Washington University School of Medicine
This study evaluates a program designed to help individuals transition from inpatient rehabilitation to home following an ischemic or hemorrhagic stroke. Half of the participants will receive a stroke education program while the other half will receive an environmental modifications program.
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. Investigators will conduct a randomized, controlled multi-center trial (RCT) and concurrent implementation evaluation and review of process data to examine therapeutic efficacy, cost-effectiveness and implementation potential of a compensatory inter…
Inclusion Criteria: * Aged ≥55 years at the time of screening * Acute stroke diagnosis (IS or ICH) verified by the stroke team or medical record * Independent in activities of daily living (ADLs) prior to stroke (premorbid Modified Rankin Scale score ≤2) * Plan to discharge to home from an IR * Capable of giving informed consent which includes compliance with the requirements and duration of participation as listed in the Informed Consent Form (ICF). Exclusion Criteria: * Life expectancy \<6 months * Cognitive impairment that the participant's stroke team or a research team member believes…
The data from the baseline assessment will be used to develop an environmental modification intervention plan. Environmental modifications will be installed before discharge if possible. Problem areas addressed are participant specific (tailored), but the process to identify and address the target area is systematic. All participants will receive identical intervention components. The standardized components include assessment, identification of problematic activities (and environmental barriers), identification of solutions for each problem, implementation of solution set selected by the participant, training, and active practice of daily activities in one's own home and community.
The control group will experience the same effects of time and attention in the home but no effect on the outcome of interest.
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