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

Objective: It is uncertain whether self-propulsion in a wheelchair should b e 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 un certain whether self-propulsion in a wheelchair should be encouraged were s tudied. Intervention: A central randomization service at Newcastle University was u sed to determine the policy about wheelchair provision and use for each pat ient. They were allocated to either an 'encouraged to self-propel' or a 'di scouraged from self-propulsion group'. Outcome measures used: Independent outcome assessment was performed by post al questionnaire and telephone interview using the Barthel ADL Scale, Notti ngham Extended ADL Scales and the shortened General Health Questionnaire (G HQ-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 discharg ed from hospital. Results: After considerable preparation time it was possible to conduct a t rial on self-propulsion in early stroke rehabilitation in the two-pilot cen tres. No major differences were found between the pilot groups for any of t he outcome measures. Conclusions: A multicentre randomized controlled trial to assess this quest ion is feasible but further work is being conducted before proceeding, to s atisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures.