COMPASS: A NOVEL TRANSITION PROGRAM TO REDUCE DISABILITY AFTER STROKE

项目摘要 中风是美国残疾的主要原因。大多数中风幸存者 进行日常活动并参与社区活动。干预措施的功效， 满足中风幸存者的慢性需求已被确定为中风的高度优先事项 research.从住院康复（IR）到家庭的过渡点存在护理差距， 当幸存者遇到新的环境障碍，由于认知和感觉运动， 中风后遗症消除这些障碍，提高社区的独立性 有可能显著改善中风幸存者的长期发病率。拟定研究 研究了一种新的增强康复过渡计划的有效性和安全性， 减少环境障碍，改善日常活动表现和社区 参与的中风后社区参与过渡（COMPASS）使用2 补充的循证干预措施：家庭改造和战略培训 在家里交付。家庭改造提供环境支持，以弥补 损伤策略培训使患者能够识别和优先考虑ADL问题， 绩效障碍，并制定解决障碍的战略。互补效应 这些治疗在一个新的护理点提供了一个强大的干预目前的服务差距。 这项IIb期、单盲、平行组、随机对照试验的主要目的是 调查COMPASS在从IR到家庭过渡期间的功效。参与者将被 随机接受COMPASS或注意力控制。我们假设指南针 参与者将在社区参与和ADL方面表现出显着改善 性能和显著减少环境障碍与控制。在制备 对于III期多中心试验，我们将探索其他候选研究终点， 通过检查福尔斯和再入院率确定干预安全性。最后， 我们将进行过程评估，检查覆盖范围、成本、保真度等结果， 坚持试验和实施的可解释性。这些目标填补了 中风康复的证据，通过调查的有效性，安全性和实施， 针对从急性疾病向慢性疾病过渡的干预措施。这项试验的结果 将提供有关长期参与和环境障碍的重要信息， 中风幸存者该项目有可能解决残疾人的重大未满足需求 中风后

PROJECT SUMMARY ABSTRACT Stroke is a leading cause of disability in the United States. Most stroke survivors have difficulty performing daily activities and participating in the community. Efficacy of interventions that address the chronic needs of stroke survivors has been identified as a high priority for stroke research. A gap in care exists at the point of transition from inpatient rehabilitation (IR) to home, when survivors encounter new environmental barriers due to the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have potential to significantly improve stroke survivors’ long-term morbidity. The proposed study investigates the efficacy and safety of a novel enhanced rehabilitation-transition program to reduce environmental barriers and improve daily activity performance and community participation. Community Participation Transition after Stroke (COMPASS) uses 2 complimentary evidence-based interventions: home modifications and strategy training delivered in the home. Home modifications provide environmental support to compensate for impairments. Strategy training enables patients to identify and prioritize ADL problems, identify barriers to performance, and develop strategies to resolve barriers. The complementary effects of these therapies at a novel point of care offer a robust intervention for a current service gap. The primary aim of this phase IIb, single-blind, parallel-group, randomized controlled trial is to investigate the efficacy of COMPASS during the transition from IR to home. Participants will be randomized to receive either COMPASS or attentional control. We hypothesize that COMPASS participants will demonstrate significant improvements in community participation and ADL performance and significant reduction in environmental barriers versus control. In preparation for a phase III multicenter trial, we will explore additional candidate study endpoints and establish intervention safety by examining the rates of falls and hospital readmissions. Finally, we will conduct a process evaluation examining outcomes such as reach, cost, fidelity, and adherence to aid interpretability of the trial and implementation. The aims fill critical gaps in stroke rehabilitation evidence by investigating the efficacy, safety, and implementation of an intervention targeting the transition from an acute to chronic condition. The results of this trial will provide important information about the long-term participation and environmental barriers of stroke survivors. The project has the potential to resolve the significant unmet need of disability after stroke.