Community Participation Transition After Stroke
Community Participation Transition After Stroke
Stroke is one of the most serious, disabling health conditions in the United States. Patients
 who undergo rehabilitation treatment for stroke have a high rate of disability. Poor outcomes
 for many persons with stroke may be low because of incomplete treatment. The investigators
 will conduct a randomized controlled trial and a process evaluation to examine the
 feasibility, safety, and preliminary efficacy of an enhanced rehabilitation transition
 program, Community Participation Transition after Stroke (COMPASS), designed to bridge
 inpatient rehabilitation and the home to support the performance of everyday activities.
We propose an enhanced rehabilitation transition program: Community Participation Transition
 after Stroke (COMPASS) is a compensatory intervention consisting of one pre-discharge and
 five post-discharge home visits by an occupational therapist to supplement usual care. This
 intervention is focused on resolving barriers to independence in daily activities and
 participation using environmental support and active practice of daily activities in an
 individual's real home (versus an idealized clinical setting). This is a new combination of
 evidence-based compensatory treatments delivered in a novel treatment setting (transition to
 home). Our long-term goal is the development of an effective intervention for a transition
 home designed to prevent excess disability for people living with stroke that could have an
 immediate effect and high public health significance.16

 We will recruit 40 patients currently undergoing inpatient rehabilitation (IR) for ischemic
 stroke from longitudinal studies of stroke at Washington University School of Medicine (WUSM)
 and randomize them to receive six additional sessions of the enhanced rehabilitation
 transition program or attention control. Exploratory participation outcomes will be assessed
 by blinded evaluators at baseline, 6 months, 9 months, and 12 months after stroke.

 We will test the central hypothesis that COMPASS will be acceptable, feasible, and superior
 to attention control on measures of participation and daily activity performance at 6 months
 after stroke.
Inclusion Criteria:

 1. ≥45 years old

 2. acute ischemic stroke, verified by a neurologist

 3. baseline National Institutes of Health Stroke Scale (NIHSS) ≥8

 4. independent in activities of daily living prior to stroke (premorbid Rankin score of
 ≤2)

 5. plan to discharge to home

 Exclusion Criteria:

 1. severe terminal systemic disease that limits life expectancy to <6 months

 2. previous disorder (e.g., dementia) that makes interpretation of the self-rated scales
 difficult or a Short Blessed Test (SBT) score of ≥9 (indicating significant cognitive
 impairment)

 3. moderate to severe aphasia, as determined by the NIHSS Best Language rating of ≥2

 4. residence in a congregate living facility

 5. not eligible for a therapeutic pass