Stroke, Stroke Rehabilitation, Transitional Care
Conditions
Keywords
Patient Oriented Research, Community-Based Services, Intersectoral Partnership, Volunteers, Stroke rehabilitation, Transitional care
Brief summary
The goal of this clinical trial is to learn if a home visit by a trained volunteer can improve stroke recovery after a stroke survivor is discharged home from the hospital. The main questions it aims to answer are: 1. After 3 months of being discharged from the hospital, does this additional volunteer support at home improve coping skills for stroke survivors? 2. Does the effects of the volunteer support last over 3 to 6 months after being discharged home? Researchers will compare between a group who will receive the volunteer support and a group who will not to see if the additional support can improve stroke recovery. Participants will: * Either receive volunteer support over an 8-week time period OR receive no additional volunteer support * Continue with their usual care plan and receive educational resources from the research team during the study * Complete online surveys during study enrollment, at 3 months, and at 6 months after hospital discharge
Detailed description
Acute stroke often leads to adult disability in Canada, and about 108,707 Canadians experience a stroke each year. While most people survive stroke (80 percent) and return home, some survivors are left with ongoing challenges that require them to seek help in the community. These challenges can lead to stress for the individual and their caregiver. Research on volunteer-supported home-to-hospital programs has shown positive outcomes. However, despite the growing evidence that supports volunteer engagement in care transitions, we have yet to determine the impact of a complex psychosocial volunteer-delivered care transition intervention for stroke survivors. This study will assess whether a volunteer-delivered transitional care intervention, designed by Bruyère Health Research Institute in partnership with March of Dimes Canada (MODC), for adults discharged home from a stroke rehabilitation unit following an acute stroke can improve coping compared to usual care. MODC will implement the volunteer-support transition program across two Ontario regions for stroke rehabilitation sites. Those allocated to the intervention group will receive an initial visit from the Volunteer Coordinator and then weekly one-on-one visits by a trained volunteer for eight weeks. The volunteer may assist the study participant with instrumental daily living activities and psychosocial and informational support. Those not receiving the intervention will receive educational material at 4- and 8-week time points in addition to their usual care. All study participants will complete validated patient-reported outcome measures at 3- and 6-months post-hospital discharge.
Interventions
BEHAVIORALDischarge Assistance and Supports at Home (DASH)
One-on-one weekly visits in the stroke survivor participants' residence by a trained volunteer for approximately 8 weeks (about 2 months). Volunteer support could span three types: i) instrumental activities of daily living assistance (e.g., assistance with meal preparation, light house duties, and transportation), ii) psychosocial support (e.g., befriending visits), and iii) informational supports (signposting to other community services).
Sponsors
Bruyère Health Research Institute.
March of Dimes, Canada
Canadian Institutes of Health Research (CIHR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Confirmed diagnosis of stroke * Either undergoing or recently completed in-patient rehabilitation within the last 3 weeks * Lived at home pre-stroke * Discharged directly home (to own residence or that of a family member) * Live in one of the program implementation areas (i.e., Toronto, Ottawa)
Exclusion criteria
* Discharged to additional hospital inpatient care, nursing home, or other long-term care * Inability to communicate in English * Inability to provide informed consent due to cognitive deficits
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Coping at Time 1 as assessed by Post-Discharge Coping Difficulty Scale (PDCDS) | Measured at 3 months post-hospital discharge | Coping will be assessed using the Post-Discharge Coping Difficulty Scale (PDCDS), a 10-item patient-reported outcome measure evaluating perceived difficulty coping following hospital discharge. Each item is scored on a scale from 0 to 10. Item scores are summed to yield a total score ranging from 0 to 100, with higher scores indicating greater difficulty coping. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in coping as assessed by Post-Discharge Coping Difficulty Scale (PDCDS) | Measured at 3 months and 6 months post-hospital discharge | Coping will be assessed using the Post-Discharge Coping Difficulty Scale (PDCDS), a 10-item patient-reported measure. Each item is scored from 0 to 10, with total scores ranging from 0 to 100. Change in total score will be calculated between time points. Higher scores indicate greater difficulty coping. |
| Change in quality of life as assessed by Stroke-Specific Quality of Life (SS-QOL) | Measured at 3 months and 6 months post-hospital discharge | Quality of life will be assessed using the Stroke-Specific Quality of Life (SS-QOL) scale, a 49-item patient-reported measure evaluating multiple domains of health-related quality of life in stroke survivors. Each item is scored on a 5-point Likert scale (1 to 5). Domain scores are calculated as the average of items within each domain, and the overall score is calculated as the average of all domain scores or as the sum of all 49 items (ranging 49 to 245). Higher scores indicate better quality of life. |
| Change in symptoms of depression as assessed by Patient Health Questionnaire-9 (PHQ-9) | Measured at 3 months and 6 months post-hospital discharge | Depressive symptoms will be assessed using the Patient Health Questionnaire-9 (PHQ-9), a 9-item patient-reported measure. Each item is scored from 0 to 3, resulting in a total score ranging from 0 to 27, with higher scores indicating greater severity of depressive symptoms. |
| Change in social isolation and loneliness indicators as assessed by UCLA Loneliness Scale (Version 3) | Measured at 3 months and 6 months post-hospital discharge | Social isolation and loneliness will be assessed using the UCLA Loneliness Scale (Version 3), a 20-item patient-reported measure evaluating subjective feelings of loneliness and social isolation. Each item is scored on a 4-point scale. Total scores range from 20 to 80, with higher scores indicating greater loneliness. |
Countries
Canada
Contacts
CONTACTMichelle LA Nelson, MA, PhD, FAHA, FWSO
CONTACTResearch Coordinator
Outcome results
None listed