Community Participation Transition After Stroke

Washington University School of Medicine15 enrolled

Overview

Stroke is one of the most serious, disabling health conditions in the United States. Patients who undergo rehabilitation treatment for stroke have a high rate of disability. Poor outcomes for many persons with stroke may be low because of incomplete treatment. The investigators will conduct a randomized controlled trial and a process evaluation to examine the feasibility, safety, and preliminary efficacy of an enhanced rehabilitation transition program, Community Participation Transition after Stroke (COMPASS), designed to bridge inpatient rehabilitation and the home to support the performance of everyday activities.

We propose an enhanced rehabilitation transition program: Community Participation Transition after Stroke (COMPASS) is a compensatory intervention consisting of one pre-discharge and five post-discharge home visits by an occupational therapist to supplement usual care. This intervention is focused on resolving barriers to independence in daily activities and participation using environmental support and active practice of daily activities in an individual's real home (versus an idealized clinical setting). This is a new combination of evidence-based compensatory treatments delivered in a novel treatment setting (transition to home). Our long-term goal is the development of an effective intervention for a transition home designed to prevent excess disability for people living with stroke that could have an immediate effect and high public health significance.16 We will recruit 40 patients currently undergoing inpatient rehabilitation (IR) for ischemic stroke from longitudinal studies of stroke at Washington University School of Medicine (WUSM) and randomize them to receive six additional sessions of the enhanced rehabilitation transition program or attention control. Exploratory participation outcomes will be assessed by blinded evaluators at baseline, 6 months, 9 months, and 12 months after stroke. We will test the central hypothesis that COMPASS will be acceptable, feasible, and superior to attention control on measures of participation and daily activity performance at 6 months after stroke.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

Conditions

Stroke

Interventions

Education GroupBEHAVIORAL

Attention will be provided to the control group to ensure they experience the same effects of time and attention but no effect on the outcome of interest.

Home Modifications GroupBEHAVIORAL

The standardized components include assessment, identification of five problematic activities (and environmental barriers), identification of three solutions (for each problem), implementation of a solution set selected by the participant, training, and active practice of daily activities in one's own home and community.

Eligibility

Sex: ALLMin age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. ≥45 years old 2. acute ischemic stroke, verified by a neurologist 3. baseline National Institutes of Health Stroke Scale (NIHSS) ≥8 4. independent in activities of daily living prior to stroke (premorbid Rankin score of ≤2) 5. plan to discharge to home Exclusion Criteria: 1. severe terminal systemic disease that limits life expectancy to \<6 months 2. previous disorder (e.g., dementia) that makes interpretation of the self-rated scales difficult or a Short Blessed Test (SBT) score of ≥9 (indicating significant cognitive impairment) 3. moderate to severe aphasia, as determined by the NIHSS Best Language rating of ≥2 4. residence in a congregate living facility 5. not eligible for a therapeutic pass

Locations (1)

Washington University School of Medicine

St Louis, Missouri, United States

Outcomes

Primary Outcomes

Rate and Severity of Falls (Calculated With an Algorithm)

We will explore the safety of the intervention by determining the rate and severity of falls (calculated with an algorithm). Scores are as follows: 0, those with no falls, 1, those with one fall without serious injury, 2, those with at least two falls without serious injury, and 3, those with one or more falls causing serious injury. Maximum score of three indicates an increased severity of fall. We will compare the difference in scores between groups using t-tests.

Time frame: 12 months

Secondary Outcomes

Intervention Dose (Minutes)

The does of the intervention as measured in minutes received by both groups. The number of minutes reported is the average of the total for each participant in each group.

Time frame: 2 months

Health Care Utilization, Number of Emergency Department Visits

We analyzed health care utilization by examining the number of emergency department visits, outpatient physical and occupational therapy visits, and doctor visits. The total number of each was calculated for each participant and the average is reported here.

Time frame: 12 months

Intervention Dose, Number of Treatment Sessions

The does of the intervention as measured by amount of treatment minutes received by both groups. The total number of treatment sessions was calculated for each participant and the average is reported here.

Time frame: 2 months

Health Care Utilization, Days of Hospitalization

We analyzed health care utilization by examining the number of days participants in each group spent in the hospital. The total number of days was calculated for participants in each group and the average is reported here.

Time frame: 12 months

Data from ClinicalTrials.gov

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