Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events

Melissa J Krauss; Brianna M Holden; Emily Somerville; Gabrielle Blenden; Rebecca M Bollinger; Abigail R Barker; Timothy D McBride; Holly Hollingsworth; Yan Yan; Susan L Stark

doi:10.1016/j.apmr.2024.05.015

Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events

Arch Phys Med Rehabil. 2024 May 19:S0003-9993(24)01004-9. doi: 10.1016/j.apmr.2024.05.015. Online ahead of print.

Affiliations

¹ Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO.
² Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, MO.
³ Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO.
⁴ Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO. Electronic address: sstark@wustl.edu.

PMID: 38772517
DOI: 10.1016/j.apmr.2024.05.015

Abstract

Objective: 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.

Design: Randomized controlled trial.

Setting: Inpatient rehabilitation (IR) to home and community transition.

Participants: Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183).

Interventions: Participants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education.

Main outcome measures: Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR.

Results: Time-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.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, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361).

Conclusions: A home-based occupational therapist-led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.

Keywords: Death; Falls; Home environment; Patient readmission; Self-management; Skilled nursing facilities; Stroke.