Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri.
Division of Neurorehabilitation, Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri.
JAMA Netw Open. 2024 Oct 1;7(10):e2437758. doi: 10.1001/jamanetworkopen.2024.37758.
Interventions are needed to support the long-term needs of stroke survivors when they transition from inpatient rehabilitation to home, where they face new home and community environmental barriers.
To compare the efficacy of a novel, enhanced rehabilitation transition program with attentional control to improve community participation and activity of daily living (ADL) performance and to reduce environmental barriers in the home and community after stroke.
DESIGN, SETTING, AND PARTICIPANTS: This phase 2b, parallel randomized clinical trial assessed patients 50 years or older who had experienced an acute ischemic stroke or intracerebral hemorrhage, were independent in ADLs before stroke, and planned to be discharged home. Patients were assessed at an inpatient rehabilitation facility in St Louis, Missouri, and their homes from January 9, 2018, to December 20, 2023.
Community Participation Transition after Stroke (COMPASS), including home modifications and strategy training.
The primary outcome was community participation (Reintegration to Normal Living Index). Secondary outcomes were daily activity performance (Stroke Impact Scale ADL domain and the In-Home Occupational Performance Evaluation [I-HOPE] activity, performance, and satisfaction scores) and environmental barriers in the home (I-HOPE environmental barriers score).
A total of 185 participants (mean [SD] age, 66.3 [9.0] years; 105 [56.8%] male) were randomized (85 to the COMPASS group and 100 to the control group). The COMPASS and control participants experienced similar improvements in community participation by 12 months, with no significant group (mean difference, 0.3; 95% CI, -4.6 to 5.2; P = .91) or group × time interaction (between-group differences in changes over time, 1.3; 95% CI, -7.1 to 9.6; P = .76) effects. Improvements in I-HOPE performance and satisfaction scores were greater for COMPASS participants than control participants at 12 months (between-group differences in changes for performance: 0.39; 95% CI, 0.01-0.77; P = .046; satisfaction: 0.52; 95% CI, 0.08-0.96; P = .02). The COMPASS participants had greater improvements for I-HOPE environmental barriers than the control participants (P = .003 for interaction), with the largest differences at 6 months (between-group differences in changes: -15.3; 95% CI -24.4 to -6.2).
In this randomized clinical trial of stroke survivors, participants in both groups experienced improvements in community participation. COMPASS participants had greater improvements in self-rated performance and satisfaction with performing daily activities as well as a greater reduction in environmental barriers than control participants. COMPASS reduced environmental barriers and improved performance of daily activities for stroke survivors as they transitioned from inpatient rehabilitation to home.
ClinicalTrials.gov Identifier: NCT03485820.
重要性：当中风幸存者从住院康复过渡到家庭时，他们面临新的家庭和社区环境障碍，需要干预措施来满足他们的长期需求。
目的：比较一种新型增强型康复过渡计划与注意力控制，以改善社区参与和日常生活活动（ADL）表现，并减少中风后家庭和社区中的环境障碍。
设计、设置和参与者：这是一项 2b 期、平行随机临床试验，评估了年龄在 50 岁及以上、中风前 ADL 独立、计划出院回家的急性缺血性中风或脑出血患者。患者在密苏里州圣路易斯的一家住院康复机构和他们的家中接受评估，时间为 2018 年 1 月 9 日至 2023 年 12 月 20 日。
干预措施：中风后的社区参与过渡（COMPASS），包括家庭改造和策略培训。
主要结果和测量：主要结果是社区参与（重新融入正常生活指数）。次要结果是每日活动表现（中风影响量表 ADL 领域和家庭作业表现评估[I-HOPE]活动、表现和满意度评分）和家庭中的环境障碍（I-HOPE 环境障碍评分）。
结果：共有 185 名参与者（平均[标准差]年龄，66.3[9.0]岁；105[56.8%]名男性）被随机分为 COMPASS 组（85 名）和对照组（100 名）。在 12 个月时，COMPASS 和对照组参与者的社区参与情况均有类似的改善，无显著组间差异（平均差异，0.3；95%置信区间，-4.6 至 5.2；P=0.91）或组间时间交互效应（两组之间随时间的变化差异，1.3；95%置信区间，-7.1 至 9.6；P=0.76）。在 12 个月时，COMPASS 组参与者的 I-HOPE 表现和满意度评分改善大于对照组（表现变化的组间差异：0.39；95%置信区间，0.01-0.77；P=0.046；满意度：0.52；95%置信区间，0.08-0.96；P=0.02）。与对照组相比，COMPASS 组参与者的 I-HOPE 环境障碍改善更大（交互作用的 P=0.003），最大差异出现在 6 个月时（变化的组间差异：-15.3；95%置信区间-24.4 至-6.2）。
结论和相关性：在这项中风幸存者的随机临床试验中，两组参与者的社区参与情况均有所改善。与对照组相比，COMPASS 组参与者的自我报告表现和日常活动满意度更高，环境障碍减少更多。COMPASS 减少了中风幸存者从住院康复过渡到家庭时的环境障碍，并改善了他们的日常活动表现。
试验注册：ClinicalTrials.gov 标识符：NCT03485820。
