The Community Participation Transition after Stroke (COMPASS) randomized controlled trial: Impact on adverse health events.

Abstract

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. Randomized controlled trial. Inpatient rehabilitation (IR) to home and community transition. Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living pre-stroke (n=183). 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. Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, fall rates after discharge from IR. 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). 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.