Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events

Melissa J. Krauss, Brianna M. Holden, Emily Somerville, Gabrielle Blenden, Rebecca M. Bollinger, Abigail R. Barker, Timothy D. McBride, Holly Hollingsworth, Yan Yan, Susan L. Stark

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: To compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke trial to reduce barriers to independent living for community-dwelling stroke survivors. Design: Randomized controlled trial. Setting: Inpatient rehabilitation (IR) to home and community transition. Participants: Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183). Interventions: Participants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education. Main Outcome Measures: Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR. Results: Time-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361). Conclusions: A home-based occupational therapist–led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.

Original languageEnglish
Pages (from-to)1623-1631
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume105
Issue number9
DOIs
StatePublished - Sep 2024

Keywords

  • Death
  • Falls
  • Home environment
  • Patient readmission
  • Self-management
  • Skilled nursing facilities
  • Stroke

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