None listed
Conditions
Brief summary
Each year more than 10,000 Australian stroke survivors are admitted to rehabilitation to improve independence. Occupational therapy assessments conducted before discharge aim to enable a safe independent transition from hospital to home, however there is no evidence that home visits improve outcomes for stroke survivors. The HOME trial will address this evidence gap with the aim of determining the effectiveness, and cost effectiveness of an occupational therapy discharge planning intervention consisting of three occupational therapy sessions primarily conducted in the home. This multicentre, randomised controlled trial will recruit 360 patients with a confirmed diagnosis of stroke admitted for inpatient rehabilitation. Patients will receive either the HOME intervention, or an inhospital predischarge planning package. The primary hypothesis is that the HOME intervention will improve functional participation levels at 4 weeks, 6 and 12 months, compared to predischarge planning package. Secondary hypotheses are that the HOME intervention will result in fewer hospital readmissions at 6 months postdischarge, and will be less costly than an occupational therapy predischarge home visit package.
Interventions
A home-based predischarge consultation followed by a 4 week postdischarge support package is provided by a trained occupational therapist following randomisation. Using standardised assessment and manualised procedures, the intervention is tailored by the occupational therapist to each participant’s pattern of functional loss and unique home and community environments as well as their personally meaningful goals. The program commences with:
(1) Predischarge both groups will receive a family-le
A home-based predischarge consultation followed by a 4 week postdischarge support package is provided by a trained occupational therapist following randomisation. Using standardised assessment and manualised procedures, the intervention is tailored by the occupational therapist to each participant’s pattern of functional loss and unique home and community environments as well as their personally meaningful goals. The program commences with: (1) Predischarge both groups will receive a family-led home environment assessment. Families of both groups will be loaned a tablet computer or digital camera to complete a home safety checklist and take photos of areas of the home that the participant would need or wish to access on return home. (2) Predischarge both groups will receive a confidence and discharge planning (30 minutes) assessment (considered best practice) using the Discharge Planning Assessment Tool (DPAT) early in hospitalisation. (3) Predischarge participants in the intervention group will receive one predischarge homevisit (approximately 90 minutes). Using standardised assessment and manualised procedures, environmental modification and equipment will be recommended and, when accepted, installed before discharge as per usual hospital policies. (4) Postdischarge participants in the intervention group will receive two home or community based occupational therapy interventions (approximately 75 minutes each) over the first 2-week period following discharge. The first postdischarge homevisit will occur in the first week post discharge and the second posdischrage homevisit will occur in the second week postdischarge. Interventions will progress in complexity from daily activities to community participation based on the participant’s goals. Two booster sessions will be conducted over the telephone during the final two weeks prior to end-of-study outcome evaluation. The fist telephone call will be conducted in the third week post discharge and the second telephone call will be conducted in the fourth week post discharge. Wherever possible, one of the postdischarge sessions will include the participant’s General Practitioner (GP) (either by joint appointment, telephone or follow-up letter). Results of the occupational therapy intervention for both groups will be shared with the rehabilitation team. Both groups will receive rehabilitation and medical care as usually provided by other professionals. This study will not affect discharge dates, which will continue to be decided upon by the patients’ treating multidisciplinary team as per the hospitals usual protocols. Adherence to the intervention will be monitored with the use of session attendance checklists, a resource use diary, and detailed intervention checklists that describe the specific intervention components required to be delivered at each of the intervention sessions.
Sponsors
Monash University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- diagnosis of stroke (confirmed by brain imaging, or where unavailable or unclear, from a neurologist or stroke-specialist medical professional); - independent in activities of daily living prior to stroke (premorbid Rankin score equal or less than 2); - admitted for inpatient rehabilitation; - expected return to live in a private residence within the community (own home, independent living unit or living with family) after discharge from hospital; - absence of severe co-morbid disease (as assessed by a score less than 8 on the Charlson co-morbidity index)
Exclusion criteria
- need for major home modifications - planned discharge to aged care facility, or to a private residence where family will provide full assistance with all self-care - planned discharge to an address 2 hours or greater from the recruiting hospital site; - significant cognitive impairment (as assessed by a score of more than 5 adjusted errors on the Short Portable Mental Status Questionnaire); - bariatric patients (as assessed as a Body Mass Index of 45 or more); - illness likely to be associated with a life expectancy of less than 12 months (as estimated by a score of 3 or less on a modified version of the Implicit Illness Severity Scale); - moderate to severe aphasia (as assessed by the NIHSS Best Language rating of greater than or equal to 2); - unable to participate in recovery / rehabilitation goals for any other clinical reasons.
Outcome results
None listed