The LAST study is a Norwegian multi site randomised controlled trial that intends to assess the effect of a long term follow up program after stroke. The program consists of a coordinating physiotherapist who will encourage and motivate included patients to perform at least 60 minutes of intensive motor training every week and 30 minutes of physical activity every day for 18 months after inclusion. The primary hypothesis is that patients receiving a long term follow up program after stroke will have better motor function at end of follow up than patients receiving standard care. A total of 390 home dwelling stroke patients living in the municipality of Trondheim, Asker and Bærum will be included at the out-patient clinic at St. Olavs Hospital or Bærum Hospital three months after their stroke. Included patients will be randomised to an intervention group receiving the long term follow up program or to a control group receiving standard care. Motor function, mental health and physical functioning in daily life will be assessed at inclusion and 18 months later. The LAST study is funded by the Norwegian Research Council, the Norwegian University of Science and Technology and the Central Norway Regional Health Authority and will conclude at the end of 2015.
Supplement to the Life After Stroke - the LAST study ClinicalTrials.gov ID: NCT01467206 Changes in the planned statistical analysis, November 9, 2015 The original plan for statistical analysis was published in; Askim T, Langhammer B, Ihle-Hansen H, Magnussen J, Engstad T, Indredavik B. A Long-Term Follow-Up Programme for Maintenance of Motor Function after Stroke: Protocol of the life after Stroke-The LAST Study. Stroke Res Treat. 2012;2012:392101. doi: 10.1155/2012/392101. Epub 2012 Nov 22. Original plan for statistical analysis Reporting will follow the CONSORT statement for parallel group randomized trials \[40\]. Descriptive statistics will be performed in order to present the population and the characteristic of the two groups. All analyses will be analysed as intention-to-treat analysis according to the CONSORT instructions. Analysis of covariance (ANCOVA) will be used to study differences between groups according to the primary endpoint, motor assessment scale at 18 months after inclusion. The ANCOVA model will include stroke severity, age, pre stroke disability, treatment group, and motor function at baseline as covariates. Mann-Whitney U test will be used for secondary data not being normal distributed. In all analyses we will control for potential confounding factors, investigate effect modifications, and present both unadjusted and adjusted effects with 95% confidence intervals. Subanalysis will be performed according to the stratification variables (stroke severity, age above 80 and recruitment site) to explore trends within subgroups of patients. Revised plan for statistical analysis Reporting will follow the CONSORT statement for parallel group randomized trials \[40\]. Descriptive statistics will be performed in order to present the population and the characteristic of the two groups. All analyses will be analysed as intention-to-treat analysis according to the CONSORT instructions. Analysis of covariance (ANCOVA) will be used to study differences between groups according to the primary endpoint, motor assessment scale at 18 months after inclusion. The ANCOVA model will include stroke severity, age, pre stroke disability, treatment group, and motor function at baseline as covariates. Similar ANCOVA analyses will be used for the relevant secondary endpoints. Mann-Whitney U test will be used for secondary data not being normal distributed. Subanalysis will be performed according to the stratification variables (stroke severity, age above 80 and recruitment site), gender, and cognitive status (Mini Mental State below 25), to explore trends within subgroups of patients. Missing values will be handled using single imputation (typically for items on instrument scales), or by multiple imputation, as appropriate.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
380
Monthly meetings with an coordinating physiotherapist who motivate and encourage the patient to do 60 minutes of weekly exercise and 30 minutes of daily physical activity
Standard care as it is given to all stoke patients after stroke
Bærum Hospital
Sandvika, Norway
St. Olavs Hospital
Trondheim, Norway
Motor Assessment Scale
A measure of over all motor function
Time frame: 18 months after inclusion
Barthel Index
A measure of activities of daily living
Time frame: 18 months follow up
Modified Rankin Scale
A measure of dependency/independency
Time frame: 18 months follow up
Berg Balance Scale
A measure of balance related to basic movement tasks
Time frame: 18 months follow up
Timed Up and Go
A measure of balance related to transfer and walking
Time frame: 18 months follow up
Sit to stand test
A measure of dynamic muscle strength according to a sit to stand task
Time frame: 18 months follow up
Six minute walk test
A measure of endurance
Time frame: 18 months follow up
Stroke Impact Scale
A measure of health related quality of life after stroke
Time frame: 18 months follow up
EuroQol 5D
A simple measure of health related quality of life for the general population
Time frame: 18 months follow up
Fatigue Severity Scale
A measure of the presence of fatigue
Time frame: 18 months follow up
One simple question on fatigue from the HUNT3 questionnaire
A simple question used to assess tiredness in teh general Norwegian population
Time frame: 18 months follow up
Hospital Anxiety and Depression Scale
A measure of anxiety and depression
Time frame: 18 months follow up
Mini Mental State Examination
A measure of cognitive function
Time frame: 18 months follow up
Montreal Cognitive Assessment
A measure of cognitive function related to vascular dementia
Time frame: 18 months follow up
falls
Serious falls will be recorded from the patients hospital records
Time frame: 6, 12 and 18 months
Readmission to hospital
Number of readmissions to hospital will be recorded from the patients medical records
Time frame: 6, 12 and 18 months
Death
Information about death will be collected from the Norwegain Death Registry
Time frame: 6, 12 and 18 months
Fractures
Information about fractures during follow up will be collected from the patients medical records
Time frame: 6, 12 and 18 months
Cardiovascular events
Information about any cardiovascular events will be collected from the patients medical record
Time frame: 6, 12 and 18 months
Cerebrovascular events
Information about any cerebrovascular events during follow up will be collected from teh patient's medical records
Time frame: 6, 12 and 18 months
International Physical Activity Questionnaire
A measure of physical activity over the last week
Time frame: 6, 12 and 18 months
Physical activity assessed by ActivPAL sensor system
A sensor system to assess the amount of physical activity during a 4-7 day period
Time frame: 6, 12 and 18 months
Three simple questions on physical activity from the HUNT questionnaire
A simple measure of physical activity
Time frame: 18 months
Health costs
Information about the use of health services will be collected by reviewing the patients' hospital records and records in primary health care system.
Time frame: 6, 12 and 18 months
National Institutes of Health Stroke Scale
A measure of stroke severity
Time frame: 18 months follow up
Modified Ashworth Scale
A measure to rate the degree of spasticity after stroke
Time frame: 18 months follow up
Gait speed
A simple measure of maximum gait speed across a 10 metres distance
Time frame: 18 months follow up
Trailmaking test A and B
A simple measure of executive cognitive function
Time frame: 18 months follow up
DS-14
A standard assessment of negative affectivity, social inhibition, and type D personality, which might be related to poor cardiovascular prognosis.
Time frame: 18 months follow up
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