Process Evaluation of a Randomized Controlled Trial of an Enhanced Rehabilitation Transition Program for Stroke Survivors

Objective: To fully describe the key elements for implementation of the Community Participation Transition after Stroke (COMPASS) intervention for stroke survivors returning home from inpatient rehabilitation (IR) using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. Design: Process evaluation of a randomized controlled trial of the COMPASS intervention. Setting: IR and participants’ homes. Participants: One hundred eighty-five (N=185) stroke survivors who were 50 years of age or older, experienced an acute ischemic stroke or intracerebral hemorrhage, were independent in activities of daily living before their stroke, and planned to discharge home from IR. Interventions: Participants were randomized to receive the COMPASS intervention (home modifications and strategy training, n=85) or attentional control (AC; stroke education, n=100). Both groups received 4 visits in the home. Main Outcome Measures: Components of the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. Results: In this study, 51.8% of eligible stroke survivors participated. More COMPASS participants completed the intervention than AC participants (94.1% vs 75.0%; reach). COMPASS participants experienced greater improvements in self-rated performance and satisfaction and barrier severity than AC participants at 12-month follow-up (effectiveness). Approximately 89% of intervention components were implemented in an average of 5.5 postdischarge home visits (average, 289min; SD=172). An average of 9.9 home modifications/recommendations was made per participant, and the median cost of adaptive equipment and contractor labor and materials was $544 ($275-$754; implementation). Adherence to home modifications at 12 months was 82.4% (SD=0.24; maintenance). Conclusions: COMPASS had good reach and was effective in improving stroke survivors’ self-rated performance and satisfaction and in reducing environmental barriers to daily activities. COMPASS was implemented with fidelity and low cost in a sample of stroke survivors.