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Citation
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Krauss MJ, Holden BM, Somerville E, Blenden G, Bollinger RM, Barker AR, McBride TD, Hollingsworth H, Yan Y, Stark SL. Arch. Phys. Med. Rehabil. 2024; ePub(ePub): ePub. |
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Abstract
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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 pre-stroke (n=183). INTERVENTION: Participants randomized to intervention (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control (n=98) received the same number of visits consisting of stroke education. MAIN OUTCOME MEASURES: Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, 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% to 96.6%%) and death (cumulative survival 100%) compared to the control group (SNF cumulative survival 78.9%, 95% CI 70.4% to 87.4%; P=0.039; death cumulative survival 87.3%, 95% CI 79.9% to 94.7%, P=0.001). Thirty-day rehospitalization also appeared lower among intervention participants (cumulative survival 95.1%, 95% CI 90.5% to 99.8%) compared to control participants (cumulative survival 86.3%, 95% CI 79.4% to 93.2%, P=0.050) 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 to 6.5) and the control group (7.2 falls per 1000 participant-days, 95% CI 6.2 to 8.3; incidence rate ratio [IRR] 0.78, 95% CI 0.46 to 1.33, P=0.361).
CONCLUSIONS: A home-based OT-led intervention that helps stroke survivors transition home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.
Language: en |