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Clin Rehabil. 2015 Dec;29(12):1198-211. doi: 10.1177/0269215514565396. Epub 2015 Jan 27.

Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke.

Author information

1
Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada nancy.mayo@mcgill.ca.
2
Department of Human Ecology, University of Alberta, Alberta, Canada.
3
Department of Physical Therapy, University of Manitoba, Manitoba, Canada.
4
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
5
School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.
6
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
7
Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
8
Education and Applied Research, Aphasia Institute - The Pat Arato Aphasia Centre, Toronto, ON, Canada.
9
School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
10
McGill University Health Center (MUHC), MUHC Research Institute, Montreal, QC, Canada.
11
Department of Rehabilitation and Center for Interdisciplinary Research in Rehabilitation and Social Integration, Laval University, Quebec, Canada.
12
Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada.
13
Department of Physical Medicine and Rehabilitation, Western University, London, UK.
14
Brain and Spinal Cord Rehab Program, UHN-Toronto Rehabilitation Institute, Toronto, ON, Canada.

Abstract

OBJECTIVE:

To enhance participation post stroke through a structured, community-based program.

DESIGN:

A controlled trial with random allocation to immediate or four-month delayed entry.

SETTING:

Eleven community sites in seven Canadian cities.

SUBJECTS:

Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently.

INTERVENTIONS:

Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups.

MAIN MEASURES:

Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months.

RESULTS:

A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97).

CONCLUSIONS:

Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.

KEYWORDS:

Stroke; participation (WHO ICF); randomized controlled trial; rehabilitation interventions

PMID:
25627292
DOI:
10.1177/0269215514565396
[Indexed for MEDLINE]

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