Community Participation Transition After Stroke

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