FEASIBILITY OF A NOVEL INTERVENTION TO IMPROVE PARTICIPATION AFTER STROKE

描述（由申请人提供）：在美国，中风是导致严重长期残疾的主要原因。一半的中风患者依赖他人进行日常生活活动（ADL），三分之二的人在中风后六个月报告参与限制。随着住院时间的缩短，更多的康复时间用于医疗稳定，而更少的时间用于恢复日常活动的独立性。过渡家园可能是一个以恢复独立为重点的干预机会。我们提出了一个增强的康复过渡计划，称为：社区参与中风后过渡（COMPASS）。Compass是一种补偿性干预措施，包括1次出院前和5次出院后职业治疗师的家访，重点是解决日常活动中的独立性障碍，并利用环境支持和积极实践日常活动。这是一种在新的治疗环境（过渡到家庭）中提供的基于证据的补偿治疗的新组合。该项目的长期目标是开发一种有效的过渡家庭干预措施，旨在防止中风患者过度残疾。本研究的目的是对COMPASS进行可行性试验。我们将检验中心假设，即在卒中后6个月时，COMPASS在社区参与和日常活动表现方面可接受、可行且上级对照组。这一提议的基本原理是，许多中风患者的长期参与结果很低，因为治疗不完全，而不是因为中风造成的生物学限制。在发现中风后认知和运动障碍的治愈方法之前，使用环境支持对于预防残疾和改善参与是必要的。重要的是要知道，如果这个简短的，增强康复计划可以提供住院康复和家庭之间的缺失环节。我们将通过在40例缺血性卒中康复患者中进行一项COMPASS的初步随机对照试验来客观地检验我们的中心假设，以达到以下目的：1）确定COMPASS的可接受性和可行性;和2）估计COMPASS对社区的主要结果和对日常活动表现、生活质量、和社区流动性，以选择最佳终点进行最终试验。我们将检验以下假设：在缺血性卒中患者中，6个月时COMPASS在主要和次要终点方面优于对照组上级。我们希望这项研究的结果将是关于缺血性卒中后接受康复治疗的人的增强过渡计划的实施和有效性的新证据。如果该计划是可接受的，可行的和安全的，我们将有能力进行一项明确的试验，有可能改善康复服务的提供，积极影响中风患者的功能和参与结果。

DESCRIPTION (provided by applicant): Stroke is a leading cause of serious, long-term disability in the US. Half of all people living with stroke are dependent on others to perform thei activities of daily living (ADL) and two-thirds report participation restrictions at six months pos stroke. With shorter inpatient hospital stays, more time in rehabilitation is devoted to medical stabilization and less on skills to regain independence in daily activities. The transition home may be an opportunity for intervention focused on regaining independence. We propose an enhanced rehabilitation transition program called: Community Participation Transition after Stroke (COMPASS). Compass is a compensatory intervention consisting of 1 pre and 5 post-discharge home visits by an occupational therapist focused on resolving barriers to independence in daily activities and participation using environmental support and active practice of daily activities. This is a new combination of evidence-based compensatory treatments delivered in a novel treatment setting (transition to home). The long-term goal of this project is the development of an effective intervention for transition home designed to prevent excess disability for people living with stroke. The purpose of this study is to conduct a feasibilty trial of COMPASS. We will test the central hypothesis that COMPASS will be acceptable, feasible, and superior to control on measures of community participation and daily activity performance at 6 months post stroke. The rationale for this proposal is that long term participation outcomes for many persons with stroke are low because of incomplete treatment, not because of biological limits imposed by the stroke. Until a cure is discovered for cognitive and motor impairments after stroke, the use of environmental support is necessary to prevent disability and improve participation. It is important to know if this brief, enhanced rehabilitatio program can provide the missing link between inpatient rehabilitation and home. We will objectively test our central hypothesis by conducting a pilot randomized controlled trial of COMPASS among 40 patients undergoing rehabilitation for ischemic stroke to achieve the following aims: 1) determine the acceptability and feasibility of COMPASS; and 2) estimate the magnitude of efficacy of COMPASS on the primary outcome of community and on exploratory outcomes of daily activity performance, quality of life, and community mobility to select optimal endpoints for a definitive trial. We will test the hypotheses that COMPASS is superior to control at 6 months on the primary and secondary endpoints among people with ischemic stroke. We expect the outcome of this study will be new evidence about implementation and effectiveness of an enhanced transition program for people undergoing rehabilitation after an ischemic stroke. If this program is acceptable, feasible, and safe, we will be well positioned to conduct a definitive trial that has the potential to improve the delivery of rehabilitation services, positivly impacting functional and participation outcomes for people with stroke.