TY - JOUR
T1 - Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial
T2 - Effect on Adverse Health Events
AU - Krauss, Melissa J.
AU - Holden, Brianna M.
AU - Somerville, Emily
AU - Blenden, Gabrielle
AU - Bollinger, Rebecca M.
AU - Barker, Abigail R.
AU - McBride, Timothy D.
AU - Hollingsworth, Holly
AU - Yan, Yan
AU - Stark, Susan L.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/9
Y1 - 2024/9
N2 - 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.
AB - 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.
KW - Death
KW - Falls
KW - Home environment
KW - Patient readmission
KW - Self-management
KW - Skilled nursing facilities
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85195854441&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2024.05.015
DO - 10.1016/j.apmr.2024.05.015
M3 - Article
C2 - 38772517
AN - SCOPUS:85195854441
SN - 0003-9993
VL - 105
SP - 1623
EP - 1631
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 9
ER -