None listed
Conditions
Brief summary
Major issues impacting survivors of stroke & their carers are reduced quality of life & depression. The period of transition from hospital to home is a critical time for recovery for survivors of mild stroke; bridging hospital discharge to community integration. It has been identified that stroke survivors feel ill-prepared mentally and physically to return to their lives after discharge from hospital (Cott et al., 2007; Turner et al., 2009; Rittman, Boylstein, Hinojosa et al., 2007). A discharge care plan developed by the stroke team focusing on the needs & goals of the person with stroke facilitates the transition home inclusive of medical management, ongoing rehabilitation, and education around lifestyle modification. However, a recent clinical audit of the Australian facilities revealed that less than 50% of survivors of stroke discharged from acute care received this (National Stroke Foundation, 2014). Survivors of mild stroke, typically present with minimal impairments & are often discharged home without inpatient rehabilitation. Recent research highlights that the impact of stroke only becomes obvious on returning home when re-engaging in previous life roles (e.g. work, leisure). The overarching aim of this research is to determine the efficacy of a new allied healthled model of care for individuals with mild stroke discharged from acute care. The primary aim is to assess the efficacy of MiStrEnGTH as compared to usual care on quality of life (QoL) and client mood. A secondary aim is to assess the efficacy of MiStrEnGTH as compared to usual care on daily activity, community participation, carer mood and strain. It is hypothesized that clients and carers receiving MiStrEnGTH will have improved QoL, mood and community participation, with lower levels of carer strain as compared to usual care. A study design of a randomized controlled trial with intention-to-treat analysis will be used. All participants with acute mild stroke will be randomized to one of two intervention arms at discharge: 1) control 'standard care'; 2) intervention 'MiStrEnGTH'. Data collection from participants will occur at baseline (recruitment), and 1-, 3- and 6-months post-discharge from hospital.
Interventions
A stroke self-management program (SSMP) delivered using telehealth for individuals with mild stroke who are discharged home after acute stroke management only. Five telephone-based sessions of between 30 and 60 minutyes will be provided during the first 6 months after stroke. During these phone-based sessions the therapist will speak to both the person with stroke and the carer. The sessions will occur 1-, 4- and 8-weeks post hospital discharge, with the final 2 sessions scheduled based on the n
A stroke self-management program (SSMP) delivered using telehealth for individuals with mild stroke who are discharged home after acute stroke management only. Five telephone-based sessions of between 30 and 60 minutyes will be provided during the first 6 months after stroke. During these phone-based sessions the therapist will speak to both the person with stroke and the carer. The sessions will occur 1-, 4- and 8-weeks post hospital discharge, with the final 2 sessions scheduled based on the needs of the person with stroke within the first 6 month period. The SSMP program will be tailored to the individual needs of the person with stroke and their family. Each session will follow a pre-developed framework which includes the following: 1. Reflection: an opportunity to reflect on areas of change in their life since stroke including acknowledgement on progress and achievements. 2. Management: Identification of areas of life that have been impacted upon by the stroke through in-depth discussion followed by unmet needs from community or rehabilitation services. 3. Goal-planning: Information discussed in the reflection and management stages of the sessions will be used to guide to goal-planning. Goal planning will occur with both the person with stroke and their family as required. It will use a shared decision making process and / or motivational interviewing framework in order to develop the goals and then plan the actions required to achieve the goals. 4. Education: Educational needs related to stroke identified during the session will also be addressed through the therapist providing verbal information +/- directing the person to available resources (e.g. stroke support groups, Stroke Foundation websites). At the conclusion of each session the therapist will send the person with stroke and family as required a copy of the developed goals and the action plans associated with them, as well as any written information or website links that might assist the person in achieving their goals or addressing educational needs. Email will be the preferred mode of delivering this information. The SSMP will be provided in addition to usual care processes on an individual basis. The program will be delivered by an allied health professional with extensive experience in the management of people with stroke.
Sponsors
The Prince Charles Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Stroke participants - admitted with a confirmed new onset mild stroke - receive acute hospital management only - discharge destination is home or a community environment Carers of the stroke participant - provide informal assistance / support to a participant in the stroke group - assistance / support role will likely be ongoing during the course of the study - over 18 years of age
Exclusion criteria
Stroke participants - inadequate language or cognition to provide informed consent and / or complete outcome measures - discharged to residential care facility or other healthcare facility - existing comorbidites likely to limit participation in program (e.g. dementia or severe mental illness) Carers of the stroke participants - inadequate language or cognition to provide informed consent and / or complete outcome measures
Outcome results
None listed