FEASIBILITY OF A NOVEL INTERVENTION TO IMPROVE PARTICIPATION AFTER STROKE

描述（由申请人提供）：中风是美国严重、长期残疾的主要原因。一半的中风患者依靠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受到限制。随着住院时间的缩短，更多的康复时间用于医疗稳定，而较少用于在日常活动中重新获得独立的技能。过渡之家可能是一个专注于恢复独立的干预机会。我们提出了一个增强的康复过渡计划，称为：中风后社区参与过渡（COMPASS）。Compass是一种补偿性干预，由职业治疗师进行1次出院前和5次出院后家访组成，重点是通过环境支持和日常活动的积极实践来解决日常活动中独立和参与的障碍。这是一种基于证据的补偿性治疗的新组合，在一种新的治疗环境中提供（过渡到家庭）。该项目的长期目标是开发一种有效的过渡之家干预措施，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。我们将在卒中后6个月对社区参与和日常活动表现的测量中检验COMPASS是可接受的、可行的，并且优于对照的中心假设。这项建议的基本原理是，许多中风患者长期参与治疗的结果很低，因为治疗不完全，而不是因为中风所施加的生物学限制。在发现中风后认知和运动障碍的治疗方法之前，使用环境支持对于预防残疾和提高参与是必要的。重要的是要知道这个简短的，增强的康复计划是否可以提供住院康复和家庭之间缺失的联系。我们将在40例缺血性脑卒中康复患者中开展COMPASS的随机对照试验，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；2)评估COMPASS对社区主要结果和日常活动表现、生活质量和社区流动性的探索性结果的有效性，为最终试验选择最佳终点。在缺血性脑卒中患者中，我们将在6个月的主要和次要终点上检验COMPASS优于对照的假设。我们期望这项研究的结果将为缺血性中风后康复的强化过渡方案的实施和有效性提供新的证据。如果这个项目是可接受的、可行的和安全的，我们将很好地进行一项有可能改善康复服务交付的决定性试验，对中风患者的功能和参与结果产生积极影响。

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.