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

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  • Nancy E Mayo
    Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
  • Sharon Anderson
    Department of Human Ecology, University of Alberta, Alberta, Canada
  • Ruth Barclay
    Department of Physical Therapy, University of Manitoba, Manitoba, Canada
  • Jill I Cameron
    Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
  • Johanne Desrosiers
    School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
  • Janice J Eng
    Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
  • Maria Huijbregts
    Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
  • Aura Kagan
    Education and Applied Research, Aphasia Institute – The Pat Arato Aphasia Centre, Toronto, ON, Canada
  • Marilyn MacKay-Lyons
    School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
  • Carolina Moriello
    McGill University Health Center (MUHC), MUHC Research Institute, Montreal, QC, Canada
  • Carol L Richards
    Department of Rehabilitation and Center for Interdisciplinary Research in Rehabilitation and Social Integration, Laval University, Quebec, Canada
  • Nancy M Salbach
    Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
  • Susan C Scott
    Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
  • Robert Teasell
    Department of Physical Medicine and Rehabilitation, Western University, London, UK
  • Mark Bayley
    Brain and Spinal Cord Rehab Program, UHN-Toronto Rehabilitation Institute, Toronto, ON, Canada

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<jats:sec><jats:title>Objective:</jats:title><jats:p> To enhance participation post stroke through a structured, community-based program. </jats:p></jats:sec><jats:sec><jats:title>Design:</jats:title><jats:p> A controlled trial with random allocation to immediate or four-month delayed entry. </jats:p></jats:sec><jats:sec><jats:title>Setting:</jats:title><jats:p> Eleven community sites in seven Canadian cities. </jats:p></jats:sec><jats:sec><jats:title>Subjects:</jats:title><jats:p> Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. </jats:p></jats:sec><jats:sec><jats:title>Interventions:</jats:title><jats:p> Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. </jats:p></jats:sec><jats:sec><jats:title>Main measures:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 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). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains. </jats:p></jats:sec>

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