The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation

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Abstract
Objective: It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation. Design: A two-centre pilot study to assess the feasibility of performing a multicentre randomized controlled trial on this subject. Setting: Clatterbridge and Aintree Stroke Rehabilitation Units, Merseyside, UK. Subjects: Forty early stroke patients (mean age 67 years) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied. Intervention: A central randomization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient. They were allocated to either an ‘encouraged to self-propel’ or a ‘discouraged from self-propulsion group’. Outcome measures used: Independent outcome assessment was performed by postal questionnaire and telephone interview using the Barthel ADL Scale, Nottingham Extended ADL Scales and the shortened General Health Questionnaire (GHQ-12) at 3 and 12 months. Patient's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital. Results: After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres. No major differences were found between the pilot groups for any of the outcome measures. Conclusions: A multicentre randomized controlled trial to assess this question is feasible but further work is being conducted before proceeding, to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures. Address for correspondence: JA Barrett, Clatterbridge Hospital, Wirral, Merseyside CH69 4JY, UK. e-mail: jabarrett@clatterbridgesru.freeserve.co.uk