the Assessment for Rehabilitation Tool, and 3 copies of Assessment for Rehabilitation Tool user manual provided to acute stroke unit teams. Information provided regarding freely available associated electronic resources
3. Audit and feedback: medical record audit conducted by research physiotherapist, site-specific feedback provided verbally and written (paper-version) summary of audit distributed to participants working on acute stroke unit by research PT re proportions of patients assessed for rehabilitation, profiles of patients not assessed in audit, profiles of professionals who conducted the assessments in the audit, summary of assessment processes and access to rehabilitation
4. barrier identification and strategy development: workshops held with acute stroke unit team at each site (facilitated by research physiotherapist) to identify barriers to use of Assessment for Rehabilitation Tool, followed immediately by strategy development session (combined session 60 minute duration)
5. Site champions: each site nominated 1-3 site champions to lead implementation of strategies developed in workshop
6. reminders: 1-2 emails sent to all workshop participants by research PT regarding strategies developed to use Assessment for rehabilitation Tool. Monthly phone or email contact between research PT and site champion for 4 months following initial education session (more contact if initiated by site champion) to discuss implementation of strategies.
Records kept by research PT re which health professionals attended education sessions and strategy development workshop
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Intervention code [1]
294177
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Other interventions
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Comparator / control treatment
Education intervention for health professionals working in acute stroke units
1. education session (1 only, 30 minute duration) delivered onsite to acute stroke unit team by research physiotherapist (>10 years clinical experience). Education regarding Assessment for Rehabilitation Tool (rationale for use, how to use) provided.
2. Printed educational materials: paper copies of the Assessment for Rehabilitation Tool, and 3 copies of Assessment for Rehabilitation Tool user manual provided to acute stroke unit teams. Information provided regarding freely available associated electronic resources
Records kept by research PT re which health professionals attended the education session
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Control group
Active
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Outcomes
Primary outcome [1]
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Proportions of patients with stroke who received a documented assessment for rehabilitation. Data collected by assessor blinded to hospital allocation via medical record audit. Also collecting data regarding details of assessment (conducted by which health discipline, recommendation from assessment),
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Assessment method [1]
297648
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Timepoint [1]
297648
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6 months post-commencement of intervention
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Secondary outcome [1]
321685
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Proportions of patients who accessed stroke rehabilitation following discharge from acute hospital, collected via medical record audit by assessor blinded to hospital allocation. Details collected regarding rehabilitation setting (home, community, inpatient setting)
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Assessment method [1]
321685
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Timepoint [1]
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6 months post-commencement of intervention
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Secondary outcome [2]
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Self-reported rehabilitation assessment and referral practices at each stroke unit. Factors identified by health professionals working on acute stroke units that influenced rehabilitation assessment and referral practices. Data collected by focus groups at each site, facilitated by research PT
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Assessment method [2]
321768
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Timepoint [2]
321768
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4-6 months post-commencement of intervention sessions
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Eligibility
Key inclusion criteria
For medical record audit: Admitted to hospital with stroke
To be included in interventions and focus groups: health professional working on acute stroke unit
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Minimum age
18
Years
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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?
Yes
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Key exclusion criteria
For medical record audit: No signs of stroke on admission to hospital, receiving palliative care, transferred to another hospital for acute management/investigation
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Study design
Purpose of the study
Educational / counselling / training
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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)
Randomisation schedule generated by computer program by a third party blind to the specific hospital list
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
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Type of endpoint/s
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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
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Actual
1/10/2012
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Date of last participant enrolment
Anticipated
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Actual
1/08/2014
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
620
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Accrual to date
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Final
586
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Recruitment in Australia
Recruitment state(s)
NSW,SA
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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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Department of Education and Training
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Address [1]
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Department of Education and Training
GPO Box 9880
Canberra ACT 2601
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Country [1]
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Australia
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Primary sponsor type
University
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Name
University of South Australia
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Address
PO Box 2471
Adelaide
SA 5001
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Country
Australia
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Secondary sponsor category [1]
291879
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Government body
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Name [1]
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NSW Agency for Clinical Innovation
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Address [1]
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Level 4,
67 Albert Avenue,
Chatswood NSW 2067
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Country [1]
291879
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Australia
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Secondary sponsor category [2]
291880
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Charities/Societies/Foundations
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Name [2]
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National Stroke Foundation
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Address [2]
291880
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Level 7,
461 Bourke Street
Melbourne VIC 3000
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Country [2]
291880
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Australia
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Secondary sponsor category [3]
291881
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Government body
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Name [3]
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SA Health
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Address [3]
291881
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PO Box 287
Rundle Mall
Adelaide SA 5000
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Country [3]
291881
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
294599
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SA healthHREC
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Ethics committee address [1]
294599
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Level 10 Citi-centre Building 11 Hindmarsh Square Adelaide 5000
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Ethics committee country [1]
294599
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Australia
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Date submitted for ethics approval [1]
294599
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01/08/2012
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Approval date [1]
294599
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28/08/2012
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Ethics approval number [1]
294599
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HREC/12/SAH/31
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Ethics committee name [2]
294600
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Sydney Local Health District RPAH zone HREC
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Ethics committee address [2]
294600
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Research Development Office Royal Prince Alfred Hospital Camperdown NSW 2050
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Ethics committee country [2]
294600
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Australia
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Date submitted for ethics approval [2]
294600
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14/11/2012
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Approval date [2]
294600
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26/11/2012
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Ethics approval number [2]
294600
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HREC/12/RPAH/523
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Summary
Brief summary
This project will use a cluster randomised trial design to assess the effectiveness of an implementation program designed to increase proportions of patients with stroke receiving a documented assessment for rehabilitation. Hospitals (clusters) will be randomly assigned to receive a multifaceted intervention or an education-only intervention. The multifaceted intervention consists of a decision-making tool, education, audit and feedback, reminders and a tailored implementation package consisting of identification of barriers and facilitators and development of site-specific strategies for implementation (identified in a workshop with health professionals as participants) to help improve rehabilitation assessment practices. The education-only intervention consists of a single education session and provision of a decision-making tool. Observations will be conducted at sites assigned to the multifaceted intervention to observe how assessment are occurring prior to the intervention prior to the intervention. Focus groups will be held at all sites after the implementation period to explore how staff assess and refer patients with stroke for rehabilitation Medical records will be audited pre- and post-intervention at all hospitals to assess proportions of patients assessed for rehabilitation, and proportions of patients who access rehabilitation.
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Trial website
NA
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Trial related presentations / publications
E Lynch, J Luker, D Cadilhac, S Hillier (2015): Inequities in access to rehabilitation: Exploring how acute stroke unit clinicians decide who to refer to rehabilitation. Disability and Rehabilitation. Nov 25:1-10. [Epub ahead of print] E Lynch, J Luker, D Cadilhac, S Hillier (2015): Rehabilitation assessments for patients with stroke in Australian hospitals do not always reflect rehabilitation requirements. Archives of Physical Medicine and Rehabilitation 96: 782-9.
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Public notes
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Contacts
Principal investigator
Name
64314
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Dr Elizabeth Lynch
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Address
64314
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International Centre of Allied Health Evidence
University of South Australia
GPO Box 2471
Adelaide
5001
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Country
64314
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Australia
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Phone
64314
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+61 8 8302 2099
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Fax
64314
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Email
64314
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[email protected]
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Contact person for public queries
Name
64315
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Elizabeth Lynch
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Address
64315
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International Centre of Allied Health Evidence
University of South Australia
GPO Box 2471
Adelaide
5001
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Country
64315
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Australia
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Phone
64315
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+61 8 8302 2099
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Fax
64315
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Email
64315
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[email protected]
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Contact person for scientific queries
Name
64316
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Elizabeth Lynch
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Address
64316
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International Centre of Allied Health Evidence
University of South Australia
GPO Box 2471
Adelaide
5001
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Country
64316
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Australia
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Phone
64316
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+61 8 8302 2099
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Fax
64316
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Email
64316
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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
Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial.
2016
https://dx.doi.org/10.1186/s13012-016-0487-2
N.B. These documents automatically identified may not have been verified by the study sponsor.
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